Adult stature and diabetic complications in patients with type 1 diabetes.

  1. Johan Wadén, MD1,2,
  2. Carol Forsblom, DMSc1,2,
  3. Lena M Thorn, MD1,2,
  4. Markku Saraheimo, MD1,2,
  5. Milla Rosengård-Bärlund, MD1,2,
  6. Outi Heikkilä, MD1,2,
  7. Kustaa Hietala, MD1,2,
  8. Ken Ong, MD, PhD3,
  9. Nicholas Wareham, MD, PhD3 and
  10. Per-Henrik Groop, MD, DMSc (per-henrik.groop{at}helsinki.fi) on behalf of the FinnDiane Study Group1,2
  1. 1Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
  2. 2Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
  3. 3MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK

    Abstract

    Objective. Short adult stature has previously been associated with cardiovascular disease but its relationship with the microvascular complications of diabetes is uncertain. Therefore, we evaluated the association between adult stature and prevalence and incidence of diabetic microvascular complications.

    Research design and methods. This cross-sectional and longitudinal study comprises 3968 adult patients with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study and 1246 adult patients from the Diabetes Control and Complications Trial (DCCT). In FinnDiane, diabetic nephropathy was defined as urinary albumin excretion ≥300 mg/24h, dialysis, or renal transplantation. Retinopathy was divided into background and proliferative (laser-treated) retinopathy. In the DCCT, original nephropathy (class 1-6) and retinopathy (ETDRS) classifications were used.

    Results. In FinnDiane, patients in the lowest quartile of adult height had increased risks of prevalent diabetic nephropathy (odds ratio 1.71, 95% confidence interval 1.44-2.02) and prevalent laser-treated retinopathy (1.66, 1.43-1.93) compared to other patients. Similarly, in the DCCT, patients in the lowest quartile of adult height had increased risks of incident diabetic nephropathy class 4-6 (hazard ratio 2.70, 95% confidence interval 1.59-4.59), and incident proliferative retinopathy (2.06, 1.15-3.71). In FinnDiane, the associations were largely explained by childhood exposure to diabetes. However, in the DCCT, where a greater proportion of patients had diabetes onset >18 years, the association with nephropathy was independent of childhood diabetes exposure.

    Conclusions. Short adult stature is associated with microvascular complications in patients with type 1 diabetes. These findings are compatible with either childhood diabetes exposure or ‘common soil’ or both as potential explanations.

    Footnotes

      • Received December 19, 2008.
      • Accepted May 5, 2009.