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Higher age at onset of type 1 diabetes increases risk of macular oedema
Author(s) -
Hietala Kustaa,
Forsblom Carol,
Summanen Paula,
Groop PerHenrik
Publication year - 2013
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2012.02522.x
Subject(s) - medicine , type 2 diabetes , ophthalmology , diabetes mellitus , age of onset , pediatrics , disease , endocrinology
. Purpose: To investigate whether age at onset of type 1 diabetes is a risk factor for clinically significant macular oedema (CSME). Methods: A sample of 1354 patients with a mean duration of diabetes 24.6 ± 11.6 years was drawn from the FinnDiane Study population and divided into age at onset groups 0–4 ( n = 184), 5–14 ( n = 662) and 15–40 years ( n = 508). Type 1 diabetes was defined as age at onset ≤40 years, C‐peptide negativity and insulin treatment initiated within 1 year of diagnosis. Retinopathy status was assessed from fundus photographs and stereoscopic fundus examinations and graded with the ETDRS scale. Results: After 30 years of diabetes, the estimated cumulative incidences of CSME were 17% (95% CI 11–26) in age at onset group 0–4 years, 27% (95% CI 23–32) in age at onset group 5–14 years and 34% (95% CI 27–41) in age at onset group 15–40 years (p = 0.002, Gray’s test). In a competing risks regression model, adjusted for covariates selected with Bayesian information criteria, age at onset 5–14 years (HR 1.89 [95% CI 1.22–2.91], p = 0.004), and age at onset 15–40 years (HR 3.72 [95% CI 2.35–5.89], p < 0.0001), were significant overall risk factors for CSME (p < 0.0001). Higher ETDRS score (HR 1.04 ([95% CI 1.03–1.05], p < 0.0001), HbA 1c (HR 1.12 [95% CI 1.02–1.23], p = 0.016), and total cholesterol (HR 1.19 [95% CI 1.04–1.37], p = 0.013) also increased the risk of CSME. Conclusions: Higher age at onset of type 1 diabetes is a significant risk factor for macular oedema. This suggests that ageing may modify the risk of retinopathy in type 1 diabetes.