Short summary

This study describes the 16-year cumulative incidence of proliferative diabetic retinopathy in young Danish patients with type 1 diabetes. Furthermore, it explores the possibility of predicting microvascular complications by new early risk markers analyzed in retinal images of the retinal vasculature by computer software, namely the vessel diameters and the retinal fractal dimension.

Rationale

The aim of this study is to clarify the status of diabetes in 2011, including the development of complications in a nationwide young cohort with type 1 diabetes. The cohort was also subject for studies in 1987 and 1995. In the earlier studies a rather poor glycemic control was found and a large proportion of the participants had already developed early signs of microvascular complications during adolescence. Strict glycemic control was therefore emphasized and we now wish to investigate if this stopped progression in microvasculopathy, or maybe reversed it.

In the later years semi-automatic computer software made it possible to examine the retinal vasculature in retinal images quite detailed. It can analyze the vessel diameters very precisely and also the fractal dimension - a measurement of the vascular complexity and density. In 1995 retinal images were taken of this cohort and we therefore aim to see if these vessel analyzes on 1995 images can predict the 2011 microvascular outcome in this cohort.

Description of the cohort

This study will be using the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). The patients were originally recruited from 21 of the 22 pediatric departments in Denmark back in 1986-87. All children and adolescents below the age of 19 years with type 1 diabetes were invited and in the first study among 75% participated.

Data and biological material

Studies will be conducted on data from: Baseline study from 1995, patient journals, CPR-registry, National Patient Registry, The Registry for Course of Death, Danish Association of the Blind and The Danish Medicin Registry. Furthermore information will be gathered from retinal vascular analyzes, patient history, clinical eye examinations, blood samples, urin samples, blood pressure measurements, tests for neuropathy, fundus photography, OCT scans cornea sensibility and medical history.

Subprojects

Situation of Life, Quality of Life, Glucose test and Development of Diabetic Retinopathy, Nephropathy and Neuropathy - a 23 year nationwide cohort study of 339 young adults diagnosed with Diabetes Mellitus type 1
Senior Hospital Physician Birthe Olsen, Paediatric Department, Glostrup Hospital

Predictors of Diabetic Retinopathy in Adolescents with type 1 Diabetes in Denmark - A cohort study
PhD-student Malin Lundberg Rasmussen, MD, Department E - Ophthalmology, Odense University Hospital

Collaborating researchers and departments

Department E - Ophthalmology, Odense University Hospital

• PhD-student Rebecca Broe, MD, PhD
• Jakob Grauslund, MD, DMSc, PhD
• PhD-student Malin Lundberg Rasmussen, MD, PhD

The Pediatric Department, Herlev Hospital

• Senior Hospital Physician Birte Olsen
• Professor Henrik Mortensen, DMSc

Center of Eye Research, Melbourne, Australia

• Professor Tien Wong, PhD

Publications associated with the project

Early risk stratification in pediatric type 1 diabetes. Broe R. Acta Ophthalmol. 2015 Mar;93 Thesis 1:1-19. doi: 10.1111/aos.12702.

Long-term incidence of vitrectomy and associated risk factors in young Danish patients with Type 1 diabetes: the Danish Cohort of Paediatric Diabetes 1987. Broe R, Rasmussen ML, Frydkjaer-Olsen U, Olsen BS, Mortensen HB, Peto T, Grauslund J. Diabet Med. 2015 Apr;32(4):542-5. doi: 10.1111/dme.12628. Epub 2014 Nov 25.

Retinal vascular fractals predict long-term microvascular complications in type 1 diabetes mellitus: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). Broe R, Rasmussen ML, Frydkjaer-Olsen U, Olsen BS, Mortensen HB, Peto T, Grauslund J. Diabetologia. 2014 Oct;57(10):2215-21. doi: 10.1007/s00125-014-3317-6. Epub 2014 Jul 1.

Retinal vessel calibers predict long-term microvascular complications in type 1 diabetes: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). Broe R, Rasmussen ML, Frydkjaer-Olsen U, Olsen BS, Mortensen HB, Hodgson L, Wong TY, Peto T, Grauslund J. Diabetes. 2014 Nov;63(11):3906-14. doi: 10.2337/db14-0227. Epub 2014 Jun 9.

The 16-year incidence, progression and regression of diabetic retinopathy in a young population-based Danish cohort with type 1 diabetes mellitus: The Danish cohort of pediatric diabetes 1987 (DCPD1987). Broe R, Rasmussen ML, Frydkjaer-Olsen U, Olsen BS, Mortensen HB, Peto T, Grauslund J. Acta Diabetol. 2014;51(3):413-20. doi: 10.1007/s00592-013-0527-1. Epub 2013 Nov 6.

Microaneurysm count as a predictor of long-term progression in diabetic retinopathy in young patients with type 1 diabetes: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). Rasmussen ML, Broe R, Frydkjaer-Olsen U, Olsen BS, Mortensen HB, Peto T, Grauslund J. Graefes Arch Clin Exp Ophthalmol. 2015 Feb;253(2):199-205. doi: 10.1007/s00417-014-2682-7. Epub 2014 Jun 5.

Comparison between Early Treatment Diabetic Retinopathy Study 7-field retinal photos and non-mydriatic, mydriatic and mydriatic steered widefield scanning laser ophthalmoscopy for assessment of diabetic retinopathy. Rasmussen ML, Broe R, Frydkjaer-Olsen U, Olsen BS, Mortensen HB, Peto T, Grauslund J. J Diabetes Complications. 2015 Jan-Feb;29(1):99-104. doi: 10.1016/j.jdiacomp.2014.08.009. Epub 2014 Aug 28.

Polymorphisms in the CTSH gene may influence the progression of diabetic retinopathy: a candidate-gene study in the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). Thorsen, S. U., Sandahl, K., Nielsen, L. B., Broe, R., Rasmussen, M. L., Peto, T., Grauslund, J., Andersen, M. L. M., Mortensen, H. B., Pociot, F., Olsen, B. S. & Brorsson, C. 6 aug. 2015 I: Graefe's Archive for Clinical and Experimental Ophthalmology. 253, 11, s. 1959-1965