title: Decreasing incidence of severe diabetic microangiopathy in type 1 diabetes.
abstract: OBJECTIVE
  Conflicting evidence of a decline in incidence of microvascular complications in type 1 diabetes during the last decades has been reported. To assess recent trends in the cumulative incidence of diabetic microangiopathy in type 1 diabetes, we analyzed data from long-term prospective observational studies lasting >/=20 years.
  
  
  METHODS
  A total of 600 Caucasian patients with onset of type 1 diabetes between 1965 and 1984 were followed until death or until the year 2000. Patients were divided into four groups based on the year of diabetes onset: group A, 1965-1969 (n = 113); group B, 1970-1974 (n = 130); group C, 1975-1979 (n = 113); and group D, 1979-1984 (n = 244). Group A, B, and C are prevalence cohorts identified in 1984; group D is an inception cohort.
  
  
  RESULTS
  In patients followed for >/=20 years, the cumulative incidence (95% CI) of diabetic nephropathy after 20 years of diabetes (urinary albumin excretion >300 mg/24 h) was reduced in patients with more recent diabetes onset (groups A-D): 31.1% (22.5-39.7) vs. 28.4% (19.8-37.0) vs. 18.9% (10.9-26.9) vs. 13.7% (6.2-21.2) (P = 0.015). Similarly, the cumulative incidence of proliferative retinopathy was as follows: 31.2% (22.2-39.8) vs. 30.3% (22.2-38.4) vs. 19.3% (11.2-27.4) vs. 12.5% (5.2-19.8) (P < 0.01). In the latter groups, antihypertensive treatment was started earlier, blood pressure and HbA(1c) were lower, and fewer patients smoked.
  
  
  CONCLUSIONS
  Our study demonstrates a decrease in the cumulative incidence of diabetic microangiopathy in type 1 diabetes over the past 35 years. Improved glycemic control, lower blood pressure (in part due to early aggressive antihypertensive treatment), and reduced prevalence of smoking rates were associated with the improved prognosis.
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark. phovind@dadlnet.dk
authors.forename: Peter
authors.initials: P
authors.lastname: Hovind
authors.forename: Lise
authors.initials: L
authors.lastname: Tarnow
authors.forename: Kasper
authors.initials: K
authors.lastname: Rossing
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.forename: Stefanie
authors.initials: S
authors.lastname: Eising
authors.forename: Nicolai
authors.initials: N
authors.lastname: Larsen
authors.forename: Christian
authors.initials: C
authors.lastname: Binder
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
mesh_terms: D000368:Aged; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D044465:White People