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. 2017 Sep 22;9(2):121-128.
doi: 10.1007/s13340-017-0336-9. eCollection 2018 May.

The incidences of and risk factors for severe retinopathy requiring photocoagulation and albuminuria in Japanese patients with childhood-onset type 1 diabetes

Hiroko Takaike  1 , Yasuko Uchigata  1 , Nobuo Matsuura  2 , Nozomu Sasaki  3 , Shin Amemiya  3 , Tatsuhiko Urakami  4 , Tomoyuki Kawamura  5 , Nobuyuki Kikuchi  6 , Shigetaka Sugihara  7 ; Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT)
Collaborators, Affiliations

The incidences of and risk factors for severe retinopathy requiring photocoagulation and albuminuria in Japanese patients with childhood-onset type 1 diabetes

Hiroko Takaike et al. Diabetol Int. .

Abstract

The aim of this study was to clarify the incidences of and the risk factors for severe retinopathy requiring photocoagulation therapy and albuminuria in Japanese patients with childhood-onset type 1 diabetes mellitus. A total of 756 patients from a cohort study by the Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes were included in the study. Patients were registered in 1995 or 2000, and HbA1cwas measured every 4 months and analyzed in central hospital for an average of 6 years. The presence of severe retinopathy requiring laser photocoagulation and the presence of albuminuria was checked for during the period 2010-2011. During a median of 18 (range: 15-21) years, 34 out of 756 patients underwent laser photocoagulation and 57 out of 605 patients developed albuminuria. A Cox proportional hazards model showed that the risk of severe retinopathy requiring laser photocoagulation increased by 1.15 (95% confidence interval [CI] 1.03-1.29, p = 0.012) with each increase of a year in the age at onset, by 4.03 (95% CI 1.20-13.5, p = 0.024) in females, and by 2.05 (95% CI 1.69-2.49, p < 0.0001) with each increase of 1% in HbA1c. The risk of albuminuria increased significantly, by 1.09 (95% CI 1.01-1.18 p = 0.037), with each increase of a year in the age at onset and by 2.38 (95% CI 1.93-2.97 p < 0.0001) with each increase of 1% in HbA1c. In Japanese patients with childhood-onset type 1 diabetes, older age at the onset of diabetes, female rather than male gender, and higher HbA1c were found to increase the risk of requiring photocoagulation. No patients with HbA1c < 7.5% developed severe retinopathy requiring photocoagulation therapy. The risk of developing albuminuria increased with age at onset of diabetes and HbA1c. Female gender was a strong risk factor for severe retinopathy requiring photocoagulation, but not for albuminuria.

Keywords: Child-onset type 1 diabetes; Laser photocoagulation; Macroalbuminuria; Microalbuminuria; Microangiopathy.

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Conflict of interest statement

Tatsuhiko Urakami has served in advisory panels for Novo Nordisk and Sanofi, and has served on speakers’ bureaus for Sanofi.All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients before they were included in the study.

Figures

Fig. 1
Fig. 1
Flow diagram of the patients who participated in this study
Fig. 2
Fig. 2
Charts showing the cumulative incidence of photocoagulation therapy as a function of duration of diabetes. a Comparison of patients with different median HbA1c values during the observational period. b Comparison of patients with different median HbA1c values during 2010 or 2011. c Comparison of male and female patients. d Comparison of patients based on age at diagnosis (younger or older than 7 years). The data were obtained by the Kaplan–Meier method
See this image and copyright information in PMC

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