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The incidences of and risk factors for severe retinopathy requiring photocoagulation and albuminuria in Japanese patients with childhood-onset type 1 diabetes

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Abstract

The aim of this study was to clarify the incidences of and the risk factors for severe retinopathy requiring photocoagulation therapy and albuminuria in Japanese patients with childhood-onset type 1 diabetes mellitus. A total of 756 patients from a cohort study by the Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes were included in the study. Patients were registered in 1995 or 2000, and HbA1cwas measured every 4 months and analyzed in central hospital for an average of 6 years. The presence of severe retinopathy requiring laser photocoagulation and the presence of albuminuria was checked for during the period 2010–2011. During a median of 18 (range: 15–21) years, 34 out of 756 patients underwent laser photocoagulation and 57 out of 605 patients developed albuminuria. A Cox proportional hazards model showed that the risk of severe retinopathy requiring laser photocoagulation increased by 1.15 (95% confidence interval [CI] 1.03–1.29, p = 0.012) with each increase of a year in the age at onset, by 4.03 (95% CI 1.20–13.5, p = 0.024) in females, and by 2.05 (95% CI 1.69–2.49, p < 0.0001) with each increase of 1% in HbA1c. The risk of albuminuria increased significantly, by 1.09 (95% CI 1.01–1.18 p = 0.037), with each increase of a year in the age at onset and by 2.38 (95% CI 1.93–2.97 p < 0.0001) with each increase of 1% in HbA1c. In Japanese patients with childhood-onset type 1 diabetes, older age at the onset of diabetes, female rather than male gender, and higher HbA1c were found to increase the risk of requiring photocoagulation. No patients with HbA1c < 7.5% developed severe retinopathy requiring photocoagulation therapy. The risk of developing albuminuria increased with age at onset of diabetes and HbA1c. Female gender was a strong risk factor for severe retinopathy requiring photocoagulation, but not for albuminuria.

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Acknowledgements

This study was supported by a grant-in-aid from the Japan Diabetes Foundation. We would like to thank the following doctors who were members of the Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT): Masanori Adachi, M.D., and Katsuhiko Tachibana, M.D., Kanagawa Children’s Medical Center; Taiji Aso, M.D., and Rika Kizu, M.D., Department of Pediatrics, Yokosuka Kyousai Hospital; Masatoshi Fujimoto, M.D., Department of Pediatrics, St. Marianna University; Satoshi Fujitsuka, M.D., Akira Motegi, M.D., and Yoichi Morinishi, M.D., Department of Pediatrics, National Defence Medical Collage; Ikuma Fujiwara, M.D., and Eishin Ogawa, M.D., Department of Pediatrics, Tohoku University Hospital; Naoki Fukushima, M.D., Department of Pediatrics, Sapporo City General Hospital; Keiichi Hanaki, M.D., and Susumu Kanzaki, M.D., Department of Pediatrics, Tottori University; Yukihiro Hasegawa, M.D., Tokyo Kiyose Metropolitan Children’s Hospital; Takeki Hirano, M.D., Ibaragi Children’s Hospital; Reiko Horikawa, M.D., National Center for Child Health and Development; Tomoyuki Hotsubo, M.D., Department of Pediatrics, Tonan Hospital; Yutaka Igarashi, M.D., Igarashi Children’s Clinic; Masaru Inoue, M.D., and Susumu Kanzaki, M.D., Department of Pediatrics, Tokai University; Gen Isshiki, M.D., and Tomomi Hashimoto, M.D., Department of Pediatrics, Osaka City University Graduate School of Medicine; Yoshiya Ito, M.D., and Tokuo Mukai, M.D., Department of Pediatrics, Asahikawa Medical University; Kazuhiko Jinno, M.D., Department of Pediatrics, Hiroshima General Hospital of West Japan Railway Company; Sachiko Kanematsu, M.D., and Kaori Sasaki, M.D., Department of Pediatrics, Tokyo Women’s Medical University; Yoshihito Kasahara, M.D., Department of Pediatrics, Kanazawa University; Kaichi Kida, M.D., and Koji Takemoto, M.D., Department of Pediatrics, Ehime University Graduate School of Medicine; Nobuyuki Kikuchi, M.D., and Kentaro Shiga, M.D., Department of Pediatrics, Yokohama City University Medical Center; Hitoshi Kohno, M.D., and Saori Kinjo, M.D., Fukuoka Children’s Hospital; Masanori Minagawa, M.D., and Kaori Kinoshita, M.D., Department of Pediatrics, Chiba University; Akihiko Kinugasa, M.D., Department of Pediatrics, Kyoto Prefectural University of Medicine; Yukashi Ohki, M.D., and Megumi Kishi, M.D., Department of Pediatrics, Nippon Medical School; Koji Kobayashi, M.D., and Mie Mochizuki, M.D., Department of Pediatrics, Yamanashi University; Akemi Koike, M.D., Koike Children’s Clinic; Susumu Konda, M.D., Konda Children’s Clinic; Kazutaka Konishi, M.D., Abuyama Children’s Clinic; Ichiro Yokota, M.D., and Yumiko Kotani, M.D., Department of Pediatrics, Tokushima Univeisity Graduate School of Medicine; Kazumichi Onigata, M.D., Takanori Kowase, M.D., and Fumitake Mizoguchi, M.D., Department of Pediatrics, Gunma University; Hidenari Masuda, M.D., Department of Pediatrics, National Mie Hospital; Hisafumi Matsuoka, M.D., Department of Pediatrics, Tokyo Women’s Medical University Medical Center East; Yuko Miki, M.D., and Utako Sato, M.D., Department of Pediatrics, Tokyo University; Shigeki Miyamoto, M.D., and Rieko Takatani, M.D., Chiba Children’s Hospital; Tetsuo Mori, M.D., Department of Pediatrics, Nagano National Hospital; Yoshikazu Nishi, M.D., Department of Pediatrics, Hiroshima Red Cross Hospital; Osamu Nukada, M.D., Department of Pediatrics, Kobe City West Municipal Hospital; Haruo Ogawa, M.D., Kaoru Nasuda, M.D., and Kazuhiko Toya, M.D., Department of Pediatrics, Hamamatsu University School of Medicine; Taisuke Okada, M.D., Department of Pediatrics, Mominoki Hospital; Soroku Nishiyama, M.D., and Toshihisa Okada, M.D., Department of Pediatrics, Kumamoto University; Toshikazu Takahashi, M.D., Takahashi Clinic; Masakuni Tokuda, M.D., and Ryuzo Takaya, M.D., Department of Pediatrics, Osaka Medical College; Masaro Takesue, M.D., Department of Pediatrics, Japan Red Cross Musashino Hospital; Tokuo Taketani, M.D., Department of Pediatrics, Kurobe City Hospital; Yukifumi Yokota, M.D., and Noriyuki Takubo, M.D., Department of Pediatrics, Kitasato University; Masakuni Tokuda, M.D., Tokuda Children’s Clinic; Makoto Uchiyama, M.D., Department of Pediatrics, Niigata University.

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Authors and Affiliations

  1. Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawadacho, Shinjuku-ku, 162-8666, Tokyo, Japan

    Hiroko Takaike & Yasuko Uchigata

  2. Department of Pediatrics, Teine Keijinkai Hospital, Seitoku University, Matsudo, Japan

    Nobuo Matsuura

  3. Department of Pediatrics, Saitama Medical University Moroyama, Saitama, Japan

    Nozomu Sasaki & Shin Amemiya

  4. Department of Pediatrics, Nihon University Hospital School of Medicine, Tokyo, Japan

    Tatsuhiko Urakami

  5. Department of Pediatrics, Osaka City University School of Medicine, Osaka, Japan

    Tomoyuki Kawamura

  6. Department of Pediatrics, Yokohama City Minato Red Cross Hospital, Yokohama, Japan

    Nobuyuki Kikuchi

  7. Department of Pediatrics, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan

    Shigetaka Sugihara

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  1. Hiroko Takaike
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Consortia

The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT)

  • Masanori Adachi
  • , Katsuhiko Tachibana
  • , Taiji Aso
  • , Rika Kizu
  • , Masatoshi Fujimoto
  • , Satoshi Fujitsuka
  • , Akira Motegi
  • , Yoichi Morinishi
  • , Ikuma Fujiwara
  • , Eishin Ogawa
  • , Naoki Fukushima
  • , Keiichi Hanaki
  • , Susumu Kanzaki
  • , Yukihiro Hasegawa
  • , Takeki Hirano
  • , Reiko Horikawa
  • , Tomoyuki Hotsubo
  • , Yutaka Igarashi
  • , Masaru Inoue
  • , Susumu Kanzaki
  • , Gen Isshiki
  • , Tomomi Hashimoto
  • , Yoshiya Ito
  • , Tokuo Mukai
  • , Kazuhiko Jinno
  • , Sachiko Kanematsu
  • , Kaori Sasaki
  • , Yoshihito Kasahara
  • , Kaichi Kida
  • , Koji Takemoto
  • , Nobuyuki Kikuchi
  • , Kentaro Shiga
  • , Hitoshi Kohno
  • , Saori Kinjo
  • , Masanori Minagawa
  • , Kaori Kinoshita
  • , Akihiko Kinugasa
  • , Yukashi Ohki
  • , Megumi Kishi
  • , Koji Kobayashi
  • , Mie Mochizuki
  • , Akemi Koike
  • , Susumu Konda
  • , Kazutaka Konishi
  • , Ichiro Yokota
  • , Yumiko Kotani
  • , Kazumichi Onigata
  • , Takanori Kowase
  • , Fumitake Mizoguchi
  • , Hidenari Masuda
  • , Hisafumi Matsuoka
  • , Yuko Miki
  • , Utako Sato
  • , Shigeki Miyamoto
  • , Rieko Takatani
  • , Tetsuo Mori
  • , Yoshikazu Nishi
  • , Osamu Nukada
  • , Haruo Ogawa
  • , Kaoru Nasuda
  • , Kazuhiko Toya
  • , Taisuke Okada
  • , Soroku Nishiyama
  • , Toshihisa Okada
  • , Toshikazu Takahashi
  • , Masakuni Tokuda
  • , Ryuzo Takaya
  • , Masaro Takesue
  • , Tokuo Taketani
  • , Yukifumi Yokota
  • , Noriyuki Takubo
  • , Masakuni Tokuda
  •  & Makoto Uchiyama

Corresponding author

Correspondence to Yasuko Uchigata.

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Conflict of interest

Tatsuhiko Urakami has served in advisory panels for Novo Nordisk and Sanofi, and has served on speakers’ bureaus for Sanofi.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients before they were included in the study.

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Takaike, H., Uchigata, Y., Matsuura, N. et al. The incidences of and risk factors for severe retinopathy requiring photocoagulation and albuminuria in Japanese patients with childhood-onset type 1 diabetes. Diabetol Int 9, 121–128 (2018). https://doi.org/10.1007/s13340-017-0336-9

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