Clinical Profile of Adults with Long-Standing Type 1 Diabetes: A 30-year-Experience from Theptarin Hospital, Thailand

Abstract

Objective. To present our 30-year experience with type 1 diabetes in adults treated at Theptarin hospital, Bangkok, Thailand. Methodology. A retrospective study was conducted on medical records of patients with type 1 diabetes in Theptarin hospital between 1983 and 2013. Clinical characteristics, glycemic control, and complications were retrieved and compared between patients who developed complications and those who have remained free of complications. Results. There were 129 T1DM patients who attended our hospital during the three decades. Two patients died from sepsis and leukemia. Only 70 patients are still active on follow-up (median time of follow-up 11.1 years, range 0.3-29.2 years). In the active follow-up cohort, the mean age of onset was 25.3(12.4) years and duration of diabetes was 14.4(10.0) years. The mean HbA1c and LDL were 7.9(1.4%) and 99(30) mg/dl respectively. Optimal glycemic control (HbA1c ≤ 7%), LDL control (LDL≤ 100 mg/dl), and target blood pressure (BP ≤ 130/80 mmHg) were achieved in 31%, 54%, and 97% of patients respectively. The optimal combined target values for glucose, LDL, and blood pressure were achieved in only 17% of patients. The cumulative incidence of retinopathy, nephropathy, and cardiovascular disease were 17%, 19%, and 0.4%, respectively. Only longer duration of diabetes was associated with increased risk of development of microvascular complications. Conclusions. Despite advancement in the treatment of diabetes, optimal glycemic control has not been achieved in most adult patients with T1DM. Microvascular complications have been observed in about one fifth of patients. Intensive therapy should be implemented as early as possible in order to ameliorate long-term complications of diabetes