Danne T, Weber B, Hartmann R, Enders I, Burger W, Hovener G
Children's Hospital, Kaiserin Auguste Victoria Haus, Klinikum Rudolf Virchow, Berlin, Germany.
Diabetes Care. 1994 Dec;17(12):1390-6. doi: 10.2337/diacare.17.12.1390.
To assess the influence of long-term glycemic control on the development of background retinopathy in adolescents followed longitudinally from the onset of insulin-dependent diabetes mellitus (IDDM).
Repeated retinal fluorescein angiographies, in intervals of 1-2 years, were evaluated prospectively in 346 patients (190 males, 156 females; 19.8 [8.8-35.4] years of age; diabetes duration of 10.4 [1.1-27.4] years at their latest eye examination, median [range]). The influences of long-term HbA1c (mean of 18 [1-95] determinations per person) and microalbuminuria (> or = 2 of > or = 3 measurements > or = 15 micrograms/min x 1.73 m2) were studied by multiple linear regression, life-table analysis, and trend analyses.
The rate of background retinopathy per 100 patient-years increased with poorer glycemic control from 0.7 (long-term HbA1c < 7% to 7.3 (HbA1c > 11%) following an exponential function. Life-table analysis after subdivision in HbA1c quartiles of equal sizes (HbA1c < 8, 8-9, 9-10, and > 10%) revealed an individual median expectation of background retinopathy after more than 25, 16.2, 12.7, or 12.0 years of diabetes, respectively. However, significant differences were found only between 8-9% and 9-10%, calculated either as prevalence, life-table analysis, or relative incidence, thus suggesting that a threshold model may also fit the data. After 12 years of diabetes, < 25% of those patients exhibiting microalbuminuria (n = 18) were expected to be free from retinopathy compared with 81% of those with normoalbuminuria (n = 86).
Two statistical models are appropriate to explain the relationship between glycemic control and risk for background retinopathy: 1) a continuous exponential relationship as described by the DCCT or 2) the presence of a threshold HbA1c level at 9%. Thus, diabetes treatment in children should aim at long-term HbA1c levels < 9.0%, but every progress closer to normal may further reduce the risk.
评估从胰岛素依赖型糖尿病（IDDM）发病起就接受纵向随访的青少年长期血糖控制对背景性视网膜病变发展的影响。
前瞻性地评估了346例患者（190例男性，156例女性；年龄19.8[8.8 - 35.4]岁；在最近一次眼科检查时糖尿病病程为10.4[1.1 - 27.4]年，中位数[范围]）间隔1 - 2年进行的重复视网膜荧光血管造影。通过多元线性回归、生命表分析和趋势分析研究长期糖化血红蛋白（HbA1c）（每人平均18[1 - 95]次测定值）和微量白蛋白尿（≥3次测量中≥2次≥15微克/分钟×1.73平方米）的影响。
随着血糖控制变差，每100患者年的背景性视网膜病变发生率呈指数函数从0.7（长期HbA1c<7%）增至7.3（HbA1c>11%）。将HbA1c等分为四分位数（HbA1c<8%、8 - 9%、9 - 10%和>10%）后进行生命表分析，结果显示糖尿病病程超过25年、16.2年、12.7年或12.0年后背景性视网膜病变的个体中位预期发生率分别如此。然而，仅在8 - 9%与9 - 10%之间发现显著差异，无论是按患病率、生命表分析还是相对发病率计算，这表明阈值模型也可能适用于这些数据。糖尿病病程12年后，微量白蛋白尿患者（n = 18）中预计<25%无视网膜病变，而正常白蛋白尿患者（n = 86）中这一比例为81%。
有两种统计模型适合解释血糖控制与背景性视网膜病变风险之间的关系：1）如糖尿病控制与并发症试验（DCCT）所描述的连续指数关系；2）存在9%的HbA1c阈值水平。因此，儿童糖尿病治疗应旨在使长期HbA1c水平<9.0%，但每向正常水平靠近一步都可能进一步降低风险。
