Type 1 diabetes risk increases with A1c, duration

A1c long range of time type 1 diabetes The new data indicate that the prognosis is a strong predictor of the progression of acute retinopathy and nephropathy.

“[Weighted] HbA1c A very strong biomarker for panretinal laser therapy follows from diagnosis Diabetic retinopathy (PDR) and nephropathy, [and] Hans J says Posted online September 12 in Diabetes care.

The results came from a 32-year follow-up of 447 patients from the time of type 1 diabetes diagnosis at ages 0-34 in the Southeastern Sweden Vascular Diabetes Complications Study (VISS).

To avoid PDR and total albuminuria in patients with type 1 diabetes, A1c <7.0% (53 mmol/mol) should be recommended and as normal as possible, when possible without risk lack of blood sugar with a good quality of life,” emphasize Arnqvist, Department of Endocrinology, Linkoping University, Sweden, and co-authors.

At that time 20 to 24 years old Follow VISS, They wrote that a severe eye complication, known as PDR, or nephropathy, defined as macroalbuminuria, was not present in participants with long-term weighted average A1c <7.6% (60 mmol/mol).

Do you explain the increase in blood glucose burden with the duration of diabetes?

By years 32-36, the prevalence of PDR increased from 14% to 27%, and total albuminuria from 4% to 8%, with prevalence closely related to A1c levels. At the same time, the minimum onset of those severe complications decreased, with A1c values ​​lowering the minimum onset of PDR from 7.6% to 7.3%, and macroalbuminuria from 8.4% to 8.1%.

The authors speculate that “a possible explanation for the minimal development of severe microangiopathy is an increase in ‘glycemic burden’ with duration of diabetes.”

In all A1c categories greater than 6.7% (>50 mmol/mol), the cumulative ratio with PDR and/or macroalbuminuria continued to increase until at least 32 years of diabetes duration.

In the highest A1c quintile, >9.5% (>80 mmol/mol), 75% developed a PDR and 44.2% had significant albuminuria.

These findings are consistent with guidelines from both the International Society of Childhood and Adolescent Diabetes, which recommend an A1c level of less than 7% (53 mmol/mol) as a treatment target, and the British National Institute for Health and Care Excellence (NICE), which advises A1c goal of 6.5% (48 mmol/mol) or less in children and adults with type 1 diabetes.

The American Diabetes Association recommends individual A1c goals of 6.5% to 8.0%.

The study was supported by Barndiabetesfonden (the Swedish Children’s Diabetes Foundation) and the Ostergotlands Stiftelsefonder District. The book did not mention any other disclosures.

Diabetes care. Posted online September 12, 2022. Summary

Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR’s Shots blog, and Diabetes Forecast. It’s on Twitter: @MiriamETucker.

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