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HbA(1c) level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study

Journal article
Authors Marcus Lind
A. Pivodic
Ann-Marie Svensson
Arndis Olafsdottir
Hans Wedel
J. Ludvigsson
Published in Bmj-British Medical Journal
Volume 366
ISSN 1756-1833
Publication year 2019
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics
Language en
Links dx.doi.org/10.1136/bmj.l4894
Keywords retinal function, glycemic control, complications, progression, consensus, hba1c, General & Internal Medicine
Subject categories Endocrinology and Diabetes

Abstract

OBJECTIVE To evaluate if the lowest target level for glycated haemoglobin (HbA(1c)) of < 6.5% is associated with lower risk for retinopathy and nephropathy than less tight control in children and adults with type 1 diabetes. Swedish National Diabetes Registry, 1 January 1998 to 31 December 2017. 10 398 children and adults with type 1 diabetes followed from diagnosis, or close thereafter, until end of 2017. Relative risk (odds ratios) for retinopathy and nephropathy for different mean levels of HbA(1c). Mean age of participants was 14.7 years (43.4% female), mean duration of diabetes was 1.3 years, and mean HbA(1c) level was 8.0% (63.4 mmol/mol). After adjustment for age, sex, duration of diabetes, blood pressure, blood lipid levels, body mass index, and smoking, the odds ratio for mean HbA(1c) < 6.5% (< 48 mmol/mol) compared with 6.5-6.9% (48-52 mmol/mol) for any retinopathy (simplex or worse) was 0.77 (95% confidence interval 0.56 to 1.05, P=0.10), for preproliferative diabetic retinopathy or worse was 3.29 (0.99 to 10.96, P=0.05), for proliferative diabetic retinopathy was 2.48 (0.71 to 8.62, P=0.15), for microalbuminuria or worse was 0.98 (0.60 to 1.61, P=0.95), and for macroalbuminuria was 2.47 (0.69 to 8.87, P=0.17). Compared with HbA(1c) levels 6.56.9%, HbA(1c) levels 7.0-7.4% (53-57 mmol/mol) were associated with an increased risk of any retinopathy (1.31, 1.05 to 1.64, P=0.02) and microalbuminuria (1.55, 1.03 to 2.32, P=0.03). The risk for proliferative retinopathy (5.98, 2.10 to 17.06, P<0.001) and macroalbuminuria (3.43, 1.14 to 10.26, P=0.03) increased at HbA(1c) levels > 8.6% (> 70 mmol/mol). The risk for severe hypoglycaemia was increased at mean HbA(1c) < 6.5% compared with 6.5-6.9% (relative risk 1.34, 95% confidence interval 1.09 to 1.64, P=0.005). Risk of retinopathy and nephropathy did not differ at HbA(1c) levels < 6.5% but increased for severe hypoglycaemia compared with HbA(1c) levels 6.5-6.9%. The risk for severe complications mainly occurred at HbA(1c) levels > 8.6%, but for milder complications was increased at HbA(1c) levels > 7.0%.

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