HbA1c and the risk of developing peripheral neuropathy in childhood-onset type 1 diabetes: A follow-up study over 3 decades

IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Evangelia Baldimtsi, Salvador Amezcua, Martin Ulander, Lars Hyllienmark, Håkan Olausson, Johnny Ludvigsson, Jeanette Wahlberg
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Abstract

Aims

We have evaluated long-term weighted mean HbA1c (wHbA1c), HbA1c variability, diabetes duration, and lipid profiles in relation to the development of diabetic peripheral neuropathy (DPN), nephropathy, and retinopathy in childhood-onset type 1 diabetes.

Materials and Methods

In a longitudinal cohort study, 49 patients (21 women) with childhood-onset type 1 diabetes were investigated with neurophysiological measurements, blood tests, and clinical examinations after a diabetes duration of 7.7 (±3.3) years (baseline) and followed with repeated examinations for 30.6 (±5.2) years. We calculated wHbA1c by integrating the area under all HbA1c values since the diabetes diagnosis. Lipid profiles were analysed in relation to the presence of DPN. Long-term fluctuations of HbA1c variability were computed as the standard deviation of all HbA1c measurements. Data regarding the presence of other diabetes complications were retrieved from medical records.

Results

In this follow-up study, 51% (25/49) of the patients fulfilled electrophysiological criteria for DPN. In nerve conduction studies, there was a deterioration in the amplitudes and conduction velocities for the median, peroneal, and sural nerves over time. Patients with DPN had a longer duration of diabetes, higher wHbA1c, and increased HbA1c variability. The lowest wHbA1c value associated with the development of DPN was 62 mmol/mol (7.8%). The presence of albuminuria and retinopathy was positively correlated with the presence of neuropathy.

Conclusions

More than half of the patients had developed DPN after 30 years. None of the patients who developed DPN had a wHbA1c of less than 62 mmol/mol (7.8%).

Abstract Image

HbA1c 与儿童期发病的 1 型糖尿病患者罹患周围神经病变的风险:一项历时 30 年的随访研究。
目的:我们评估了儿童期发病的 1 型糖尿病患者长期加权平均 HbA1c(wHbA1c)、HbA1c 变异性、糖尿病病程和血脂状况与糖尿病周围神经病变(DPN)、肾病和视网膜病变发展的关系:在一项纵向队列研究中,我们对 49 名儿童期发病的 1 型糖尿病患者(21 名女性)进行了神经电生理测量、血液化验和临床检查,这些患者的糖尿病病程为 7.7(±3.3)年(基线),重复检查的随访时间为 30.6(±5.2)年。我们通过整合糖尿病确诊后所有 HbA1c 值下的面积来计算 wHbA1c。我们还分析了与 DPN 存在相关的血脂状况。HbA1c 变异性的长期波动按所有 HbA1c 测量值的标准偏差计算。其他糖尿病并发症的相关数据来自医疗记录:在这项随访研究中,51%(25/49)的患者符合 DPN 的电生理学标准。在神经传导研究中,随着时间的推移,正中神经、腓肠神经和苏木神经的振幅和传导速度均有所下降。DPN 患者的糖尿病病程较长,WHbA1c 较高,HbA1c 变异性增大。与 DPN 发病相关的最低 wHbA1c 值为 62 mmol/mol(7.8%)。白蛋白尿和视网膜病变的存在与神经病变的存在呈正相关:结论:一半以上的患者在 30 年后发展为 DPN。结论:半数以上的患者在 30 年后出现了 DPN,但没有一名 DPN 患者的 wHbA1c 低于 62 mmol/mol (7.8%)。
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来源期刊
Diabetes/Metabolism Research and Reviews
Diabetes/Metabolism Research and Reviews 医学-内分泌学与代谢
CiteScore
17.20
自引率
2.50%
发文量
84
审稿时长
4-8 weeks
期刊介绍: Diabetes/Metabolism Research and Reviews is a premier endocrinology and metabolism journal esteemed by clinicians and researchers alike. Encompassing a wide spectrum of topics including diabetes, endocrinology, metabolism, and obesity, the journal eagerly accepts submissions ranging from clinical studies to basic and translational research, as well as reviews exploring historical progress, controversial issues, and prominent opinions in the field. Join us in advancing knowledge and understanding in the realm of diabetes and metabolism.
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