Risk factors for necrobiosis lipoidica in Type 1 diabetes mellitus.
To compare the clinical and metabolic characteristics of patients with Type 1 diabetes and necrobiosis lipoidica with those of patients with Type 1 diabetes who do not have necrobiosis lipoidica. A multicentre analysis was performed.



Clinical and laboratory data were obtained from 64 133 patients (aged 0-25 years) with Type 1 diabetes with and without necrobiosis lipoidica who were registered in the German/Austrian Diabetes Prospective Documentation Initiative registry. Data were analysed using multivariable regression modelling. Age, diabetes duration, treatment year and sex were considered as confounding factors.



Results adjusted for demographic variables are presented. In patients with necrobiosis lipoidica, metabolic control was worse (HbA1c72 vs. 67 mmol/mol, 8.7% vs. 8.3%; P = 0.0065) and the duration of diabetes was longer [6.24 (3.28-9.97) vs. 5.11 (2.08-8.83) years; P = 0.014; not adjusted]. Patients with necrobiosis lipoidica required higher insulin doses than those without (1.02 vs. 0.92 U/kg/day; P < 0.0001). There was no significant difference in the frequency of microvascular complications (microalbuminuria and retinopathy) between the groups. Furthermore, 24.8% and 17.5% of patients with Type 1 diabetes with and without necrobiosis lipoidica, respectively, had elevated thyroid antibodies (P = 0.051). Necrobiosis lipoidica was correlated with coeliac disease in patients with Type 1 diabetes (3.4% vs. 1.0%; P = 0.0035).



Our data indicate a strong correlation between hyperglycaemia and the development of necrobiosis lipoidica. We postulate that the underlying pathogenic processes differ from those leading to microalbuminuria and retinopathy, and additional immunological mechanisms may play a role.
Department of Paediatrics, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany.
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Hammer
Department of Paediatrics, University of Bochum, Bochum, Germany.
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Lilienthal
Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria.
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Hofer
Department of Paediatrics, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany.
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Schulz
Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
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Bollow
Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.|German Centre for Diabetes Research (DZD), Neuherberg, Germany.
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Holl
D000293:Adolescent; D001317:Austria / Q000453:epidemiology; D002446:Celiac Disease / Q000150:complications / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D009335:Necrobiosis Lipoidica / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human