In a nutshell
The present article compares the effects of type 1 diabetes mellitus (T1DM) diagnosed before or after the onset of puberty on the occurrence of eye and kidney complications. The main findings were that patients diagnosed and treated for T1DM before puberty had a smaller risk for developing eye complications.
Some background
T1DM often develops during childhood, and results from the destruction of insulin-producing pancreatic cells. Without insulin the body accumulates glucose in the blood stream which, when consistently elevated, damages the small blood vessels in the eyes and kidneys. This leads to diabetic retinopathy (damage to the retina, the light-sensitive center of the eye) and diabetic nephropathy (diabetes-related kidney disease). If untreated, these complications can cause impaired vision and kidney failure. With a longer duration of the disease the risk for developing retinopathy and nephropathy is higher. This study aims to evaluate if the onset of T1DM before or after puberty influences the risk of these long-term complications.
Methods & findings
The study included 105 T1DM patients. 53 developed diabetes before puberty (pre-pubertal – age 0-3) and 53 had diabetes onset around puberty (pubertal – age 9-15). Patients had their eyes and kidneys regularly checked, their blood pressure measured and glycated hemoglobin (a measure for blood sugar levels, or ‘glycemic control’) evaluated.
After nearly 20 years of follow-up, more patients in the pubertal group developed retinopathy compared to the pre-pubertal group (71% versus 40%). Also, pubertal patients had more severe cases of retinopathy than pre-pubertal patients. The occurrence of nephropathy was similar in both groups.
The bottom line
In conclusion, this study found that patients diagnosed with T1DM as toddlers have a lower risk for developing diabetic retinopathy, despite the longer duration of the disease. However, this protection disappears if treatment is poor and blood sugar control is bad. Instead, when onset is at puberty, the risk of retinopathy is higher and less dependent on glycemic control and may be influenced by age-related factors, such as blood pressure.
The authors recommend maintaining good glycemic control irrespective of age, while avoiding strict control in very young children, and those prone to hypoglycemia.
The fine print
The weakness of this study is in its small size, which precludes reaching unequivocal conclusions explaining their findings.
Published By :
Diabetes Care
Date :
Apr 01, 2012
