Different risk factors of microangiopathy in patients with Type I diabetesmellitus of short versus long duration. The EURODIAB IDDM Complications Study

Aims/hypothesis. To identify factors associated with early development of a nd late protection from microvascular complications in subjects with Type I (insulin-dependent) diabetes mellitus. Methods. The frequency of microvascular complications and their relation to risk factors were studied in 300 Type I diabetic subjects with short durat ion of disease (less than or equal to 5 years) compared with 1062 subjects with long duration (greater than or equal to 14 years). Microvascular disea se was defined as the presence of either retinopathy (assessed from central ly-graded retinal photographs) or urinary albumin excretion rate of more th an 20 mu g/min. Results. The prevalence of microvascular disease was 25 % in the short dura tion group. In the long duration group 18 % had no evidence of microvascula r complications. In the short duration group factors associated with early development of complications were cigarette smoking and a family history of hypertension. Subjects free of microvascular complications in spite of lon g duration of diabetes had better glycaemic control, lower blood pressure, better lipid profile and lower von Willebrand factor levels. Conclusion/interpretation. At the early stages of Type I diabetes, cigarett e smoking and genetic susceptibility to hypertension are important risk fac tors for microvascular complications. At a later stage, additional risk fac tors are poorer glycaemic control, higher blood pressure, and an unfavourab le lipid profile possibly associated with endothelial dysfunction. Many of these factors are amenable to long-term intervention which should be starte d as soon as possible in the course of the disease.