Prediction of retinopathy at 20 years after onset in younger-onset type 1 diabetes usingmeanmetabolic memory-free HbA1c Values: The importance of using HbA1c data of total, not partial, diabetes duration

摘要

Objective - Metabolic memory, in which past hyperglycemia could affect future retinopathy, is a potential issue in studying the relationship between glycemia and retinopathy. We examined retrospectively if mean "metabolic memory-free" glycosylated hemoglobin A1C (HbA1c) values covering total diabetes duration could predict retinopathy in younger-onset type 1 diabetes mellitus (T1DM). Research Design and Methods - Inclusion criteria were T1DM onset before age 30 years, first visit to our center between 1988 and 1990 soon after onset, continuous HbA1c data for 20 years, and a 20-year follow-up retinopathy examination. Retinopathy predictive capabilities of HbA1c variables were examined. Results - Of 15 subjects, 5 were retinopathy-positive and 10 were retinopathy-negative at the 20-year follow-up. Mean metabolic memory-free HbA1c values for the 20 years showed a substantial capacity to predict retinopathy at 20 years. The longer the period without HbA1c data following onset in simulation, the less accurate the prediction. Conclusions - HbA1c values may predict retinopathy better if metabolic memory-free data are used.