Petter Bjornstad1, David M Maahs2, Marian Rewers3, Richard J Johnson4, Janet K Snell-Bergeon3. 1. Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. Electronic address: Petter.Bjornstad@childrenscolorado.org. 2. Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO; Department of Nephrology, University of Colorado Denver, Aurora, CO. 3. Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO. 4. Department of Nephrology, University of Colorado Denver, Aurora, CO.
Abstract
HYPOTHESIS: Vascular complications of type 1 diabetes are thought to cluster. We examined the prevalence and incidence of vascular complications and American Diabetes Association's ABC goal achievements in a prospective cohort of adults with type 1 diabetes. We hypothesized that ABC achievement at baseline would predict both micro- and macrovascular complications over 6-years. METHODS: Participants (N=652) were 19-56 year old at baseline and re-examined 6-years later. Microvascular complications included diabetic nephropathy (DN), defined as incident albuminuria (AER≥20 μg/min) or rapid GFR decline (>3.3%/year) by CKD-EPI cystatin C and proliferative diabetic retinopathy (PDR), defined as laser eye-therapy. Macrovascular complications were defined as coronary artery calcium progression (CACp), measured by electron-beam computed-tomography. ABC goals were defined as HbA1c<7.0%, BP<130/80 mmHg and LDL-C<100mg/dL. RESULTS: ABC control was suboptimal with only 6% meeting all goals. Meeting no ABC goals at baseline compared to meeting all goals was associated with increased odds of developing microvascular complications (OR: 8.5, 2.3-31.5, p=0.001), but did not reach significance for CACp (OR: 1.7, 0.8-3.9, p=0.19). CONCLUSION: ABC achievement at baseline strongly predicted microvascular but not macrovascular complications over 6-years in adults with type 1 diabetes, suggesting a need for novel therapeutic targets to complement conventional risk factors in treating macrovascular complications.
HYPOTHESIS: Vascular complications of type 1 diabetes are thought to cluster. We examined the prevalence and incidence of vascular complications and American Diabetes Association's ABC goal achievements in a prospective cohort of adults with type 1 diabetes. We hypothesized that ABC achievement at baseline would predict both micro- and macrovascular complications over 6-years. METHODS:Participants (N=652) were 19-56 year old at baseline and re-examined 6-years later. Microvascular complications included diabetic nephropathy (DN), defined as incident albuminuria (AER≥20 μg/min) or rapid GFR decline (>3.3%/year) by CKD-EPIcystatin C and proliferative diabetic retinopathy (PDR), defined as laser eye-therapy. Macrovascular complications were defined as coronary artery calcium progression (CACp), measured by electron-beam computed-tomography. ABC goals were defined as HbA1c<7.0%, BP<130/80 mmHg and LDL-C<100mg/dL. RESULTS:ABC control was suboptimal with only 6% meeting all goals. Meeting no ABC goals at baseline compared to meeting all goals was associated with increased odds of developing microvascular complications (OR: 8.5, 2.3-31.5, p=0.001), but did not reach significance for CACp (OR: 1.7, 0.8-3.9, p=0.19). CONCLUSION:ABC achievement at baseline strongly predicted microvascular but not macrovascular complications over 6-years in adults with type 1 diabetes, suggesting a need for novel therapeutic targets to complement conventional risk factors in treating macrovascular complications.
Authors: Ronald Klein; Emily K Marino; Lewis H Kuller; Joseph F Polak; Russell P Tracy; John S Gottdiener; Gregory L Burke; Larry D Hubbard; Robin Boineau Journal: Br J Ophthalmol Date: 2002-01 Impact factor: 4.638
Authors: Petter Bjornstad; David M Maahs; Christopher J Rivard; Laura Pyle; Marian Rewers; Richard J Johnson; Janet K Snell-Bergeon Journal: Acta Diabetol Date: 2014-06-15 Impact factor: 4.280
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Authors: Petter Bjornstad; Laura Pyle; Nhung Nguyen; Janet K Snell-Bergeon; Franziska K Bishop; R Paul Wadwa; David M Maahs Journal: Pediatr Diabetes Date: 2015-02 Impact factor: 4.866
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