Section of Endocrinology, Centro di Riferimento Regionale per la Diagnosi e Cura delle Endocrinopatie Autoimmuni e del Diabete di Tipo 1, Dipartimento di Medicina Interna e Medicina Sperimentale (DIBIMIS), Università degli Studi di Palermo, Italy.
Eur J Intern Med. 2011 Jun;22(3):266-74. doi: 10.1016/j.ejim.2011.02.009. Epub 2011 Mar 17.
Several epidemiological studies showed a close association between metabolic control and microvascular complications in type 1 Diabetes Mellitus (T1DM). The aim of our longitudinal observational study was to evaluate the predictive role of the main clinical and biochemical parameters in determining microvascular complications.
376 T1DM patients, hospitalized in our division from 1991 to 2005 (mean follow-up=10.93±4.26 years) were studied. Stepwise Cox regression analysis was used to identify the influence of residual ß-cell function, ß-cell autoimmunity, HbA1c levels and other clinical and laboratory parameters in the development of microalbuminuria and retinopathy.
The probability of developing microalbuminuria was higher in males than in females (HR 1.82; 95% CI 1.01-3.28; p=0.044), in patients with higher mean HbA1c values (HR 2.80; 95% CI 1.63-4.83; p<0.001), longer duration of disease (HR 1.98; 95% CI 1.10-3.57; p=0.022) and younger age of diabetes onset (HR 0.53; 95% CI 0.03-0.92; p=0.026). An increased probability of developing retinopathy was found in patients with higher mean HbA1c levels during follow-up (HR 2.35; 95% CI 1.34-4.12, p=0.003), as well as at onset (HR 1.85; 95% CI 1.06-3.24; p=0.030).
Our study suggests that among the clinical, metabolic, immunological and biochemical factors evaluated at onset, only HbA1c is predictive for the microangiopathy development in T1DM.
几项流行病学研究表明，1 型糖尿病（T1DM）患者的代谢控制与微血管并发症之间存在密切关联。我们的纵向观察性研究旨在评估主要临床和生化参数在确定微血管并发症中的预测作用。
我们研究了 1991 年至 2005 年期间在我们科室住院的 376 名 T1DM 患者（平均随访时间=10.93±4.26 年）。采用逐步 Cox 回归分析来确定残余β细胞功能、β细胞自身免疫、HbA1c 水平以及其他临床和实验室参数对微量白蛋白尿和视网膜病变发展的影响。
男性发生微量白蛋白尿的概率高于女性（HR 1.82；95%CI 1.01-3.28；p=0.044），HbA1c 平均值较高的患者（HR 2.80；95%CI 1.63-4.83；p<0.001）、疾病病程较长的患者（HR 1.98；95%CI 1.10-3.57；p=0.022）和糖尿病发病年龄较小的患者（HR 0.53；95%CI 0.03-0.92；p=0.026）。在随访期间，HbA1c 平均值较高的患者发生视网膜病变的概率增加（HR 2.35；95%CI 1.34-4.12，p=0.003），发病时也是如此（HR 1.85；95%CI 1.06-3.24；p=0.030）。
我们的研究表明，在发病时评估的临床、代谢、免疫和生化因素中，只有 HbA1c 可以预测 T1DM 微血管病变的发生。
