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Tytuł:
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Visit-to-visit variability of clinical risk markers in relation to long-term complications in type 1 diabetes.
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Autorzy:
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Rotbain Curovic V; Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Theilade S; Steno Diabetes Center Copenhagen, Gentofte, Denmark.; Department of Medicine, Herlev-Gentofte Hospital, Herlev, Denmark.
Winther SA; Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Tofte N; Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Tarnow L; Steno Diabetes Center Sjaelland, Holbaek, Denmark.
Jorsal A; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Parving HH; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.
Persson F; Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Hansen TW; Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Rossing P; Steno Diabetes Center Copenhagen, Gentofte, Denmark.; University of Copenhagen, Copenhagen, Denmark.
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Źródło:
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Diabetic medicine : a journal of the British Diabetic Association [Diabet Med] 2021 May; Vol. 38 (5), pp. e14459. Date of Electronic Publication: 2020 Nov 23.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: Oxford : Blackwell Science
Original Publication: Chichester [Sussex, England] ; New York : Wiley, [c1984-
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MeSH Terms:
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Biomarkers/*analysis
Diabetes Complications/*etiology
Diabetes Mellitus, Type 1/*diagnosis
Adult ; Aged ; Albuminuria/diagnosis ; Albuminuria/epidemiology ; Albuminuria/etiology ; Ambulatory Care/statistics & numerical data ; Biomarkers/metabolism ; Blood Pressure/physiology ; Diabetes Complications/blood ; Diabetes Complications/epidemiology ; Diabetes Mellitus, Type 1/complications ; Diabetes Mellitus, Type 1/epidemiology ; Diabetes Mellitus, Type 1/pathology ; Disease Progression ; Female ; Glomerular Filtration Rate ; Glycated Hemoglobin/analysis ; Glycated Hemoglobin/metabolism ; Humans ; Male ; Middle Aged ; Observer Variation ; Prognosis ; Prospective Studies ; Risk Factors
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References:
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Substance Nomenclature:
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0 (Biomarkers)
0 (Glycated Hemoglobin A)
0 (hemoglobin A1c protein, human)
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Entry Date(s):
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Date Created: 20201112 Date Completed: 20220309 Latest Revision: 20221207
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Update Code:
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20240105
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DOI:
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10.1111/dme.14459
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PMID:
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33179275
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Background: Clinical characteristics such as HbA 1c , systolic blood pressure (SBP), albuminuria and estimated glomerular filtration rate (eGFR) are important when treating type 1 diabetes. We investigated the variability in these measures as risk markers for micro- and macrovascular complications.
Methods: This prospective study included 1062 individuals with type 1 diabetes. Visit-to-visit variability of HbA 1c , SBP, albuminuria and eGFR was calculated as the SD of the residuals in individual linear regression models using all available measures in a specified period of 3 years (VV). Endpoints included were as follows: cardiovascular events (CVE) defined as myocardial infarction, non-fatal stroke, or coronary or peripheral arterial intervention; end-stage kidney disease (ESKD) defined as eGFR <15 ml/min/1.73 m 2 , chronic dialysis or kidney transplantation; eGFR decline ≥30%; and mortality. Adjustment included age, sex, cholesterol, HbA 1c , SBP, body mass index, smoking, albuminuria, eGFR, and mean, intercept, slope of respective exposure variables and regression models.
Results: SBP VV was significantly associated with CVE (adjusted hazard ratio per 50% increase, (CI 95%); p: 1.21 [1.05-1.39]; p = 0.008), ESKD (1.51 [1.16-1.96]; p = 0.002) and mortality (1.25 [1.09-1.44]; p = 0.002). HbA 1c VV was significantly associated with mortality (1.51 [1.30-1.75]; p < 0.001); albuminuria VV with eGFR decline (1.14 [1.08-1.20]; p = 0.024) and ESKD (1.14 [1.02-1.27]; p < 0.001), but neither CVE nor mortality. Adjusted eGFR VV was not associated with endpoints.
Conclusion: In type 1 diabetes, higher variability of basic clinical risk markers adds important risk stratification information for the development of micro- and macrovascular complications.
(© 2020 Diabetes UK.)