Clinical observations in patients with type 1 diabetes of over 50 years duration in one practice in Hungary
DOI:
https://doi.org/10.55677/IJCSMR/V3I1-03/2023Keywords:
complete cross-sectional analysis, continuous glucose monitoring (CGM), diabetes duration 50 years, duration of care 28-53 years, insulin treatments, insulin pump, longitudinal analysis for 28-33 years, macrovascular & microvascular complicationsAbstract
Within one practice (József Fövényi.), four male and two female patients, aged 54-73 years, with diabetes duration of 51-68 years, received care for 28-53 years, respectively. All physical status data, HbA1c, lipids, and renal parameters were available from 1989 onwards. The bodyweight of three male patients increased, while that of one male and two female patients remained normal. HbA1c levels ranged from 6 to 9%, LDL-cholesterol levels ranged from 1.3 to 3.5 mmol/l, HDL-cholesterol and triglycerides were normal, serum creatinine, eGFR in all but one patient remained within the normal range. All patients were C-peptide negative. One patient was free from retinopathy, four had mild background and one had pre-proliferative retinopathy, four patients had mild, two moderate sensory and autonomic neuropathy. Based on cardiac evaluation and coronary CT angiography, as well as ultrasound examination of the cervical and lower limb arteries, ne0ither the coronaries nor the peripheral arteries showed signs of arteriosclerosis in one woman and two men, while the other three patients had severe atherosclerosis and severe coronary calcifications. All patients had been receiving intensive insulin therapy since the 1980s had been receiving only analogue insulin for 18 years, one female patient had been using an insulin pump (since 2014 with continuous glucose monitoring) for 20 years, and four additional patients used also CGM (continuous glucose monitoring). All patients were taking statins, all patients had well-treated hypertension. All patients – except for one woman – considered their quality of life to be good and had no significant complaints attributable to diabetes.
References
Adamsson Eryd, S., Svensson, A.-M., Franzén, S., Eliasson, B., Nilsson, P.M., Gudbjörnsdottir, S., 2016. Risk of future microvascular and macrovascular disease in people with Type 1 diabetes of very long duration: a national study with 10-year follow-up Diabetic Medicine 34, 411-418. https://doi.org/10.1111/dme.13266
Altman, JJ., Vincent-Cassy, C. Feldman-Billard, S., 2009. Improvements in the lifestyle of patients who have had type 1 diabetes for 50 years: an optimistic message. Diabetologia 52, 364-366. https://doi.org/10.1007/s00125-008-1216-4
Amquist, H.J., Westerlund, M.C., Fredrikson, M., Ludvigsson, J., Nordwall, M., 2022. Impact of HbA1c Followed 32 Years From Diagnosis of Type 1 Diabetes on Development of Severe Retinopathy and Nephropathy: The VISS Study. Diabetes Care 45, 2675–2682 https://doi.org/10.2337/dc22-0239
Bain, S.C., Gill, G.V., Dyer, P.H., Jones, A.F., Murphy, M., Jones, K.E., Smyth, C., Barnett, A.H, 2003. Characteristics of Type 1 diabetes of over 50 years duration (the Golden Years Cohort), Diabetic Medicine 20, 808-811. https://doi.org/10.1046/j.1464-5491.2003.01029.x
Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group, 2016. Risk factors for cardiovascular disease in type 1 diabetes. Diabetes 65, 1370–1379. https://doi.org/10.2337/db15-1517
Fovenyi, J. 2019. Eighty Six Years Duration of Type 1 Diabetes Mellitus. J Clin Diabetes 3: e104.
Harjutsalo, V., Pongrac Barlovic, D., Gorgin, D., Forsblom, C., King, G., Groop, P-H., on behalf of the FinnDiane Study Group. 2021. Presence and Determinants of Cardiovascular Disease and Mortality in Individuals With Type 1 Diabetes of Long Duration: The FinnDiane 50 Years of Diabetes Study. Diabetes Care 44, 1–9 https://doi.org/10.2337/dc20-2816.
Holte, K.B., Svanteson, M., Hanssen, K.F., Haig ,Y., Solheim ,S., Berg, T.J., 2019 Undiagnosed coronary artery disease in long-term type 1 diabetes. The Dialong study. J Diabetes Complicat 33, 383–389. https://doi.org/10.1016/j.jdiacomp.
Juel, N.G., Brox, J.I., Brunborg, C., KB. Holte, K.B., Berg, T.J., 2017. High Prevalence of Frozen Shoulder in Patients With Type 1 Diabetes of ≥45 Years' Duration: The Dialong Shoulder Study. Arch of Phis Med and Rehab 1998, 1551-1559. https://doi.org/10.1016/j.apmr.2017.01.020
Lovshin, J.A., Bjornstad, P., Lovblom, L.E., Bai, J-W., Lytvyn, Y., Boulet, G., Farooqi, M.A., Santiago, S., Orszag, A., Scarr, D., Weisman, A., Keenan, H.A., Brent, M.H., Paul, N., Bril, V., Perkins, B.A., Cherney, D.Z.I., 2018. Atherosclerosis and Microvascular Complications: Results From the Canadian Study of Longevity in Type 1 Diabetes. Diabetes Care 41, 2570–2578. https://doi.org/10.2337/dc18-1236.
Maddaloni, E., D’Eon, S., Hastings, S., Tinsley, L.J., Napoli, N., Khamaisei, M., Bouxsein, M.L., Fouda, S.M.R., Keenan, H.A., 2017. Bone health in subjects with type 1 diabetes for more than 50 years. Acta Diabetol 54, 479–488. https://doi.org/10.1007/s00592-017-0973-2
Miller, RG, Costacou, T., Orchard , T.J., 2019. Risk factor modeling for cardiovascular disease in type 1 diabetes in the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study: a comparison with the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC). Diabetes 68, 409–419. https://doi.org/10.2337/db18-0515
Miller, R.G., Orchard, T., T. Costacou, T., 2022. 30-Year Cardiovascular Disease in Type 1 Diabetes: Risk and Risk Factors Differ by Long-term Patterns of Glycemic Control Diabetes Care 45, 142–150. https://doi.org/10.2337/dc21-1381
Nádas, J., Putz, Z., Fövényi, J., Gaál, Z., Gyimesi, A., Hídvégi, T., Hosszúfalusi, N., Neuwirth, G., Oroszlán, T., Pánczél, P., Széles, G., Vándorfi, G., Winkler, G., Wittmann, I., Jermendy G., 2009. Cardiovascular Risk Factors Characteristic for the Metabolic Syndrome in Adult Patients with Type 1 Diabetes. Clin Endocrinol Diabetes 117, 112-112 DOI: 10.1055/s-0030-1249167
Oram, R.A., McDonald, T.J., Shields, B.M., Hudson,M.M., Shepherd, M.H., Hammersley, S., Ewan R. Pearson E.R., Hattersley A.T., 2015. Most People With Long-Duration Type 1 Diabetes in a Large Population-Based Study Are Insulin Microsecretors. Diabetes Care, 38, 323-328.15. https://doi.org/10.2337/dc14-0871
Otani, T., Kasahara, T., Miura, J., Uchigata, Y., Babazono, T., 2019. Clinical background of Japanese patients with type 1 diabetes mellitus who have received insulin therapy for 50 years or longer. Diabetology International 10, 288-294. https://doi.org/10.1007/s13340-019-00393-x
Prince C.T., Becker D.J., Costacou T., Miller R.G., Orchard T.J., 2007. Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC). Diabetologia 50, 2280–2288 DOI 10.1007/s00125-007-0797-7
Raile, K., Galler, A., S. Hofer, S., Herbst, A., Dunstheimer, D., Busch, P., Holl, R.W., 2007. Diabetic Nephropathy in 27,805 Children, Adolescents, and Adults With Type 1 Diabetes Effect of diabetes duration, A1C, hypertension, dyslipidemia, diabetes onset, and sex. Diabetes Care 30, 2523–2528, https://DOI: 10.2337/dc07-0282.
The Medalist Program and Study at Joslin recognizes and studies people who have been living with diabetes for more 50+ years. Joslin Diabetes Center, Boston, MA., 2019. Available: https://www.joslin.org/research/our-research/medalist-program-study.
