Control glucémico y complicaciones crónicas a 20 años del comienzo de la diabetes tipo 1. Resultados de una unidad especializada

Objectives: To determine the prevalence of chronic complications in a group of patients with long duration type 1 diabetes (DM1), and their relationship with glycemic control since diagnosis of disease, as well as control and prevalence of cardiovascular risk factors (CVRF). Material and methods: The study included patients diagnosed in our center between 1985 and 1994 and followed-up until the present. Anthropometric data, glycemic control, chronic complications, and CVRF were collected from medical records at baseline and annually. A visit was made that included a physical examination and complete blood analysis. Results: A total of 77 patients were studied (46 males, and mean age 47 +/- 8.5 years, duration of follow-up, 22.4 +/- 2.2 years). Sixteen patients (20.4%) developed retinopathy, 8 (10.4%) nephropathy, 12 (15.6%) polyneuropathy, and 3 (3.9%) macroangiopathy. Hypertension, dyslipidemia and obesity were found in 28.6%, 46.8% and 20.8%, respectively, and 22.1% were sedentary, and 35.1% were smokers. Mean glycosylated hemoglobin (HbA1c) during the entire follow-up was 7.2 +/- 0.8%. In the first five years it was 6.4 +/- 1.2% and at the study visit, it was 7.6 +/- 1.1%. More than two-thirds (70%) of patients remained on target in the first five years, with 45% in the next five years, and about 25% from years 10 to 22. Patients with no complications showed better glycemic control during the entire follow-up (HbA1c 7.0 +/- 0.7% vs. 7.6 +/- 0.9%; P=.003), and also in the first five years (HbA1c 6.1 +/- 0.9 vs. 7.0 1.4%; P=.001). Conclusion: Prevalence of complications after 20 years of follow-up in well controlled DM1 since diagnosis is low, and is related to the overall glycemic control during follow-up and in the early years of the disease. The prevalence of smoking is high. (C) 2014 Sociedad Espanola de Diabetes. Published by Elsevier Espana, S.L.U. All rights reserved.