Early glycaemic control for maintaining visual function in type 1 diabetes: The Oulu cohort study of diabetic retinopathy.

PURPOSE:: The purpose of this study was to evaluate the visual function and the ophthalmic status of young Finnish adults with long duration of type 1 diabetes in relation to the history of the metabolic control. METHODS:: A population-based cohort of children with type 1 diabetes examined in the Northern Ostrobothnia hospital district in 1989 (n = 216) was re-examined 18 years later. High-contrast visual acuity (best-corrected visual acuity), contrast sensitivity, refractive error, lens status, intraocular pressure, stage of diabetic retinopathy and received treatments were evaluated. The metabolic control was reflected by the mean of glycated haemoglobin A1 or glycated haemoglobin A1c values of the years 1983-1989 and 1992-2007, respectively. RESULTS:: In all, 96 men and 76 women age 30 ± 3 years with type 1 diabetes duration of 23 ± 4 years attended the re-evaluation. About 60% (103/172) had normal best-corrected visual acuity and 3% had low vision. Contrast sensitivity was abnormal in two-thirds. Half had myopia. Four patients had cataract surgery. Low childhood glycated haemoglobin A1 was indicative, and favourable glycated haemoglobin A1c during youth was a significant predictor of better contrast sensitivity and ocular state in adulthood. CONCLUSION:: The majority of the patients have useful vision, although minor functional impairments are commonly detectable. Long duration of type 1 diabetes in association with non-optimal glycaemic control threatens visual function already at young adulthood. Thus, strong emphasis to control diabetes from onset is important in maintaining good visual function.

Social well-being of young adults with type 1 diabetes since childhood. The Oulu cohort study of diabetic retinopathy.

AIM: To evaluate the social performance of young adults with type 1 diabetes (T1D) since childhood with particular interest in its relation to the severity of diabetic retinopathy (DR). METHODS: The prevalence of DR was evaluated in a population-based Finnish cohort of children with T1D during 1989-1990. The subjects were contacted 18 years later for evaluation of DR, education, employment, and family relations. RESULTS: 136 of 216 subjects participated in the study in 2007 (mean age 30 ± 3 years, mean diabetes duration 23 ± 4 years, 78 men). There were 42 subjects (31%) with proliferative diabetic retinopathy (PDR). A university degree was held by 9%, a degree from a university of applied sciences by 33%, and 45% had a vocational school education; 7% were full-time students while 4% had received no education after comprehensive school. PDR was associated with lower education. Sixty percent of the subjects with PDR and 68% of those with non-PDR held full-time jobs. Four percent of the non-PDR group were unemployed while 26% of subjects with PDR were outside working life because of either unemployment or retirement. Seventy-one percent of the subjects had a spouse, and 60 subjects had a total of 119 children. PDR did not compromise the likelihood of having a spouse and children. CONCLUSIONS: The majority of young adults with T1D take active roles in society by working and raising families. However, patients with PDR lacked secondary education significantly more often and were less likely to work than those with non-PDR.

Prevalence of diabetic retinopathy in young adults with type 1 diabetes since childhood: the Oulu cohort study of diabetic retinopathy.

PURPOSE: To evaluate the prevalence and stage of diabetic retinopathy (DR) in a population-based cohort of young Finnish adults who have had type 1 diabetes (T1D) since childhood. MATERIAL AND METHODS: The cohort includes all 5- to 16-year-old patients with T1D who lived in the Northern Ostrobothnia Hospital District of Finland, in 1989 (n = 216). DR was evaluated from fundus photographs taken in 1989-1990 and again in 2007. The patients were 7 ± 4 years age (range 0-15 years) at the time of diagnosis of T1D, and the average duration of diabetes at the re-evaluation was 23 ± 4 years (range 17-32 years). RESULTS: The prevalence of DR was analysed in 172 patients (80% of the original cohort) at 22-35 years. Proliferative DR (PDR) was observed in 35% (60/172) and non-proliferative DR in 59% (101/172), with no signs of DR being present in the remaining 6% (11/172) of the subjects. The prevalence of DR did not differ by gender (p = 0.356). CONCLUSIONS: After the 18-year follow-up, a high prevalence of DR and PDR (94% and 35%, respectively) was found in patients who have had T1D since childhood, with no difference between the genders.

Health-related quality of life--using the 15D instrument--of young adults with type 1 diabetes since childhood. Population-based Oulu cohort study of diabetic retinopathy.

PURPOSE: The aim of this study was to evaluate the health-related quality of life (HRQoL) of young adults with type 1 diabetes (T1D) since childhood using the 15D instrument. The possible impact of diabetic retinopathy (DR) and proliferative diabetic retinopathy (PDR) on the HRQoL was focused on. METHODS: During the years 1989-1990, the prevalence of DR was evaluated from ocular fundus photographs of a population-based cohort of children with T1D living in the Northern Osthrobothnia Hospital District, Finland. These 216 individuals were contacted 18 years later and invited for assessment of the 15D HRQoL as well as current stage of DR. The results were compared with age- and gender-standardized Finnish general population. RESULTS: The 15D data were obtained from 123 patients aged 29±3 years with a duration of diabetes of 23±4 years. The mean 15D score was similar in the patients with T1D and the general population [0.954±0.062 versus 0.964±0.052, respectively (p=0.085)]. However, the subgroup of patients with PDR (N=38) had a statistically significantly lower mean 15D score than those subjects with nonproliferative or no DR [0.931±0.086 versus 0.965±0.044, respectively (p=0.026)]. CONCLUSION: Young adults with T1D since childhood had 15D HRQoL score equal to that of age- and gender-standardized general population as long as no more severe than nonproliferative DR was present. Presence of PDR, not T1D of long duration per se, significantly impaired the 15D score.

Prevalence of retinopathy in Finnish children and adolescents with type 1 diabetes: a cross-sectional population-based retrospective study.

AIM: A population-based study was carried out to evaluate the prevalence and risk factors of diabetic retinopathy (DR) in children with type 1 diabetes (T1D) in The Northern Osthrobothnia Hospital District, Finland. The aim was to compare the current prevalence and the risk factors with those obtained in a study performed in a similar setting 17 years earlier. METHODS AND PATIENTS: The prevalence of DR was evaluated from fundus photographs in a cross-sectional manner in children and adolescents with T1D (n=297) living in the Northern Osthrobothnia Hospital District on 1 January 2007. RESULTS: The prevalence of DR was 7.6% (12/158) in males and 16.5% (23/139) in females in the present study and 7.3% in males and 12.9% in females in the former study. The mean age of the patients was 11.9 and 11.8 years, and the mean duration of diabetes was 4.9 and 5.0 years in the present and the former study, respectively. DR was associated with older age (p<0.001), longer duration of diabetes (p<0.001), higher glycated haemoglobin A1c (GHbA1c) (9.3% in those with DR vs 8.3% in those without DR, p=0.001, or 78 vs 67 mmol/mol, respectively) and female sex (p=0.016); in a logistic regression analysis, these factors explained 35% of DR. These risk factors are essentially the same as identified in the cohort 17 years earlier. GHbA1c levels had not significantly improved during that time. CONCLUSIONS: The overall prevalence of DR among children with T1D was 11.8% (35/297) showing no decrease over the past 17 years; in girls, DR was diagnosed more often in the present than in the former study, but there was no change in the prevalence among the boys. Glycaemic control had remained unchanged.