Unlike type 2 diabetes, where prevention is possible, type 1 diabetes is currently neither preventable nor curable and its Incidence continues to rise approximately 3% per yr. Thus, the continuing investigation of type 1 diabetes complications remains imperative. The Epidemiology of Diabetes Complications (EDC) study has examined the prevalence and incidence of and risk factors contributing to the diabetes complications for 25 yrs. The study population is a well defined cohort of childhood onset type 1 diabetes identified from the Children's Hospital of Pittsburgh Registry (diagnosis: 1950-80). All 658 participants attending a clinical exam at study entry (1986-88) have been subsequently followed for up to 25 yrs, leading to over 150 peer reviewed publications. A number of striking observations were made during the last phase of the study which have given rise to questions and hypotheses this continuation will continue to address. These include the increasingly complex interaction between various pro- and anti-glycoxidative and inflammatory cytokines, as well as the rapidly changing natural history of complications which provides further insight into the interrelationships of, and specific risk factors for, complications, and renders historic data outdated for health care and insurance purposes. The current proposal, therefore, focuses on further assessment of complication development for a total follow up period of 30 yrs, thus allowing reasonably stable estimates of complication development over 40 yrs duration of childhood onset type 1 diabetes. This gives the opportunity to document morbidity risk and to estimate life expectancy in the modern era, i.e. for those diagnosed in 1965-80 and who have had more than half their diabetes duration since the availability of HbA1c testing and self monitoring of blood glucose. The roles of glycemic, oxidative and inflammatory stress, and the host's responses they invoke, on complication development will be another major focus along with women's health issues and continuing a number of collaborations. Finally, we will evaluate skin advanced glycosylation end products as a complication predictor for 232 individuals with at least one such assessment. This will be facilitated by continuing the annual surveys and, at 30 yrs of follow up, a full exam.

Public Health Relevance

Type 1 diabetes is currently neither preventable nor curable and its incidence continues to rise about 3% per yr. Thus, the continuing investigation of type 1 diabetes complications remains imperative. The current proposal will not only provide insight on complication incidence, but also fill gaps in knowledge on T1D women's health issues, and the role of stress and host's response and skin AGE on complications.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Method to Extend Research in Time (MERIT) Award (R37)
Project #
5R37DK034818-32
Application #
9085269
Study Section
Special Emphasis Panel (NSS)
Program Officer
Jones, Teresa L Z
Project Start
1985-09-01
Project End
2019-05-31
Budget Start
2016-06-01
Budget End
2017-05-31
Support Year
32
Fiscal Year
2016
Total Cost
Indirect Cost
Name
University of Pittsburgh
Department
Public Health & Prev Medicine
Type
Graduate Schools
DUNS #
004514360
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
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
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
Nunley, Karen A; Metti, Andrea L; Klein, Ronald et al. (2018) Long-term changes in retinal vascular diameter and cognitive impairment in type 1 diabetes. Diab Vasc Dis Res 15:223-232
Nunley, Karen A; Leckie, Regina L; Orchard, Trevor J et al. (2017) Physical activity and hippocampal volume in middle-aged patients with type 1 diabetes. Neurology 88:1564-1570
Nunley, Karen A; Orchard, Trevor J; Ryan, Christopher M et al. (2017) Statin use and cognitive function in middle-aged adults with type 1 diabetes. World J Diabetes 8:286-296
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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