The complications of diabetes mellitus continue to be a major source of morbidity and early morality. Type 1 diabetes, the subject of this application, contributes disproportionately to the health effects and health care costs of this disease. The prevalence, incidence and interrelationships of seven major complications (i.e., death, proliferative retinopathy, microalbuminuria, overt nephropathy, renal failure, neuropathy, and coronary and lower extremity arterial disease) of Type 1 diabetes and their risk factors have been examined in a 1-year prospective study of Type 1 diabetic subjects diagnosed in childhood. Risk factors and complication status have been determined on a biennial basis since baseline (1986-88). The investigators point out that this study population is a well defined cohort of Type 1 diabetic patients identified from Children's Hospital of Pittsburgh Registry and shown to be representative of the local county-wide diabetic population. All 658 study subjects have been diagnosed between 1950-80. Data collection will be complete in November 1998. Over 60 publications have reported on the prevalence, incidence and risk factors for complications in this population. Important links between blood pressure and neuropathy and lipoprotein concentrations and nephropathy have been identified. Extremely high rates of coronary artery disease, approaching 18% per year after 37 years of diabetes, have led to proposals in the new application to continue examination follow-up of those with long duration, i.e., 35+ years, Type 1 diabetes. A general survey follow-up will be continued until 2002 in all participants and further statistical analyses, including Markov Modeling and Tree Structured analysis, are planned. The genetic basis of complications will also be examined using a candidate gene approach using very specific detailed phenotyping of subjects according to their complication pattern. The effect of health care, access and type, and utilization on complication outcome will also be examined. A series of nested case controlled analyses will look at markers of oxidized lipoproteins and their role in predicting both cardiovascular and nephropathic outcomes. Homocysteine will also be studied in this manner. A particular focus will be on the role of Electron Beam Computerized Tomography (EBCT) as a screening tool for asymptomatic heart disease given the high cardiovascular mortality and morbidity in this population. Its predictive ability for future coronary events will be determined, as will the rate of progression of coronary calcification and its associated risk factors. The investigators state that this study will continue to advance our knowledge of the pathogenesis and prediction of complications of diabetes and lead to appropriate preventive strategies.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK034818-18
Application #
6517079
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Jones, Teresa L Z
Project Start
1985-09-01
Project End
2004-02-29
Budget Start
2002-03-01
Budget End
2003-02-28
Support Year
18
Fiscal Year
2002
Total Cost
$493,150
Indirect Cost
Name
University of Pittsburgh
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
053785812
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Williams, Katherine V; Cristaldi, Christina L; Miller, Rachel G et al. (2018) Celiac Autoimmunity Is Associated With Lower Blood Pressure and Renal Risk in Type 1 Diabetes. J Clin Endocrinol Metab 103:3828-3836
Ghai, Vikas; Wu, Xiaogang; Bheda-Malge, Anjalei et al. (2018) Genome-wide Profiling of Urinary Extracellular Vesicle microRNAs Associated With Diabetic Nephropathy in Type 1 Diabetes. Kidney Int Rep 3:555-572
Miller, Rachel G; Anderson, Stewart J; Costacou, Tina et al. (2018) Hemoglobin A1c Level and Cardiovascular Disease Incidence in Persons With Type 1 Diabetes: An Application of Joint Modeling of Longitudinal and Time-to-Event Data in the Pittsburgh Epidemiology of Diabetes Complications Study. Am J Epidemiol 187:1520-1529
Guo, Jingchuan; Miller, Rachel G; Costacou, Tina et al. (2018) Left ventricular systolic dysfunction predicts long-term major microvascular complication outcomes in type 1 diabetes. The Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood onset diabetes. J Diabetes Complications 32:298-304
Ray, Evan C; Miller, Rachel G; Demko, John E et al. (2018) Urinary Plasmin(ogen) as a Prognostic Factor for Hypertension. Kidney Int Rep 3:1434-1442
Costacou, Tina; Orchard, Trevor J (2018) Cumulative Kidney Complication Risk by 50 Years of Type 1 Diabetes: The Effects of Sex, Age, and Calendar Year at Onset. Diabetes Care 41:426-433
Swasey, Krystal K; Orchard, Trevor J; Costacou, Tina (2018) Trends in cardiovascular risk factor management in type 1 diabetes by sex. J Diabetes Complications 32:411-417
Guo, Jingchuan; Erqou, Sebhat A; Miller, Rachel G et al. (2018) The role of coronary artery calcification testing in incident coronary artery disease risk prediction in type 1 diabetes. Diabetologia :
Bjornstad, P; Costacou, T; Miller, R G et al. (2017) Predictors of early renal function decline in adults with Type 1 diabetes: the Coronary Artery Calcification in Type 1 Diabetes and the Pittsburgh Epidemiology of Diabetes Complications studies. Diabet Med 34:1532-1540
Nunley, Karen A; Ryan, Christopher M; Aizenstein, Howard J et al. (2017) Regional Gray Matter Volumes as Related to Psychomotor Slowing in Adults with Type 1 Diabetes. Psychosom Med 79:533-540

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