Abstract
Aims Prevention and prediction of microvascular complications are
important aims of medical care in people with type 1 diabetes. Since the course
of the disease is heterogenous, we tried to identify subgroups with specific
risk profiles for microvascular complications.
Methods Retrospective analysis of a cohort of 285 people (22637
consultations) with >10 years of type 1 diabetes. Persons were grouped
into slow (<15 years), fast (>15 years) and non progressors
according to the average onset of microvascular complications. Generalized
estimating equations for binary outcomes were applied and pseudo coefficients of
determination were calculated.
Results Progression to microvascular disease was associated with age (OR:
1.034 [1.001–1.068]; p=0.04), diabetes duration (OR: 1.057
[1.021–1.094]; p=0.002), HbA1c (OR: 1.035
[1.011–1.060]; p=0.005), BMI (OR: 0.928 [0.866–0.994];
p=0.034) and the social strata index (OR: 0.910 [0.830–0.998];
p=0.046). Generalized estimating equations predicted 31.02% and
exclusion of HbA1c marginally reduced the value to 28.88%.
The proportion of patients with LADA was higher in fast than slow progressors
[13 (26.5%) vs. 14 (11.9%); p=0.019]. A generalized
estimating equation comparing slow to fast progressors revealed no significant
markers.
Conclusion In our analysis, we were able to confirm known risk factors
for microvascular disease in people with type 1 diabetes. Overall, prediction of
individual risk was difficult, the effect of individual markers minor and we
could not find differences regarding slow or fast progression. We therefore
emphasis the need for additional markers to predict individual risk for
microvascular disease.
Key words
diabetes mellitus type 1 - microvascular complications - classification - disease progression - social status - biomarkers
