Epidemiology of Diabetes Complications (EDC) Phase II: renewal

描述（由申请人提供）：与2型糖尿病不同，在预防是可能的情况下，1型糖尿病目前既不可预防也不可治愈，其发病率每年持续上升约3%。因此，1型糖尿病并发症的持续调查仍然是必要的。糖尿病并发症流行病学（EDC）研究已经检查了20年的糖尿病并发症的患病率和发病率以及导致糖尿病并发症的危险因素。研究人群是匹兹堡儿童医院登记处确定的儿童期发病1型糖尿病的明确队列（诊断：1950-80）。所有658名参与者在研究入组时（1986-88年）参加了临床检查，随后随访了长达20年，导致超过114篇同行评议的出版物。在研究的最后阶段提出了一些引人注目的初步观察结果，提出了本更新旨在解决的问题和假设。这些包括各种促和抗糖氧化和炎症细胞因子之间日益复杂的相互作用，以及并发症的快速变化的自然史，这提供了对并发症的相互关系和特定风险因素的进一步了解，并使历史数据过时用于医疗保健和保险目的。因此，本申请集中于进一步评估25年总随访期的并发症发展，从而允许对儿童期发作的1型糖尿病持续40年的并发症发展进行合理稳定的估计。这提供了记录发病风险和估计现代预期寿命的机会，即对于那些在1965-80年诊断出糖尿病的人，以及自HbA 1c检测和自我血糖监测可用以来糖尿病持续时间超过一半的人。血糖，氧化和炎症应激的作用，以及他们调用的主机的反应，并发症的发展将是沿着妇女的健康问题和继续一些合作的另一个主要重点。最后，我们将使用一种新的仪器评估皮肤晚期糖基化终产物，以及它们与并发症风险的关系。继续进行年度调查，并在25年后进行全面检查，将有助于实现这一目标。公共卫生相关性：该应用的重要性在于能够在大的1型糖尿病队列中提供发病风险的记录和在HbA 1c测试和血糖的自我监测的现代时代的预期寿命的估计，而储存样本的可用性提供了解决压力作用的机会（血糖、氧化和/或炎症）和它引起的宿主反应，在血管并发症的发病机制中起作用。该应用程序还解决了妇女的健康问题，并评估了新仪器预测并发症风险的能力。由于目前1型糖尿病既不可预防也不可治愈，因此对其并发症的持续调查仍然是必要的，本研究既可以进一步了解并发症的自然史，也可以指出预防和管理的新方法。

DESCRIPTION (provided by applicant): Unlike type 2 diabetes, where prevention is possible, type 1 diabetes is currently neither preventable nor curable and its incidence continues to rise approximately 3% per year. Thus, the continuing investigation of type 1 diabetes complications remains imperative. The Epidemiology of Diabetes Complications (EDC) study has examined the prevalence and incidence of and risk factors contributing to the diabetes complications for 20 years. The study population is a well defined cohort of childhood onset type 1 diabetes identified from the Children's Hospital of Pittsburgh Registry (diagnosis: 1950-80). All 658 participants attending a clinical exam at study entry (1986-88) have been subsequently followed for up to 20 years, leading to over 114 peer reviewed publications. A number of striking preliminary observations made during the last phase of the study have given rise to questions and hypotheses this renewal aims to address. These include the increasingly complex interaction between various pro- and anti-glycoxidative and inflammatory cytokines, as well as the rapidly changing natural history of complications which provides further insight into the interrelationships of, and specific risk factors for, complications, and renders historic data outdated for health care and insurance purposes. The current application, therefore, focuses on further assessment of complication development for a total follow up period of 25 years, thus allowing reasonably stable estimates of complication development over 40 years duration of childhood onset type 1 diabetes. This gives the opportunity to document morbidity risk and to estimate life expectancy in the modern era, i.e. for those diagnosed in 1965-80 and who have had more than half their diabetes duration since the availability of HbA1c testing and self monitoring of blood glucose. The roles of glycemic, oxidative and inflammatory stress, and the host's responses they invoke, on complication development will be another major focus along with women's health issues and continuing a number of collaborations. Finally, we will evaluate skin advanced glycosylation end products using a new instrument and how they relate to complication risk. This will be facilitated by continuing the annual surveys and, at 25 years of follow up, a full examination. PUBLIC HEALTH RELEVANCE: The significance of this application lies in the ability to provide, in a large type 1 diabetes cohort, documentation of morbidity risk and estimates of life expectancy in the modern era of HbA1c testing and self monitoring of blood glucose, whereas the availability of stored specimen offers the opportunity to address the role of stress (glycemic, oxidative and/or inflammatory) and the host's response it provokes, in the pathogenesis of vascular complications. This application also addresses women's health issues and evaluates new instruments in their ability to predict complication risk. As currently type 1 diabetes is neither preventable nor curable, the continuing investigation of its complications remains imperative and the present study may both further our knowledge of the natural history of complications and also point to novel approaches to prevention and management.