Diabetes Mellitus at the Time for Diagnosis : Studies on Prognostic Factors

• Main Author: Martinell, Mats
• Format: Doctoral Thesis
• Language: English
• Published: Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap 2017
• Subjects: New-onset Diabetes Mellitus; socioeconomic position; epidemiology; diabetes complications; diabetic retinopathy; cellular immunology; diabetes classification; type 2 diabetes; latent autoimmune diabetes in adults (LADA); type 1 diabetes; Family Medicine; Allmän medicin
• Online Access: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-328382; http://nbn-resolving.de/urn:isbn:978-91-513-0047-4

The aim for this thesis was to identify prognostic factors for chronic diabetes complications that exist at the time of diabetes diagnosis. Low level of education (<12 years) and low income (<60% of median) was found to increase the risk to have high (>70 mmol/mol) HbA1c at the time of diagnosis with 34 % and 35 %, respectively. Prevalence of diabetic retinopathy (DR) was 12% in a cohort of patients newly diagnosed with diabetes. Diabetic macular edema was present in 11% of patients with type 2 diabetes (T2D) and 13% of those with Latent Autoimmune Diabetes in Adults (LADA). Low beta cell function and low level of education increased the risk for DR with 110% and 43%, respectively. For every unit of increase in body mass index, the risk for DR was reduced by 3%. The cellular immunology of LADA patients was a mixture of that observed in both type 1 (T1D) and T2D patients. Compared to patients with T1D, LADA patients had more B-regulatory lymphocytes and antigen presenting cells capable of producing interleukine-35. This indicates a higher anti-inflammatory capacity in LADA patients compared to type T1D patients. By imputing age, body mass index, HbA1c at diagnosis, beta cell function and insulin resistance in a cluster analysis, five distinct diabetes clusters were identified. The four clusters representing T2D patients differed in incidence of DR, nephropathy and non-alcoholic fatty liver disease. This was replicated with similar results in three geographically separate populations. By studying socioeconomic background and factors present at the time of diagnosis we can better predict prognosis for chronic diabetes complications. These findings may facilitate better-targeted diabetes screening programs and more individually tailored treatment regimes.