By Nicole MacKee
Maintaining stable, targeted glycaemic control from the time a child is diagnosed with type 1 diabetes can help to reduce the risk of severe diabetic retinopathy in adulthood, Australian researchers say.
In a data linkage study published in the Medical Journal of Australia, researchers investigated the outcomes for adults who had been diagnosed with childhood-onset type 1 diabetes between 1975 and 2010, and had transitioned from care at Melbourne’s Royal Children’s Hospital to Royal Melbourne Hospital between 1992 and 2013.
Among 503 study participants, 26 (5.2%) were found to have had at least one severe complication, including 16 (3.2%) with severe diabetic retinopathy.
The study included only the most severe complications, and participants were classified as having severe diabetic retinopathy if they had had one or more of maculopathy, proliferative retinopathy or a need for photocoagulation surgery.
To determine the effect on risk of trajectories in glycaemic control, participants were classified into four groups according to their mean HbA1c in childhood and adulthood: stable low (paediatric and adult HbA1c ≤66 mmol/mol [8.2%]); improving (paediatric HbA1c >66 mmol/mol, adult HbA1c ≤66 mmol/mol); worsening
(paediatric HbA1c ≤66 mmol/mol, adult HbA1c >66 mmol/mol); and stable high (paediatric and adult HbA1c >66 mmol/mol).
No participants in the stable low group developed severe diabetic retinopathy, but 4% of the improving group, 1% of the worsening group and 7% of the stable high group developed this complication. Each 10.9 mmol/mol (1%) increase in mean paediatric HbA1c increased the odds of severe retinopathy almost threefold (odds ratio, 2.9).
The study authors also noted that 64.6% of participants remained in the same HbA1c category – either stable low or high – during the paediatric and adult periods.
Dr Mary White, lead author and a paediatric endocrinologist at The Royal Children’s Hospital and Monash Children’s Hospital in Melbourne, said the findings reinforced the importance of optimising glycaemic control from the time of diagnosis because most patients do not change trajectory from childhood to adulthood.
‘We are laying the foundations for lifetime glycaemic control in childhood, so the way we manage our paediatric patients is going to have lasting effects on both their HbA1c and potentially their diabetes-related complications,’ Dr White told Endocrinology Today.
Dr White said the findings were reassuring to patients and to physicians, that achieving good glycaemic control in childhood could help patients to avoid complications down the track.
‘Those with stable control – the individuals who maintained their HbA1c at 8.2% or below [or ≤66 mmol/mol] in both childhood and adulthood – didn’t develop any retinopathy,’ she said.
Med J Aust 2017; 206: 398-401.
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