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A Zebrafish Model of Diabetes Mellitus and Metabolic Memory
Published on: February 28, 2013
Long-term study of mortality and vascular complications in juvenile-onset (type I) diabetes
Insights
This study followed 372 children with insulin-dependent diabetes for 26 years. Long-term diabetes complications, including retinopathy, proteinuria, and hypertension, significantly increased over time.
Area of Science:
- Pediatrics
- Endocrinology
- Diabetology
Background:
- Long-term outcomes for childhood-onset diabetes are crucial for understanding disease progression.
- Standardized treatment protocols were applied consistently over decades, allowing for reliable data analysis.
Purpose of the Study:
- To assess the long-term mortality and complication rates in a cohort of children with insulin-dependent diabetes.
- To evaluate the incidence of major diabetic complications such as retinopathy, proteinuria, and hypertension over a 26-year follow-up period.
Main Methods:
- A cohort of 372 children diagnosed with insulin-dependent diabetes before age 16 between 1949 and 1960 was followed until 1976.
- Standardized treatment involving daily insulin adjustments, clinical assessment, and regular urine tests for sugar and ketones was administered.
- Actuarial methods were used to compute mortality and complication rates.
Main Results:
- Over 26 years, 26 deaths occurred, with 16 directly linked to diabetes.
- After 16 years, complication rates were: proteinuria (4%), hypertension (2.1%), and retinopathy (27%, including 1.5% proliferative).
- After 26 years, complication rates increased to: proteinuria (14%), hypertension (16%), and retinopathy (85%, including 18% proliferative).
Conclusions:
- Childhood-onset insulin-dependent diabetes is associated with a significant risk of severe long-term complications.
- The incidence of diabetic retinopathy, proteinuria, and hypertension escalates substantially over decades of follow-up.
- Consistent, standardized treatment over extended periods reveals a progressive burden of diabetic microvascular and macrovascular complications.
Abstract:
A cohort of 372 insulin-dependent diabetic children, diagnosed between October 1949 and December 1960, were followed-up until December 1976 by the same team of physicians. At the time of diagnosis all patients were under 16 yr of age and were given standardized treatment which did not change from 1949 to 1976. The therapy consisted of daily insulin adjustment based on clinical assessment, the degree of physical activity, and the results of semi-quantitative urine tests for sugar and ketone bodies. These tests were systematically performed before breakfast, lunch, and dinner. Diet was normal, unmeasured, rich in carbohydrates (approximately 60%), and quantitatively unrestricted unless the patient was overweight. Rates for mortality and for the principal complications among this cohort were computed by the actuarial method. During the 26 yr of study, 26 deaths occurred, 16 of which were directly connected with diabetes. After 16 yr of follow-up, rates of proteinuria and hypertension were 4% and 2.1% respectively. The incidence of retinopathy reached 27%, including 1.5% proliferative retinopathy. After 26 yr, the rates rose to 14% for proteinuria, 16% for hypertension, and 85% for retinopathy, including 18% in the proliferative phase.
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