HbA 1c level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study
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OBJECTIVE: ) of <6.5% is associated with lower risk for retinopathy and nephropathy than less tight control in children and adults with type 1 diabetes. DESIGN: Population based cohort study. SETTING: Swedish National Diabetes Registry, 1 January 1998 to 31 December 2017. PARTICIPANTS: 10 398 children and adults with type 1 diabetes followed from diagnosis, or close thereafter, until end of 2017. MAIN OUTCOME MEASURES: . RESULTS: <6.5% compared with 6.5-6.9% (relative risk 1.34, 95% confidence interval 1.09 to 1.64, P=0.005). CONCLUSIONS: levels >7.0%.
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Much of the mortality in the ACCORD trial may have been related to hypoglycemia, and the hazard ratio for hypoglycemia-associated deaths was higher in the standard treatment group than in the intensive therapy group.
“As discussed in Q14. How should hypoglycemia be managed?, much of the mortality in the ACCORD trial may have been related to hypoglycemia, and the hazard ratio (HR) for hypoglycemia-associated deaths was actually higher in the standard treatment than the intensive therapy groups.87”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [87]
The Results section on severe hypoglycaemias reports risks by HbA1c level in a Swedish type 1 diabetes cohort, not deaths in the ACCORD trial. Searches for ACCORD mortality and the claimed standard-versus-intensive treatment hazard ratio found no passage addressing either point. Page numbers were unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredAchieving A1C targets of <7% (53 mmol/mol) has been shown to reduce microvascular complications of type 1 and type 2 diabetes when instituted early in the course of disease.
“Therefore, achieving A1C targets of <7% (53 mmol/mol) has been shown to reduce microvascular complications of type 1 and type 2 diabetes when instituted early in the course of disease (2,48).”
From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [48]
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References 34 · Cited by 175
Research works printed but not linked: 1
- [12]National Institute for Health and Care Excellence. Type 1 diabetes in adults: diagnosis and management NICE guideline 26 August 2015 www.nice.org.uk/guidance/ng17 accessed 2019 Jul 9. 26334079
- Authors
- Lind, M., Pivodic, A., Svensson, A.-M., Ólafsdóttir, A. F., Wedel, H., & Ludvigsson, J.
- Affiliations
- NU Hospital Group (SE)
- Region Västra Götaland (SE)
- University of Gothenburg (SE)
- Linköping University (SE)
- Corresponding author
- Lind, Marcus
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2019-08-28
- Volume
- 366
- Pages
- l4894
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC6712507
- OpenAlex
- W2971251202
- Cited by
- 175
- References
- 34
- Citations by year
- 2026: 15 · 2025: 23 · 2024: 25 · 2023: 30 · 2022: 26 · 2021: 33 · 2020: 22 · 2019: 1
- FWCI
- 16.63
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DiVA (Linkoping University) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Novo Nordisk Fonden (NNF15OC0015260)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Keywords
- HbA1c, type 1 diabetes, diabetic retinopathy, diabetic nephropathy, glycemic control, risk factors, children and adults, diabetes complications
- MeSH terms
- Adolescent, Adult, Blood Glucose, Child, Diabetes Mellitus, Type 1, Diabetic Nephropathies, Diabetic Retinopathy, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Male, Registries, Retrospective Studies, Risk Factors, Sweden, Young Adult
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