Adult stature and diabetes complications in patients with type 1 diabetes: the FinnDiane Study and the diabetes control and complications trial

Abstract

Objective: Short adult stature has previously been associated with cardiovascular disease, but its relationship with the microvascular complications of diabetes is uncertain. Therefore, we evaluated the association between adult stature and prevalence and incidence of diabetic microvascular complications.

Research design and methods: This cross-sectional and longitudinal study comprises 3,968 adult patients with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study and 1,246 adult patients from the Diabetes Control and Complications Trial (DCCT). In FinnDiane, diabetic nephropathy was defined as urinary albumin excretion > or = 300 mg/24 h, dialysis, or renal transplantation. Retinopathy was divided into background and proliferative (laser-treated) retinopathy. In the DCCT, original nephropathy (class 1-6) and retinopathy (Early Treatment of Diabetic Retinopathy Study) classifications were used.

Results: In the FinnDiane study, patients in the lowest quartile of adult height had increased risks of prevalent diabetic nephropathy (odds ratio [OR] 1.71, 95% CI 1.44-2.02) and prevalent laser-treated retinopathy (1.66, 1.43-1.93) compared with other patients. Similarly, in the DCCT, patients in the lowest quartile of adult height had increased risks of incident diabetic nephropathy class 4-6 (hazard ratio 2.70, 95% CI 1.59-4.59) and incident proliferative retinopathy (2.06, 1.15-3.71). In the FinnDiane study, the associations were largely explained by childhood exposure to diabetes. However, in the DCCT, where a greater proportion of patients had diabetes onset >18 years, the association with nephropathy was independent of childhood diabetes exposure.

Conclusions: Short adult stature is associated with microvascular complications in patients with type 1 diabetes. These findings are compatible with either childhood diabetes exposure or "common soil" or both as potential explanations.

FIG. 1

A: Prevalence (%) of diabetic nephropathy (macroalbuminuria, dialysis, or renal transplantation) in FinnDiane by quartile of height and decade of birth. ORs (95% CI) for nephropathy per quartile of height are given for each decade of birth. NA, not applicable. B: Prevalence (%) of laser-treated retinopathy in FinnDiane by quartile of height and decade of birth. ORs (95% CI) for retinopathy per quartile of height are given for each decade of birth. C: Prevalence (%) of laser-treated retinopathy in FinnDiane by quartile of height and decade of birth. Patients with diabetic nephropathy (macroalbuminuria, dialysis, or renal transplantation) were excluded from the analyses. ORs (95% CI) for retinopathy per quartile of height are given for each decade of birth. D: Prevalence (%) of diabetic nephropathy (macroalbuminuria, dialysis, or renal transplantation) in FinnDiane by groups of age at onset of diabetes. ORs (95% CI) for nephropathy per quartile of height are given for each decade of birth.