Ketoacidosis at diagnosis in childhood-onset diabetes and the risk of retinopathy 20 years later

Silvana Salardi, Massimo Porta, Giulio Maltoni, Franco Cerutti, Silvia Rovere, Dario Iafusco, Stefano Tumini, Vittoria Cauvin, Stefano Zucchini, Francesco Cadario, Giuseppe Dannunzio, Sonia Toni, Alessandro Salvatoni, Maria Antonietta Zedda, Riccardo Schiaffini

Research output: Contribution to journalArticle

Abstract

Aims To investigate on the relationship between severity of ketoacidosis, an important risk factor for C-peptide preservation, and long-term microvascular complications in childhood-onset type 1 diabetes mellitus (T1DM). Methods 230 childhood-onset diabetic patients (177 pre-pubertal), aged 7.0 ± 3.8 years followed for at least 15 years after their diagnosis, were enrolled. Clinical and laboratory data at diagnosis, and C-peptide levels in a subset of patients, were compared with the severity of retinopathy and nephropathy, after a mean of 19.6 ± 3.8 years of disease. Digital retinal photographs were taken in all patients, and centrally graded. Repeated measurements of HbA1c and microalbuminuria for the whole duration of diabetes were collected in over half of the cases. Results Out of 230 patients, those with the lowest age at diagnosis had the most severe DKA and clinical conditions (p <0.05), and lower C-peptide levels (p <0.0001) at diagnosis. There was a significant relationship between pH and clinical severity (r = - 0.783, p <0.0001), and between pH and C-peptide levels (r = 0.278, p <0.05). The severity of ketoacidosis had no relationship with subsequent lifetime HbA1c values and long-term microvascular complications. In logistic regression analysis, the only variables that independently influenced severity of retinopathy were lifetime HbA1c (B = 0.838, p <0.001), duration of disease (B = 0.208, p <0.005) and age at diagnosis (B = 0.116, p <0.05). Conclusions The degree of metabolic derangement at diagnosis is not associated with retinopathy and nephropathy in childhood-onset T1DM. Age at diagnosis seems to be an important variable to be considered when evaluating the long-term effects of residual beta-cell function.

Original languageEnglish
Pages (from-to)55-60
Number of pages6
JournalJournal of Diabetes and its Complications
Volume30
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

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Ketosis
C-Peptide
Type 1 Diabetes Mellitus
Logistic Models
Regression Analysis

Keywords

  • C-peptide
  • childhood-onset diabetes
  • HbA1c
  • ketoacidosis
  • nephropathy
  • retinopathy

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

Ketoacidosis at diagnosis in childhood-onset diabetes and the risk of retinopathy 20 years later. / Salardi, Silvana; Porta, Massimo; Maltoni, Giulio; Cerutti, Franco; Rovere, Silvia; Iafusco, Dario; Tumini, Stefano; Cauvin, Vittoria; Zucchini, Stefano; Cadario, Francesco; Dannunzio, Giuseppe; Toni, Sonia; Salvatoni, Alessandro; Zedda, Maria Antonietta; Schiaffini, Riccardo.

In: Journal of Diabetes and its Complications, Vol. 30, No. 1, 01.01.2016, p. 55-60.

Research output: Contribution to journalArticle

Salardi, S, Porta, M, Maltoni, G, Cerutti, F, Rovere, S, Iafusco, D, Tumini, S, Cauvin, V, Zucchini, S, Cadario, F, Dannunzio, G, Toni, S, Salvatoni, A, Zedda, MA & Schiaffini, R 2016, 'Ketoacidosis at diagnosis in childhood-onset diabetes and the risk of retinopathy 20 years later', Journal of Diabetes and its Complications, vol. 30, no. 1, pp. 55-60. https://doi.org/10.1016/j.jdiacomp.2015.10.009
Salardi, Silvana ; Porta, Massimo ; Maltoni, Giulio ; Cerutti, Franco ; Rovere, Silvia ; Iafusco, Dario ; Tumini, Stefano ; Cauvin, Vittoria ; Zucchini, Stefano ; Cadario, Francesco ; Dannunzio, Giuseppe ; Toni, Sonia ; Salvatoni, Alessandro ; Zedda, Maria Antonietta ; Schiaffini, Riccardo. / Ketoacidosis at diagnosis in childhood-onset diabetes and the risk of retinopathy 20 years later. In: Journal of Diabetes and its Complications. 2016 ; Vol. 30, No. 1. pp. 55-60.
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AU - Porta, Massimo

AU - Maltoni, Giulio

AU - Cerutti, Franco

AU - Rovere, Silvia

AU - Iafusco, Dario

AU - Tumini, Stefano

AU - Cauvin, Vittoria

AU - Zucchini, Stefano

AU - Cadario, Francesco

AU - Dannunzio, Giuseppe

AU - Toni, Sonia

AU - Salvatoni, Alessandro

AU - Zedda, Maria Antonietta

AU - Schiaffini, Riccardo

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N2 - Aims To investigate on the relationship between severity of ketoacidosis, an important risk factor for C-peptide preservation, and long-term microvascular complications in childhood-onset type 1 diabetes mellitus (T1DM). Methods 230 childhood-onset diabetic patients (177 pre-pubertal), aged 7.0 ± 3.8 years followed for at least 15 years after their diagnosis, were enrolled. Clinical and laboratory data at diagnosis, and C-peptide levels in a subset of patients, were compared with the severity of retinopathy and nephropathy, after a mean of 19.6 ± 3.8 years of disease. Digital retinal photographs were taken in all patients, and centrally graded. Repeated measurements of HbA1c and microalbuminuria for the whole duration of diabetes were collected in over half of the cases. Results Out of 230 patients, those with the lowest age at diagnosis had the most severe DKA and clinical conditions (p <0.05), and lower C-peptide levels (p <0.0001) at diagnosis. There was a significant relationship between pH and clinical severity (r = - 0.783, p <0.0001), and between pH and C-peptide levels (r = 0.278, p <0.05). The severity of ketoacidosis had no relationship with subsequent lifetime HbA1c values and long-term microvascular complications. In logistic regression analysis, the only variables that independently influenced severity of retinopathy were lifetime HbA1c (B = 0.838, p <0.001), duration of disease (B = 0.208, p <0.005) and age at diagnosis (B = 0.116, p <0.05). Conclusions The degree of metabolic derangement at diagnosis is not associated with retinopathy and nephropathy in childhood-onset T1DM. Age at diagnosis seems to be an important variable to be considered when evaluating the long-term effects of residual beta-cell function.

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