[Chronic complications and risk factors in patients with type 1 diabetes mellitus--retrospective analysis]

Chronic diabetic complications are the main problems in diabetology causing work unfitness, disability and premature death. Complete and homogenous assessment of diabetic complications is possible in hospitalised patients.

Assessment of the occurrence of chronic diabetic complications and their risk factors in patients with type 1 diabetes mellitus (DMT1).

Retrospective analysis included clinical data from 241 patients admitted to the Department of Metabolic Diseases CMUJ in Krakow, 159 women (age 29.76 +/- 9.7, diabetes duration 10.00 +/- 8.6) and 82 men (age 36.52 +/- 13.4, diabetes duration 11.78 +/- 11.08). We analysed the occurrence and risk factors of diabetic retinopathy, diabetic nephropathy, peripheral and autonomic neuropathy, diabetic foot syndrome and coronary artery disease (CAD). The following risk factors were considered: BMI, diabetic control (HbA, c), lipid profile, hypertension, smoking, alcohol consumption and family occurrence of cardiovascular diseases and diabetes.

The frequency of chronic diabetic complications was as follows: diabetic retinopathy 41.5%, peripheral polyneuropathy 29%, nephropathy 17%, cardiovascular autonomic neuropathy 8.7%, diabetic foot syndrome 8.3% and coronary artery disease 7.1% of patients. Half of retinopathic patients had peripheral polyneuropathy, at the same time retinopathy was the most frequent complication in patients with diabetic foot (90%), CAD (88.1%), nephropathy (85%), polyneuropathy (65.6%) and cardiovascular autonomic neuropathy (71.4%). Diabetic nephropathy was found in 70% with diabetic foot, in 58.7% with CAD, in 52.2% with cardiovascular autonomic neuropathy, in 41.5% with polyneuropathy and in 35% with retinopathy. The presence of diabetic foot was associated with the risk for co-occurrence of all the remaining diabetic complications. In CAD patients microangiopathy was much more frequent than the reverse relationship. All the complications except for CAD were more frequent in men with DMT1. Risk factors that correlated with all chronic diabetic complications were diabetes duration and arterial hypertension. Age, lipid abnormalities, smoking and alcohol consumption, family history were associated with varying degrees of DMT1 complications. In patients with microangiopathy, neuropathy and CAD the following components of metabolic syndrome were found: obesity, hypertension, dyslipidemia implying the contribution of insulin resistance to the pathogenesis of these complications.