title: Major diabetes-related vascular events do not improve glycaemic control in a population-based cohort of type 1 diabetic individuals.
abstract: OBJECTIVE
  It is known that sudden serious events alter life styles related to treatment efficiency, as for example in cancer patients. However, it has not been specifically addressed if a first-time diabetes-related clinical event has impact on glycaemic regulation. We therefore assessed this in a population-based cohort of patients with long-term type 1 diabetes.
  
  
  METHODS
  This study was based on a cohort of type 1 diabetes patients with at least 20 years duration of diabetes. Of the 460 patients from the original cohort still alive at 1 January 1994, all patients with a major first-time diabetes-related clinical event (limb amputation, blindness, stroke, cardiac event, or panretinal photocoagulation) and glycated haemoglobin (HbA(1c)) measurements before, 3 and/or 12 months after the event were included. Differences in HbA(1c) measurements before and after the event were tested with Wilcoxon's test.
  
  
  RESULTS
  A total of 64 patients with a major clinical event between 1994 and 2006 entered the study. Mean HbA(1c) measurements decreased from 8.8% at baseline to 8.6% at 3 months and 8.7% after 12 months, a non-significant decrease. In all event groups, glycaemic regulation was unaltered in the majority of the patients. Only a minority worsened or improved their regulation, and in all groups only non-significant changes were seen.
  
  
  CONCLUSIONS
  Surprisingly, complication-related events did not improve glycaemic regulation in long-term type 1 diabetes patients. This is in contrast with the experience from other patient categories and shows how difficult it can be to alter glycaemic regulation in diabetes patients with stabilized disease.
authors.affiliation: Department of Biochemistry, Pharmacology and Genetics, Odense University Hospital, Sdr. Boulevard 29, Odense, Denmark.
authors.forename: Trine Maria Mejnert
authors.initials: TM
authors.lastname: Jørgensen
authors.forename: Jakob
authors.initials: J
authors.lastname: Grauslund
authors.forename: Anne Katrin
authors.initials: AK
authors.lastname: Sjølie
authors.forename: Anders
authors.initials: A
authors.lastname: Green
authors.forename: Lars Melholt
authors.initials: LM
authors.lastname: Rasmussen
authors.forename: Mads
authors.initials: M
authors.lastname: Nybo
mesh_terms: D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged
chemical_list: D006442:Glycated Hemoglobin