Longitudinal analysis of factors affecting the complications of Type1 Diabetes : retinopathy, nephropathy and cardiovascular outcomes

Abstract

To assess longitudinally the impact of Kallikrein biomarker along with covariates of interest on three complications of diabetes: Retinopathy, Nephropathy and Cardiovascular complications.A longitudinal cohort study design conducted on type 1 diabetic patients chosen from the DCCT-EDIC study. 350 type 1 diabetic subjects were randomly selected out of 1441 total sample. The duration of diabetes at baseline ranged from 1 to 15 years and ages were between 13 and 39 years. Plasma Kallikrein levels for these randomly selected individuals were longitudinally measured at five points in time by Jaffa et al (2003) from 1983 to 2004 across 29 different centers in the United States of Americaand the values of the covariates that correspond to these time points were also recorded. This results in a total number of 1750 observations. Longitudinal analyses along with survival analysis were used in the data analysis mainly. Cross-sectional analysis was also used.Longitudinally most covariates were significantly associated with kallikrein (P-values 0.05). ETDRS and AER were significantly associated with Log kallikrein over time (P-values: 0.011 and0.039 respectively) (Tables5 and 6). The longitudinal analysis of log IMT internal and common showed no significant association with log Kallikrein both at univariate and multivariate levels. Besides, patients whosekallikrein levels below the 50th percentile had lower risk to develop microvascular complications such as retinipathy and nephropathy. Intensive treatment had played a major role in reducing the risk of microvascular complications such as retinopathy and nephropathy.Evidently, it is important to continue and expand surveillance for childhood diabetes across the world since it is one of the most potent strategies for understanding the multifactorial etiology of the disease and ultimately preventing it.