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J.M. Coney, C.E. Brathwaite, A. Doria, R. Jager, N. Timothy, L.P. Aiello, G.L. King; Evaluation of Insulin Dependent Diabetic Patients with more than Fifty Years of Diabetes. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4119.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To identify clinical characteristics associated with long term survival in patients with Type 1 diabetes without significant vascular complications. Methods: An extensive questionnaire was sent to all known Type 1 diabetic patients in the United States with at least 50 yrs of diabetes (N=504). Each patient was evaluated for micro– and macro–vascular complications. Results:75% (378) of recipients responded. Mean age was 69.6±8.1 yrs, 53% were female, and mean duration of diabetes was 57.2±5.6 yrs. Diabetic retinopathy was reported in 44.2% of patients, of whom 49.7% reported laser photocoagulation and 15.3 % pars plana vitrectomy. Diabetic neuropathy was reported in 49.0%, of whom 27.5% reported ulcers and 11.3% amputations. Only 5.5% reported any diabetes–related kidney complications, whereas 33.7% reported heart problems. Patients reporting retinopathy were 1.6 times more likely to report cardiac disease and 2.2 times more likely to report kidney complications. Of the 163 patients analyzed to date, 25% (41 of 163) of the patients did not report any micovascular complications of which 77% (30 of 39) of these patients reported a HbA1c ≤7.5%. 47% (7of 15) of all patients with a HbA1c <6.0% were complication free, while 25% (15 of 60) in the 7–8% range, and 21% (7 of 33) when >8% were complication free. Complication–free individuals were 2.7 times more likely to report "excellent" (versus "good", "fair," or "poor") diabetes control (95% Cl 1.4–5, p=0.001). Overall mean parental age at death was 77.6+13.11 years, and 77.5±13.2 and 76.7+ 12.7 (p=0.5) for all patients and those with and without microvascular complications, respectively. This is similar when compared to the USA general life expectancy which was 75.3 yrs. in 1993 and 76.9 yrs in 2000. Conclusions:Long term survival without retinopathy and other microvascular complications in type 1 diabetes is partly associated with good glycemic control, and not related to familial longevity genes. However, unknown factors not related to glycemic control may also be important since a significant number of diabetic patients with poor glycemic control were also complication free. CR: Lion Eye
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