Mohsin Fauzia, Craig Maria E, Cusumano Janine, Chan Albert K F, Hing Stephen, Lee Jennifer W, Silink Martin, Howard Neville J, Donaghue Kim C
Institute of Endocrinology and Diabetes, Locked Bag 4001, Westmead, NSW 2145, Australia.
Diabetes Care. 2005 Aug;28(8):1974-80. doi: 10.2337/diacare.28.8.1974.
Since the Diabetes Control and Complications Trial, diabetes management goals have changed. The aims of the present study were to assess complication rates, including nerve abnormalities, in adolescents from 1990 to 2002 and to investigate associated risk factors.
Cross-sectional analysis of complications was assessed in three study periods (1990-1994 [T1], 1995-1998 [T2], and 1999-2002 [T3]) in adolescents matched for age and diabetes duration (n = 878, median age 14.6 years, median duration 7.5 years). Retinopathy was assessed by seven-field stereoscopic fundal photography, albumin excretion rate (AER) from three consecutive timed overnight urine collections, peripheral nerve function by thermal and vibration thresholds, and autonomic nerve function by cardiovascular reflexes.
Retinopathy declined significantly (T1, 49%; T2, 31%; and T3, 24%; P < 0.0001), early elevation of AER (> or = 7.5 microg/min) declined (38, 30, and 25%, respectively, P = 0.022), and microalbuminuria (AER > or = 20 microg/min) declined (7, 3, and 3%, respectively; P = 0.017, T1 vs. T2 and T3). Autonomic nerve abnormalities were unchanged (18, 21, and 18%, respectively; P = 0.60), but peripheral nerve abnormalities increased (12, 19, and 24%, respectively; P = 0.0017). More patients were treated with three or more injections per day (12, 46, and 67%, respectively; P < 0.0001) and insulin dose increased (1.08, 1.17, and 1.22 units x kg(-1) x day(-1), respectively; P < 0.0001), but median HbA(1c) (A1C) was unchanged (8.5, 8.5, and 8.4%, respectively). BMI and height SD score increased: BMI 0.46, 0.67, and 0.79, respectively (P < 0.0001), and height -0.09, 0.05, and 0.27, respectively (P < 0.0001).
Retinopathy and microalbuminuria declined over time in this cohort, but the increased rate of peripheral nerve abnormalities is of concern. Despite intensified management (higher insulin dose and more injections), A1C has not changed and remains well above the recommended targets for adolescents.
自糖尿病控制与并发症试验以来，糖尿病管理目标已经改变。本研究的目的是评估1990年至2002年青少年中的并发症发生率，包括神经异常情况，并调查相关危险因素。
在三个研究时间段（1990 - 1994年[T1]、1995 - 1998年[T2]和1999 - 2002年[T3]）对年龄和糖尿病病程相匹配的青少年（n = 878，中位年龄14.6岁，中位病程7.5年）进行并发症的横断面分析。通过七视野立体眼底照相术评估视网膜病变，通过连续三次定时过夜尿液收集测定白蛋白排泄率（AER），通过热阈值和振动阈值评估周围神经功能，通过心血管反射评估自主神经功能。
视网膜病变显著下降（T1为49%；T2为31%；T3为24%；P < 0.0001），AER早期升高（≥7.5微克/分钟）下降（分别为38%、30%和25%，P = 0.022），微量白蛋白尿（AER≥20微克/分钟）下降（分别为7%、3%和3%；P = 0.017，T1与T2和T3相比）。自主神经异常情况未变（分别为18%、21%和18%；P = 0.60），但周围神经异常情况增加（分别为12%、19%和24%；P = 0.0017）。更多患者每天接受三次或更多次注射治疗（分别为12%、46%和67%；P < 0.0001），胰岛素剂量增加（分别为1.08、1.17和1.22单位×千克⁻¹×天⁻¹；P < 0.0001），但HbA₁c（A1C）中位数未变（分别为8.5%、8.5%和8.4%）。BMI和身高标准差评分增加：BMI分别为0.46、0.67和0.79（P < 0.0001），身高分别为 - 0.09、0.05和0.27（P < 0.0001）。
该队列中视网膜病变和微量白蛋白尿随时间下降，但周围神经异常情况的增加速率令人担忧。尽管管理强化（更高的胰岛素剂量和更多次注射），A1C并未改变，仍远高于青少年推荐目标。
