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Contribution of diabetes duration before puberty to development of microvascular complications in IDDM subjects
J N Kostraba1, J S Dorman, T J Orchard
1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh School of Medicine.
Insights
The duration of diabetes after puberty significantly impacts microvascular complications and mortality. Prepubertal diabetes duration appears to have minimal long-term effects on overall prognosis.
Area of Science:
- Endocrinology
- Diabetology
- Public Health
Background:
- Diabetes duration is a key factor in complication development.
- The impact of prepubertal versus postpubertal diabetes duration requires further clarification.
Purpose of the Study:
- To investigate the distinct contributions of pre- and postpubertal diabetes duration to microvascular complications and mortality.
- To compare complication rates based on age at diagnosis (prepubertal vs. pubertal onset).
Main Methods:
- Life-table analyses were performed on three distinct study populations from the Children's Hospital of Pittsburgh Insulin-Dependent Diabetes Mellitus (IDDM) Registry.
- Subjects were categorized based on IDDM onset before or during puberty (girls ≤11 yr, boys ≤12 yr).
- Prevalence of microvascular complications (retinopathy, nephropathy) and diabetes-related mortality were assessed.
Main Results:
- In adult subjects, a higher prevalence of retinopathy and nephropathy was observed in those diagnosed during puberty compared to before puberty.
- However, analyses based solely on postpubertal duration did not reveal significant differences in complication prevalence.
- Adolescent analyses showed a similar trend for retinopathy, and mortality risk was more accurately predicted by postpubertal duration.
Conclusions:
- Postpubertal duration of Insulin-Dependent Diabetes Mellitus (IDDM) is a more critical determinant of microvascular complications and mortality than total duration.
- The contribution of prepubertal diabetes duration to long-term prognosis appears to be minimal.
Abstract:
The contribution of diabetes duration, both pre- and postpuberty, to the development of microvascular complications and mortality in diabetic subjects was investigated in three study populations from the Children's Hospital of Pittsburgh Insulin-Dependent Diabetes Mellitus (IDDM) Registry. Life-table analyses by total and postpubertal IDDM duration were used to evaluate differences in the prevalence of microvascular complications and diabetes-related mortality in subjects diagnosed before and during puberty, as defined by an age at IDDM onset marker of 11 yr for girls and 12 yr for boys. The prevalence of retinopathy and overt nephropathy in 552 White adult diabetic subjects (population 1, mean IDDM duration 20.8 yr was significantly greater in subjects diagnosed during puberty compared with those diagnosed before puberty. However, similar analyses by postpubertal duration showed no difference in microvascular complication prevalence between the two groups. These findings did not appear to be due to a confounding effect of age. Additional analyses of 239 adolescent diabetic subjects (population 2, mean duration 8.3 yr) revealed the same trend for the prevalence of retinopathy. Finally, results concerning the risk of diabetes-related mortality in a cohort of 1582 subjects (population 3, mean duration 12.9 yr) indicated that postpubertal duration of IDDM may be a more accurate determinant of the development of microvascular complications and diabetes-related mortality than total duration, and it is suggested that the contribution of the prepubertal years of diabetes to long-term prognosis may be minimal.