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Abstract
Objective To estimate the incidence densities and cumulative incidence of diabetes-related complications in patients with type 1 diabetes for a maximum of 15-year follow-up. The estimations were further stratified by gender and age at diagnosis (ie, early onset: 0–12 years, late onset:≥13 years).
Design A population-based retrospective longitudinal cohort study.
Setting Taiwan’s National Health Insurance medical claims.
Participants 4007 patients newly diagnosed with type 1 diabetes were identified during 1999–2012.
Outcome measures Acute complications included diabetic ketoacidosis (DKA) and hypoglycaemia. Chronic complications were cardiovascular diseases (CVD), retinopathy, neuropathy and nephropathy.
Results The incidence density of retinopathy was greatest (97.74 per 1000 person-years), followed by those of nephropathy (31.36), neuropathy (23.93) and CVD (4.39). Among acute complications, the incidence density of DKA was greatest (121.11 per 1000 person-years). The cumulative incidences of acute complications after 12 years following diagnosis were estimated to be 52.1%, 36.1% and 4.1% for DKA, outpatient hypoglycaemia and hospitalised hypoglycaemia, respectively. For chronic complications, the cumulative incidence of retinopathy after 12 years following diagnosis was greatest (65.2%), followed by those of nephropathy (30.2%), neuropathy (23.7%) and CVD (4.1%). Females with late-onset diabetes were greatly affected by advanced retinopathy (ie, sight-threatening diabetic retinopathy) and hospitalised hypoglycaemia, whereas those with early-onset diabetes were more vulnerable to DKA. Chronic complications were more commonly seen in late-onset diabetes, whereas early-onset diabetes were most affected by acute complications.
Conclusions Ethnic Chinese patients with type 1 diabetes were greatly affected by DKA and retinopathy. The incidence of diabetes-related complications differed by age at diagnosis and sex.
- DIABETES & ENDOCRINOLOGY
- EPIDEMIOLOGY
- Diabetic neuropathy
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Footnotes
Acknowledgements We gratefully thank National Cheng Kung University and its affiliated hospital for all their support.
Contributors H-TO contributed substantially to the study concept and design, acquisition of data, analysis and interpretation of data. T-YL contributed to data collection and the analysis. C-YL, J-SW and Z-JS provided statistical and clinical interpretation of the results. H-TO wrote the first draft of the manuscript, and T-YL, C-YL, J-SW and Z-JS very critically revised the manuscript. All authors gave approval for the publication of the final version.
Funding This research was supported by the following two grants: the National Cheng Kung University Hospital, Tainan, Taiwan (grant no. NCKUH 10602008), and the Ministry of Science and Technology, Taiwan (grant no. MOST 104-2320-B-006-008-MY3).
Competing interests None declared.
Patient consent This study used deidentified personal medical reimbursement claims data. The patient informed consent was waived by the the Institutional Review Board of National Cheng Kung University Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There are no additional data available in relation to this manuscript.
Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected theseerrors and the correct publishers have been inserted into the references.