title: Predictors of microvascular complications in type 1 diabetic patients at onset: the role of metabolic memory.
abstract: BACKGROUND
  Several epidemiological studies showed a close association between metabolic control and microvascular complications in type 1 Diabetes Mellitus (T1DM). The aim of our longitudinal observational study was to evaluate the predictive role of the main clinical and biochemical parameters in determining microvascular complications.
  
  
  METHODS
  376 T1DM patients, hospitalized in our division from 1991 to 2005 (mean follow-up=10.93±4.26 years) were studied. Stepwise Cox regression analysis was used to identify the influence of residual ß-cell function, ß-cell autoimmunity, HbA1c levels and other clinical and laboratory parameters in the development of microalbuminuria and retinopathy.
  
  
  RESULTS
  The probability of developing microalbuminuria was higher in males than in females (HR 1.82; 95% CI 1.01-3.28; p=0.044), in patients with higher mean HbA1c values (HR 2.80; 95% CI 1.63-4.83; p<0.001), longer duration of disease (HR 1.98; 95% CI 1.10-3.57; p=0.022) and younger age of diabetes onset (HR 0.53; 95% CI 0.03-0.92; p=0.026). An increased probability of developing retinopathy was found in patients with higher mean HbA1c levels during follow-up (HR 2.35; 95% CI 1.34-4.12, p=0.003), as well as at onset (HR 1.85; 95% CI 1.06-3.24; p=0.030).
  
  
  CONCLUSIONS
  Our study suggests that among the clinical, metabolic, immunological and biochemical factors evaluated at onset, only HbA1c is predictive for the microangiopathy development in T1DM.
authors.affiliation: Section of Endocrinology, Centro di Riferimento Regionale per la Diagnosi e Cura delle Endocrinopatie Autoimmuni e del Diabete di Tipo 1, Dipartimento di Medicina Interna e Medicina Sperimentale (DIBIMIS), Università degli Studi di Palermo, Italy. cgiordan@unipa.it
authors.forename: Carla
authors.initials: C
authors.lastname: Giordano
authors.forename: Marco Calogero
authors.initials: MC
authors.lastname: Amato
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ciresi
authors.forename: Roberto
authors.initials: R
authors.lastname: Citarrella
authors.forename: Lucilla
authors.initials: L
authors.lastname: Mantione
authors.forename: Maria
authors.initials: M
authors.lastname: Accidenti
authors.forename: Felicia
authors.initials: F
authors.lastname: Pantò
authors.forename: Valentina
authors.initials: V
authors.lastname: Guarnotta
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Allotta
authors.forename: Angela
authors.initials: A
authors.lastname: Criscimanna
authors.forename: Aldo
authors.initials: A
authors.lastname: Galluzzo
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000419:Albuminuria / Q000453:epidemiology / Q000276:immunology / Q000378:metabolism; D001323:Autoantibodies / Q000097:blood; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000276:immunology / Q000378:metabolism*; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000378:metabolism*; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000276:immunology / Q000378:metabolism; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000276:immunology / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D050417:Insulin-Secreting Cells / Q000276:immunology / Q000378:metabolism; D008137:Longitudinal Studies; D008297:Male; D008833:Microcirculation / Q000502:physiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human