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Certain factors may prevent complications in diabetes veterans
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Patients who have lived with type 1 diabetes for decades but have experienced few negative effects may hold the key to staving off complications associated with the disease, researchers said.
“Studies evaluating diabetic patients over 20 to 30 years have identified complication risk factors, including worse glycemic control, longer diabetes duration, hypertension and hyperlipidemia,” researchers at the Joslin Diabetes Center in Boston wrote in Diabetes Care. “However, other than glycemic and systemic control, no clinical or biochemical factors have conclusively been shown to protect against long-term complications.”
To investigate potential protective factors in patients with diabetes, the researchers performed a cross-sectional, observational study of 351 US residents who had type 1 diabetes for at least 50 years. All were included in the Joslin Medalist Study and are commonly referred to as Joslin Medalists. The researchers analyzed the prevalence of retinopathy, nephropathy and cardiovascular disease in relation to HbA1c levels, lipids and advanced glycation end products.
Patients’ mean age was 67.5 years and mean duration of diabetes was 56.5 years. The average HbA1c level was 7.3%, with an average HDL level of 1.63 mmol/L and LDL level of 2.22 mmol/L. The researchers also identified human leukocyte antigen DR3 and DR4 risk alleles in 90.8% of patients and random C-peptide levels of more than 0.13 nmol/L in 6% of patients.
Results indicated that many patients did not experience the specified outcomes, with 42.6% remaining free from proliferative diabetic retinopathy; 86.9% from nephropathy; 39.4% from neuropathy; and 51.5% from CVD. In addition, of the patients whose retinopathy did not worsen after 17 years of follow-up, 96% still had not experienced progression after at least 50.4 years of follow-up.
The researchers noted discrepancies between factors associated with complications of diabetes after 50 years and those associated with complications during shorter duration of disease. Glycemic control and systolic and diastolic blood pressure, for instance, were not linked to any complications experienced by Medalists. However, Medalists with high plasma levels of the advanced glycation end products carboxyethyl-lysine and pentosidine were 7.2-fold more likely to have any complication, the researchers said. Nevertheless, none of the patients with low levels of these products combined with high carboxymethyl-lysine and fructose-lysine levels progressed to proliferative diabetic retinopathy.
“Insights from the Medalist Study are great motivators for patients who have just been diagnosed with diabetes or are early in the disease, particularly young kids and adolescents,” Jennifer K. Sun, MD, one of the study researchers, said in a press release. “We can tell these patients that we encourage them to control their blood sugars and get their recommended diabetes care because they can live many decades with excellent vision and the chance to avoid other severe complications.”
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Disclosure: Dr. Sun reports no relevant financial disclosures.
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