Is Pubertal Onset a Risk Factor for Blindness and Renal Replacement Therapy in Childhood-Onset Type 1 Diabetes in Japan?

Abstract

We previously reported that mortality is worse for pubertal-onset type 1 diabetes than for the prepubertal-onset variety (1). Other studies have disparately reported that the risk for incipient microangiopathy in type 1 diabetic patients is higher during puberty than before puberty (2–4) or that the risk is similar (5,6). However, evidence regarding the relationship between puberty and advanced microangiopathy is limited (7). We therefore investigated the incidence of blindness and renal replacement therapy (RRT) by pubertal status at diagnosis. A total of 1,408 type 1 diabetic patients diagnosed at <18 years of age were placed on insulin therapy within 1 month of diagnosis. They were chosen from two nationwide type 1 diabetes surveys (1,8,9). The patients were either 1 ) diagnosed between 1965 and 1969 and alive as of 1 January 1970 (the 1960s cohort) or 2 ) diagnosed between 1970 and 1979 and alive as of 1 January 1980 (the 1970s cohort). Follow-up for the 1960s and 1970s cohorts was initiated on 1 January in 1970 or 1980, respectively. Diagnosis in males aged ≥12 years and females aged ≥11 years was defined as pubertal onset, as earlier reported (1,2,5,9–11). The cohorts accounted for ∼75% of all type 1 diabetic subjects in Japan (1,8,12). Status of blindness and …