Kind 1 Diabetes Complication Danger Rises With A1c, Length
Very long-phrase A1c from the time of variety 1 diabetic issues prognosis strongly predicts the improvement of intense retinopathy and nephropathy, new data recommend.
“[Weighted] HbA1c followed from analysis is a pretty potent biomarker for pan-retinal laser-handled diabetic retinopathy (PDR) and nephropathy, [and] the prevalence of each is nonetheless raising 32 decades after analysis,” say Hans J. Arnqvist, MD, and colleagues in their research posted on-line September 12 in Diabetic issues Care.
The outcomes are from a 32-yr abide by-up of 447 individuals from time of diagnosis of form 1 diabetic issues at age -34 in the Vascular Diabetic Difficulties in Southeast Sweden (VISS) research.
“To steer clear of PDR and macroalbuminuria in individuals with type 1 diabetes, A1c < 7.0% (53 mmol/mol) and as normal as possible, should be recommended when achievable without severe hypoglycemia and with good quality of life," stress Arnqvist, Department of Endocrinology, Linkoping University, Sweden, and coauthors.
At the time of the 20- to 24-year VISS follow-up, severe eye complications, defined as PDR, or nephropathy, defined as macroalbuminuria, were not present in participants with a long-term weighted mean A1c < 7.6% (60 mmol/mol), they write.
Is Explanation an Increase in Glycemic Burden With Diabetes Duration?
By years 32-36, the prevalence of PDR had risen from 14% to 27%, and macroalbuminuria from 4% to 8%, with prevalence strongly correlated with A1c levels. At the same time, the threshold for the appearance of those severe complications had dropped, with the lowest A1c values for appearance of PDR decreasing from 7.6% to 7.3%, and for macroalbuminuria from 8.4% to 8.1%.
“A possible explanation for the lowered threshold for development of severe microangiopathy is the increase in ‘glycemic burden’ with diabetes duration,” the authors speculate.
In all A1c categories above 6.7% (> 50 mmol/mol), the cumulative proportion with PDR and/or macroproteinuria continued to boost up to at least 32 a long time of diabetic issues period.
At the highest A1c quintile, > 9.5% (> 80mmol/mol), 75% had formulated PDR and 44.2% had macroalbuminuria.
These results align with recommendations from both equally the International Culture for Pediatric and Adolescent Diabetic issues, which endorse A1c less than < 7% (53 mmol/mol) as a treatment goal, and the UK National Institute for Health and Care Excellence (NICE), which advises a target A1c of 6.5% (48 mmol/mol) or lower in children and adults with type 1 diabetes.
The American Diabetes Association recommends individualized A1c targets ranging from 6.5% to 8.0%.
The study was supported by Barndiabetesfonden (Swedish Children’s Diabetes Foundation) and Region Ostergotlands Stiftelsefonder. The authors reported no further disclosures.
Diabetes Care. Published online September 12, 2022. Abstract
Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR’s Shots blog, and Diabetes Forecast magazine. She is on Twitter: @MiriamETucker.
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