Long-term prognosis of type 1 diabetes in relation to the clinical characteristics at the onset of diabetes

摘要

Introduction It is known that age, the degree of glycemic deterioration and the immune status at the time of the onset of type 1 diabetes (T1DM) are objective factors that can predict the residual B-cell function and the glycemic control 1 year after diagnosis. Objective: Evaluation of the long-term prognosis of T1DM in relation to the clinical characteristics at the time of diabetes onset. Methods: An observational retrospective study conducted on 200 patients including all the patients with newly diagnosed T1DM in the period from 2003 to 2013. Results: Fifty-three percent of the studied cohort presented initially by diabetic ketoacidosis (DKA). The current studied cohort showed that younger patients required more insulin during follow-up. Female patients needed higher insulin doses at 8 and 10 years after diagnosis, yet no difference among both genders during early years of follow up. Patients presenting with DKA required higher insulin requirements over the first 2 years and poor glycemic control. C-peptide levels at diagnosis correlated with insulin requirements during the first 2 years. Insulin dose at onset correlated positively with the insulin dose over the entire follow up period. A positive correlation was found between HbA1c at onset and 1, 2 and 4 year. Conclusion: Female gender, younger age, presence of DKA, lower C-peptide and higher HbA1c at onset could predict a poor long-term outcome. Identification of factors related to a worse outcome of T1DM at the onset of diabetes might help in selecting those patients who should be given more intensive treatment.