High Number of 'Medalists' Free From Diabetes Complications

Advanced glycation end products linked to increased complications in long-standing diabetes

WEDNESDAY, March 30 (HealthDay News) -- The relatively high proportion of patients with type 1 diabetes for 50 years or more without complications indicates the presence of protective factors, according to a study published in the April issue of Diabetes Care.

Jennifer K. Sun, M.D., M.P.H., from the Joslin Diabetes Center in Boston, and colleagues assessed the prevalence of diabetic vascular complications in 351 patients with type 1 diabetes durations of 50 years or more (Medalists). The effects of glycemic control (measured by hemoglobin A1c), lipids, and advanced glycation end products on proliferative diabetic retinopathy (PDR), nephropathy, neuropathy, and cardiovascular disease were assessed. Longitudinal ophthalmic data were collected from a subgroup of patients.

The investigators found that a high proportion of Medalists remained free from complications: 42.6 percent from PDR, 86.9 percent from nephropathy, 39.4 percent from neuropathy, and 51.5 percent from cardiovascular disease. Complications were 7.2 times more likely in patients with high plasma carboxyethyl-lysine and pentosidine, and they were unrelated to current or longitudinal (the past 15 years) glycemic control. For those Medalists who did not have PDR, 96 percent of those without retinopathy progression in the first 17 years did not experience a subsequent worsening of symptoms.

"Given survival with unexpectedly few complications despite extremely long-duration diabetes, the Medalist group appears to be enriched for factors protective against morbidity and mortality," the authors write.

This study was partially funded by Eli Lilly.

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