Снижение уровня сахара и инсулиновая помпа уменьшают риски осложнений у подростков с диабетом 1 типа

For adolescents living with type 1 diabetes (T1D), aiming for lower glycemic targets, using insulin pump therapy, and addressing modifiable risk factors can help reduce risks for microvascular complications, according to study findings published in Diabetes Care. Over the past few decades, the risk for complications in pediatric patients with T1D has declined due to improved glycemic control strategies. This trend has been accompanied by a greater understanding of how modifiable risk factors, like obesity and high blood pressure (BP), influence the occurrence of microvascular complications. Researchers examined how microvascular complications and treatments have evolved over a recent 30-year period to understand long-term trends in microvascular complications (including retinopathy, kidney disease, and neuropathy) and treatment delivery methods, and to identify risk factors associated with T1D in young patients. Eligible participants were aged 12 to 20 years who had been diagnosed with T1D for at least 5 years and were prospectively assessed for diabetes complications at the Children’s Hospital at Westmead in Australia. Interventions including hypertension and lipid management, reduction in BMI, and insulin resistance may mitigate the risk of type 1 diabetes complications. A total of 2761 patients with T1D were included in the analysis, with 5487 visits completed between 1990 and 2019. Overall, diabetes complications became less frequent after decade 1 (1990-1999) and then leveled off in decade 2 (2000-2009) and decade 3 (2010-2019). Across the 30-year study period, rates of retinopathy were 40%, 21%, and 20% (P <.001), and rates of early elevation of albumin excretion rate or mean albumin-to-creatinine ratio were 35%, 29%, and 28% (P =.009) for decades 1, 2, and 3, respectively. Peripheral nerve abnormality data were included in the study’s measured complications starting in 2006, with a significant decline in the rate from 35% before 2010 to 28% in decade 3 (P =.007). Autonomic nerve function assessed with heart rate variability remained unchanged (P =.884), while pupillary reflex abnormalities (resting pupil diameter <5th percentile) changed significantly across decades (P =.024), peaking at 5.4% in the second decade before declining to 2.3% in decade 3. These trends coincided with a steady improvement in glycemic control, with the percentage of adolescents achieving a glycated hemoglobin (HbA1c) level (≤7.5%) increasing from 7.4% to 9.6% to 14.1% across each of the decades (P <.001), respectively. Using multivariable logistic generalized estimating equation (GEE) models, higher mean HbA1c levels were consistently associated with significantly greater odds of retinopathy (odds ratio [OR], 1.75; 95% CI, 1.58-1.92). The researchers also found an association with early elevation of albumin excretion rate/albumin-to-creatine ratio (AER/ACR; OR, 1.30; 95% CI, 1.19-1.43), albuminuria (OR, 1.31; 95% CI, 1.20-1.44), peripheral nerve abnormalities (OR, 1.14; 95% CI, 1.02-1.27), and abnormal heart rate (OR, 1.28; 95% CI, 1.12-1.46). Insulin-related factors were broadly significant as well. Compared with the use of continuous subcutaneous insulin infusion (CSII), for instance, twice-daily injections (OR, 1.59; 95% CI, 1.23-2.06) and multiple daily injections (MDI; OR, 1.31; 95% CI, 1.06-1.62) were associated with greater odds of retinopathy. Use of twice-daily injections rather than MDI or CSII therapy was associated with greater odds of early elevation of AER/ACR (OR, 1.26; 95% CI, 1.06-1.48). Similarly, twice-daily or MDI regimens vs CSII were associated with an increased likelihood of abnormal heart rate (OR, 1.43; 95% CI, 1.12-1.82). Additionally, higher total daily insulin doses per unit body weight were associated with increased occurrence of both early elevation of AER/ACR and albuminuria. Other risk factors included higher systolic/diastolic BP or cholesterol, a longer diabetes duration, an increased HbA1c coefficient of variation, and a greater body mass index (BMI; associated specifically with peripheral nerve abnormality; categorical obesity/overweight was not significant in multivariable models). Study limitations include challenges with comparing the prevalence of glycemic control across decades; uncertain generalizability outside the tertiary-care setting where assessments were performed; incomplete ethnicity data; and the inability to assess attrition over time. The study authors concluded, “In conjunction with intensive insulin therapy, interventions including hypertension and lipid management, reduction in BMI, and insulin resistance may mitigate the risk of type 1 diabetes complications.” References: Calligaro LI, Liew G, Cho YH, et al. 30-year trends in microvascular complications and treatment in adolescents with type 1 diabetes. Diabetes Care. Published online July 8, 2026. doi:10.2337/dc26-0388