, Volume 37, Issue 3, pp 278–285 | Cite as

Microvascular and acute complications in IDDM patients: the EURODIAB IDDM Complications Study

  • J. Stephenson
  • J. H. Fuller
  • EUROBIAB IDDM Complications Study Group


The prevalence of microvascular and acute diabetic complications, and their relation to duration of diabetes and glycaemic control were examined in a cross-sectional study of 3250 IDDM patients in Europe (EURODIAB IDDM Complications Study). Mean (SD) duration of diabetes was 14.7 (9.3) years. HbA1c and AER were measured centrally. Retinopathy was assessed by centrally graded retinal photography. Autonomic neuropathy was measured by heart rate and blood pressure responses to standing up. Sensory neuropathy was measured by biothesiometry. Normal HbA1c was found in 16% of patients. An AER of 20 μg/min or higher was found in 30.6% (95% CI 29.0%, 32.2%) of all patients, and 19.3% (15.6%, 23.0%) of those with diabetes for 1 to 5 years. The prevalence of retinopathy (46% in all patients; 82% after 20 or more years) was substantially lower than in comparable studies. Of all patients 5.9% (5.1%, 6.7%) had postural hypotension, 19.3% (17.9%, 20.7%) had abnormal heart rate variability, 32.2% (30.6%, 33.8%) reported one or more severe hypoglycaemic attacks during the last 12 months and 8.6% (7.6%, 9.6%) reported hospital admission for ketosis over the same period. Microvascular and acute complications were clearly related to duration of diabetes and to glycaemic control. However, the relation of glycaemic control to raised albuminuria differed qualitatively from its relation to retinopathy.

Key words

IDDM glycaemic control hypoglycaemia ketosis retinopathy nephropathy neuropathy 



Insulin-dependent diabetes mellitus


vibration perception threshold


rate of urinary albumin excretion


confidence interval


  1. 1.
    Bingley PJ, Gale EAM (1989) Rising incidence of IDDM in Europe. Diabetes Care 12: 289–295Google Scholar
  2. 2.
    World Health Organisation (1992) Diabetes care and research in Europe: The St Vincent Declaration Action Programme. WHO, Regional Office for Europe, CopenhagenGoogle Scholar
  3. 3.
    Chase PH, Jackson WE, Hoops SL, Cockerham RS, Archer PG, O'Brien D (1989) Glucose control and the renal and retinal complications of insulin-dependent diabetes. JAMA 261: 1155–1160Google Scholar
  4. 4.
    Leslie ND, Sperring MA (1986) Relation of metabolic control to complications of diabetes mellitus. J Pediatrics 108: 491–497Google Scholar
  5. 5.
    Raskin P, Rosenstock J (1986) Blood glucose control and diabetic complications. Ann Intern Med 105: 254–263Google Scholar
  6. 6.
    Diabetic Retinopathy Study Research Group: report 7 (1981) A modification of the Airlie House classification of diabetic retinopathy. Invest Ophthalmol Vis Sci 21: 210–226Google Scholar
  7. 7.
    Kearney EM, Mount JN, Watts GF, Slavin BM, Kind PRN (1987) Simple immunoturbidometric method for determining urinary albumin at low concentrations using centrifugal analyser. J Clin Path 40: 465–468Google Scholar
  8. 8.
    John GW, Gray MR, Bates DL, Beacham JL (1993) Enzyme immunoassay — a new technique for estimating HbA1c. Clin Chem 39: 663–666Google Scholar
  9. 9.
    Ewing DJ, Martyn CN, Young RJ, Clarke BF (1985) The value of cardiovascular autonomic function test: 10 years experience in diabetes. Diabetes Care 8: 491–498Google Scholar
  10. 10.
    Hammersley MS, Holland MR, Walford S, Thorn PA (1985) What happens to defaulters from a diabetic clinic? BMJ 291: 1330–1332Google Scholar
  11. 11.
    Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL (1984) The Wisconsin Epidemiologic Study of diabetic retinopathy. II Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 102: 520–526Google Scholar
  12. 12.
    Orchard TJ, Dorman JS, Maser RE et al. (1990) Prevalence of complications in IDDM by sex and duration. Pittsburgh Epidemiology of Diabetes Complications Study II. Diabetes 39: 1116–1124Google Scholar
  13. 13.
    DCCT Research Group (1990) Diabetes Control and Complications Trial (DCCT). Update. Diabetes Care 13: 427–433Google Scholar
  14. 14.
    DCCT Research Group (1991) Epidemiology of severe hypoglycaemia in the Diabetes Control and Complications Trial. Am J Med 90: 450–459Google Scholar
  15. 15.
    Klein R, Klein BEK, Moss SE et al. (1988) Glycosylated haemoglobin predicts the incidence and progression of diabetic retinopathy. Ophthalmology 260: 2864–2871Google Scholar
  16. 16.
    Janka HU, Warram JH, Rand LI, Krolewski AS (1989) Risk factors for progression of background retinopathy in long-standing IDDM. Diabetes 38: 460–464Google Scholar
  17. 17.
    MacMahon S, Peto R, Cutler J et al. (1990) Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335: 764–774Google Scholar
  18. 18.
    Krolewski AS, Warram JH, Christlieb AR, Busick EJ, Kahn CR (1985) The changing natural history of nephropathy in type 1 diabetes. Am J Med 78: 785–794Google Scholar
  19. 19.
    Andersen AR, Christiansen JS, Andersen JK, Kreiner S, Deckert T (1983) Diabetic nephropathy in type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia 25: 496–501Google Scholar
  20. 20.
    Forsblom CM, Groop P-H, Ekstrand A, Groop LC (1992) Predictive value of microalbuminuria in patients with insulin-dependent diabetes of long duration. BMJ 305: 1051–1053Google Scholar
  21. 21.
    Parving HH, Hommel E, Mathiesen E et al. (1988) Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin dependent diabetes. BMJ 296: 156–160Google Scholar
  22. 22.
    Boulton AJM, Knight G, Drury P, Ward JD (1985) The prevalence of symptomatic diabetic neuropathy in an insulin treated population. Diabetes Care 8: 125–128Google Scholar
  23. 23.
    Brown MJ, Asberry AK (1984) Diabetic neuropathy. Ann Neurol 15: 2–12Google Scholar
  24. 24.
    Ziegler D, Mayer P, Muhlen H, Gries FA (1991) The natural history of somatosensory and autonomic nerve dysfunction to glycaemic control during the first 5 years after diagnosis of type 1 (insulin-dependent) diabetes mellitus. Diabetologia 34: 822–829Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • J. Stephenson
    • 1
  • J. H. Fuller
    • 1
  • EUROBIAB IDDM Complications Study Group
  1. 1.EURODIAB, Department of Epidemiology and Public HealthUniversity College LondonLondonUK

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