Diabetic retinopathy and adiponectin through 20 years type 1 diabetes duration for the Wisconsin diabetes registry study.

摘要

The management of type 1 diabetes has changed greatly over the last few decades with much better tools to achieve tight glycemic control. Diabetic retinopathy, recently a leading cause of preventable blindness in adults, may be less severe in the current era. However, current treatment may result in weight gain and insulin resistance, associated with complications risk. Adiponectin, produced by adipocytes, may serve as a risk marker. Little information exists on adiponectin levels across type 1 diabetes duration, whether determinants differ during early and later diabetes, and on its relationship with retinopathy. This dissertation addresses these issues using data from The Wisconsin Diabetes Registry Study (WDRS), an incident cohort of persons with type 1 diabetes followed from diagnosis up to 20 years diabetes.;First, retinopathy and retinopathy severity at 20 years was evaluated in the WDRS and compared at similar diabetes duration with individuals diagnosed 8-34 years earlier from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). Slightly lower prevalence of retinopathy (92% versus 97%) and much lower prevalence of severe retinopathy (18% versus 43%) were found. The adjusted odds of more severe retinopathy was 3 times greater in WESDR. Better glycemic control in the WDRS explained some of the difference (adjusted odds ratio 2.2, 95% CI 1.6-3.0).;Next, levels of adiponectin were examined and significant tracking (r=0.59) was noted for individuals with on average 3 observations at 1, 4, 7, 9 and/or 20 years diabetes duration. As expected, adiponectin was lower at 20 years among those with correlates of insulin resistance (higher insulin dose, higher waist circumference, lower HDL-cholesterol). However, poor glycemic control, and higher urine protein excretion after 7 years diabetes, were related to higher adiponectin level.;Lastly, whether adiponectin levels measured during the first 20 years of diabetes duration predict progression or severity of retinopathy at 20 years was investigated. Higher adiponectin was related with retinopathy severity, which was partially explained statistically by poor glycemic control, and completely by higher systolic blood pressure or urine protein excretion. Adiponectin did not predict retinopathy progression. At 20 years, higher adiponectin appears to quantify microvascular damage, especially in the kidney.