The long-term renal and retinal outcome of childhood-onset Type 1 diabetes
The long-term renal and retinal outcome of childhood-onset Type 1 diabetes
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DOI：
10.1046/j.1464-5491.2003.01062.x
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发表时间：
2004-01-01
影响因子：
3.5
通讯作者：
Allagoa, B
中科院分区：
文献类型：
--
作者：
Harvey, JN;Allagoa, B
目的量化儿童期发病对1型diabetes.Methods的长期肾脏和视网膜的结果的影响，我们使用了基于人口的糖尿病登记，以确定所有1型患者在15岁之前诊断1960年至1982年，并在1999年在一个定义的集水区居民。结果与成人发病对照组相比，儿童期发病糖尿病患者蛋白尿发生早（P = 0.02），肾病转归差（P = 0.008）。儿童期发病的糖尿病患者发生微量白蛋白尿的风险更大：比值比为2.6（95%可信区间为1.4-4.9，P = 0.003）。儿童期发病的肾病相对危险度为3.8（1.5-9.4，P = 0.005）。发生背景视网膜病变的人数与发病年龄无关，但年轻患者更可能需要激光治疗：相对风险2.1（1.1-3.8，P = 0.02）。这保持了视力的结果，这是没有显着不同的年龄在发病groups.Conclusions发病的1型糖尿病患者在15岁之前有实质上更糟糕的肾脏的结果，需要更多的激光治疗比成人发病的患者。与儿童期发病和成人期发病之间的差异相比，5岁以前发病、5-9岁发病和10-14岁发病之间的差异较小。因此，青少年时期的事件似乎对发生长期微血管并发症的风险有重大不利影响。
Aims To quantify the influence of childhood onset on long-term renal and retinal outcome in Type 1 diabetes.Methods We used a population-based diabetes register to identify all Type 1 patients diagnosed before age 15 from 1960 to 1982 and resident in a defined catchment area in 1999. Those diagnosed before age 5, aged 5-9 and 10-14 years were compared with a reference group diagnosed at age 21-25 years over the same period.Results Compared with adult-onset controls, proteinuria occurred earlier (P = 0.02) and nephropathy outcome was worse (P = 0.008) in childhood-onset diabetes. The risk of developing microalbuminuria was greater in childhood-onset diabetes: odds ratio 2.6 (95% confidence interval 1.4-4.9, P = 0.003). The relative risk of established nephropathy was 3.8 (1.5-9.4, P = 0.005) with childhood onset. The number developing background retinopathy did not differ with age at onset but younger onset patients were more likely to need laser treatment: relative risk 2.1 (1.1-3.8, P = 0.02). This maintained visual outcome which was not significantly different between the various age at onset groups.Conclusions Patients with onset of Type 1 diabetes before age 15 have substantially worse renal outcome and require more laser treatment than adult-onset patients. Differences between those with onset before age 5, onset at 5-9 and 10-14 years are small compared with the difference between childhood onset and adult onset. Events in the teenage years therefore appear to have a major adverse effect on the risk of developing long-term microvascular complications.