Silvana Salardi1, Massimo Porta2, Giulio Maltoni3, Franco Cerutti4, Silvia Rovere2, Dario Iafusco5, Stefano Tumini6, Vittoria Cauvin7, Stefano Zucchini3, Francesco Cadario8, Giuseppe dʾAnnunzio9, Sonia Toni10, Alessandro Salvatoni11, Maria Antonietta Zedda12, Riccardo Schiaffini13. 1. Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Electronic address: silvana.salardi@unibo.it. 2. Diabetic Retinopathy Centre of the Department of Medical Sciences, University of Turin, Turin, Italy. 3. Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 4. Department of Pediatrics, University of Turin, Turin, Italy. 5. Department of Pediatrics, Second University of Naples, Naples, Italy. 6. Department of Pediatrics, University of Chieti, Chieti, Italy. 7. Pediatric Unit, S. Chiara Hospital, Trento, Italy. 8. Department of Pediatrics, "Maggiore della Carità" Hospital Novara, University of Piemonte Orientale, Vercelli, Italy. 9. Department of Pediatrics, IRCCS Gaslini Children's Hospital, University of Genoa, Genoa, Italy. 10. Meyer Pediatric Institute, University of Firenze, Firenze, Italy. 11. Pediatric Clinic, Insubria University, Varese, Italy. 12. Pediatric Clinic, University of Cagliari, Cagliari, Italy. 13. Endocrinology and Diabetes Palidoro Unit, University Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Abstract
AIMS: To investigate on the relationship between severity of ketoacidosis, an important risk factor for C-peptide preservation, and long-term microvascular complications in childhood-onset type 1 diabetes mellitus (T1DM). METHODS: 230 childhood-onset diabetic patients (177 pre-pubertal), aged 7.0±3.8years followed for at least 15years after their diagnosis, were enrolled. Clinical and laboratory data at diagnosis, and C-peptide levels in a subset of patients, were compared with the severity of retinopathy and nephropathy, after a mean of 19.6±3.8years of disease. Digital retinal photographs were taken in all patients, and centrally graded. Repeated measurements of HbA1c and microalbuminuria for the whole duration of diabetes were collected in over half of the cases. RESULTS: Out of 230 patients, those with the lowest age at diagnosis had the most severe DKA and clinical conditions (p<0.05), and lower C-peptide levels (p<0.0001) at diagnosis. There was a significant relationship between pH and clinical severity (r=-0.783, p<0.0001), and between pH and C-peptide levels (r=0.278, p<0.05). The severity of ketoacidosis had no relationship with subsequent lifetime HbA1c values and long-term microvascular complications. In logistic regression analysis, the only variables that independently influenced severity of retinopathy were lifetime HbA1c (B=0.838, p<0.001), duration of disease (B=0.208, p<0.005) and age at diagnosis (B=0.116, p<0.05). CONCLUSIONS: The degree of metabolic derangement at diagnosis is not associated with retinopathy and nephropathy in childhood-onset T1DM. Age at diagnosis seems to be an important variable to be considered when evaluating the long-term effects of residual beta-cell function.
AIMS: To investigate on the relationship between severity of ketoacidosis, an important risk factor for C-peptide preservation, and long-term microvascular complications in childhood-onset type 1 diabetes mellitus (T1DM). METHODS: 230 childhood-onset diabeticpatients (177 pre-pubertal), aged 7.0±3.8years followed for at least 15years after their diagnosis, were enrolled. Clinical and laboratory data at diagnosis, and C-peptide levels in a subset of patients, were compared with the severity of retinopathy and nephropathy, after a mean of 19.6±3.8years of disease. Digital retinal photographs were taken in all patients, and centrally graded. Repeated measurements of HbA1c and microalbuminuria for the whole duration of diabetes were collected in over half of the cases. RESULTS: Out of 230 patients, those with the lowest age at diagnosis had the most severe DKA and clinical conditions (p<0.05), and lower C-peptide levels (p<0.0001) at diagnosis. There was a significant relationship between pH and clinical severity (r=-0.783, p<0.0001), and between pH and C-peptide levels (r=0.278, p<0.05). The severity of ketoacidosis had no relationship with subsequent lifetime HbA1c values and long-term microvascular complications. In logistic regression analysis, the only variables that independently influenced severity of retinopathy were lifetime HbA1c (B=0.838, p<0.001), duration of disease (B=0.208, p<0.005) and age at diagnosis (B=0.116, p<0.05). CONCLUSIONS: The degree of metabolic derangement at diagnosis is not associated with retinopathy and nephropathy in childhood-onset T1DM. Age at diagnosis seems to be an important variable to be considered when evaluating the long-term effects of residual beta-cell function.
Authors: Marta Wysocka-Mincewicz; Marta Baszyńska-Wilk; Joanna Gołębiewska; Andrzej Olechowski; Aleksandra Byczyńska; Wojciech Hautz; Mieczysław Szalecki Journal: J Diabetes Res Date: 2020-11-18 Impact factor: 4.011
Authors: P Ruiz-Ocaña; P Espinoza Requena; A Alonso-Ojembarrena; P Alemany Márquez; S Jiménez Carmona; A M Lechuga-Sancho Journal: Int J Endocrinol Date: 2018-04-26 Impact factor: 3.257
Authors: Veena Mazarello Paes; Jessica K Barrett; David B Dunger; Evelien F Gevers; David C Taylor-Robinson; Russell M Viner; Terence J Stephenson Journal: Pediatr Diabetes Date: 2019-12-17 Impact factor: 4.866