Clustering of microvascular complications in Type 1 diabetes mellitus

Abstract

Aims: To describe to what extent microvascular complications exhibit clustering in persons with Type 1 diabetes, and to assess whether the presence of one complication modified the strength of the association between the other two.

Methods: We conducted a cross-sectional analysis of the electronic medical records of 2276 persons with Type 1 diabetes treated in a specialized care hospital in Denmark in 2013. We used log-linear analysis to describe associations between diabetic kidney disease, neuropathy and retinopathy and logistic regression models to quantify the magnitude of associations adjusting for potential confounders.

Results: The median duration of diabetes was 24 years and median HbA1c was 63 mmol/mol (7.9%). We found strong indication of clustering and found no evidence that presence of one complication modified the association between the other two. In models adjusted for diabetes duration and HbA_1c, persons with neuropathy had an OR of 2.15 (95% CI: 1.73-2.66) for concurrent diabetic kidney disease. Those with retinopathy had an OR of 2.49 (1.92-3.24) for diabetic kidney disease and of 2.66 (1.94-3.64) for neuropathy.

Conclusions: Microvascular complications in persons with Type 1 diabetes exhibit strong clustering. However, the association between any pair of complications is not modified by the presence of the third.

Keywords: Diabetes complications; Diabetic kidney disease; Epidemiology; Neuropathy; Retinopathy; Type 1 diabetes mellitus.