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Harjutsalo V.,University of Helsinki | Harjutsalo V.,Finnish National Institute for Health and Welfare | Feodoroff M.,University of Helsinki | Forsblom C.,University of Helsinki | And 2 more authors.
Diabetic Medicine | Year: 2014

Aims: Our aim was to evaluate the effect of the amount of alcohol consumption and the type of beverage on the risk of diabetic nephropathy and severe diabetic retinopathy. Methods: The alcohol consumption data were available from 3608 patients with Type 1 diabetes participating in the Finnish Diabetic Nephropathy Study (FinnDiane). We assessed the cross-sectional association between alcohol consumption and diabetic nephropathy as well as retinopathy. Patients were divided into different groups according to the amount of alcohol and the type of beverage they were consuming. Results: In the multivariate analysis, the odds ratio for nephropathy was 1.39 (95% CI 1.05-1.84) for abstainers and 2.44 (95% CI 1.49-3.99) for former users compared with light consumers. The results were similar in retinopathy, with an odds ratio of 1.42 (95% CI 1.11-1.82) for abstainers and 1.73 (95% CI 1.07-2.79) for former users. No difference between light consumers and moderate or heavy consumers was observed. Compared with wine drinkers, men consuming mostly alcoholic spirits had a higher risk of nephropathy with an odds ratio of 2.80 (95% CI 1.15-6.81). In women, there was no difference in the risk of nephropathy between the different beverage types. Alcoholic spirit consumers had a higher risk of retinopathy with an odds ratio of 2.32 (95% CI 1.35-4.00). There was no difference between wine and beer consumers. Conclusions: Alcoholic spirit drinkers carry a higher risk of nephropathy and severe retinopathy compared with wine drinkers. Lifelong abstainers and former users of alcohol have a higher risk of nephropathy and severe retinopathy compared with light consumers. © 2013 Diabetes UK.


Feodoroff M.,University of Helsinki | Harjutsalo V.,University of Helsinki | Harjutsalo V.,Finnish National Institute for Health and Welfare | Forsblom C.,University of Helsinki | And 6 more authors.
Acta Diabetologica | Year: 2015

Aims: To evaluate the effect of cumulative smoking on the development of diabetic nephropathy. Methods: Study included 3613 patients with type 1 diabetes, participating in the Finnish Diabetic Nephropathy Study. The 12-year cumulative risk of microalbuminuria, macroalbuminuria and end-stage renal disease (ESRD) was estimated for current, ex- and nonsmokers. Cox regression analyses, with multivariable adjustments for other risk factors for diabetic nephropathy, were used to evaluate the risk at different stages of diabetic nephropathy based on the cumulative amount of smoking in pack-years. Results: The 12-year cumulative risk of microalbuminuria was 18.9 % (95 % CI 14.6–23.0, P < 0.0001) for current smokers and 15.1 % (10.3–19.6, P = 0.087) for ex-smokers, compared with 10.0 % (7.8–12.1) for nonsmokers. The corresponding risks of macroalbuminuria were 14.4 % (95 % CI 10.8–17.9, P < 0.0001), 6.1 % (3.5–8.6, P = 0.082) and 4.7 % (3.0–6.4), respectively. The 12-year cumulative risk of ESRD was 10.3 % (95 % CI 8.4–12.4, P < 0.0001) for current smokers and 10.0 % (7.9–12.3, P < 0.0001) for ex-smokers, compared with 5.6 % (4.6–6.7) for nonsmokers. In the current smokers, one pack-year increased the risk of macroalbuminuria with a HR of 1.025 (1.010–1.041) and the risk of ESRD with a HR of 1.014 (1.001–1.026) compared with nonsmokers, in the fully adjusted model. In the ex-smokers, the risk of macroalbuminuria and ESRD was no different from the risk in nonsmokers after multivariable adjustment. Conclusions: Current smoking is a risk factor for the progression of diabetic nephropathy and the risk increases with the increasing dose of smoking. Ex-smokers seem to carry a similar risk of progression of diabetic nephropathy as nonsmokers. © 2015 Springer-Verlag Italia


Harjutsalo V.,University of Helsinki | Harjutsalo V.,Finnish National Institute for Health and Welfare | Maric C.,University of Mississippi Medical Center | Forsblom C.,University of Helsinki | And 4 more authors.
Diabetologia | Year: 2011

Aims/hypothesis: This study examined sex-related differences in the cumulative risk of proliferative retinopathy (PR) and end-stage renal disease (ESRD) over 40 years of duration of type 1 diabetes according to age at diabetes onset. Methods: We assessed 4,416 patients from the Finnish Diabetic Nephropathy Study population. Kaplan-Meier analysis was used to provide cumulative incidence rates and Cox regression analyses for HRs. Results: There were no sex-related differences in the cumulative incidence of ESRD in patients diagnosed with type 1 diabetes between 0 to 4 and 5 to 9 years. Thereafter the risk started to diverge. The cumulative incidence of ESRD in patients diagnosed between 10 to 14 and ≥15 years was 17.4% (95% CI 13.4-21.2) and 13.0% (9.6-16.2) respectively in women, while in men it was 32.2% (28.0-36.1) and 24.6% (20.8-28.1) respectively. The respective HRs were (onset at 10 to 14 years) 1.9 (p < 0.0001) and (onset at ≥15 years) 1.8 (p < 0.001), respectively. There was no difference in the risk of PR between men and women diagnosed between 0 and 4 years of age, but progressive sex-related differences in the cumulative incidence of PR were observed with increasing age at onset. The HRs for men in the age-at-onset groups 5 to 9, 10 to 14 and ≥15 years of age were 1.3 (95% CI 1.0-1.6), 1.3 (1.1-1.6) and 2.1 (1.6-2.6) compared with women in these groups, respectively. Conclusions/interpretation: The difference between the sexes with regard to risk of diabetic microvascular complications is highly dependent on the age at onset of diabetes. The risk of ESRD and PR risk doubled in men compared with women when age at onset was ≥15 years. © 2011 Springer-Verlag.


Hietala K.,Folkhalsan Institute of Genetics | Hietala K.,University of Helsinki | Forsblom C.,Folkhalsan Institute of Genetics | Forsblom C.,University of Helsinki | And 4 more authors.
Diabetic Medicine | Year: 2012

Aims The siblings first affected by Type1 diabetes (probands) within a sibship have been shown to have a lower age at onset of Type1 diabetes compared with their later-affected siblings. The aim of the present study was to investigate whether this difference affects the long-term risk of proliferative diabetic retinopathy. Methods A cohort of 396 siblings with Type1 diabetes in 188 sibships was drawn from a larger Finnish Diabetic Nephropathy Study population (4800 patients). Ophthalmic records were obtained for 369/396 (93%) patients. Retinopathy was graded based on fundus photographs and/or repeated ophthalmoscopies. Results The median age at onset of Type1 diabetes was 8.4 (interquartile range 4.2-13.3) years in probands and 16.9 (interquartile range 10.2-27.8) years in later-affected siblings (P<0.001). Proliferative retinopathy was diagnosed in 115/369 (31%) patients. The cumulative incidence estimates for proliferative retinopathy, accounting for the competing risk of death, were 21% (95%CI 15-27) in probands and 26% (95%CI 19-35) in later-affected siblings at 20years of diabetes duration, and the respective 30years' incidences were 37% (95%CI 29-45) and 53% (95%CI 40-64), (P=0.05, Gray's test). The risk of proliferative retinopathy, adjusted for conventional risk factors, age at onset and sibship size, was higher in later-affected siblings [hazard ratio 1.75 (95%CI 1.13-2.75), P=0.01] compared with their probands. Conclusion The siblings first affected by Type1 diabetes had a better long-term prognosis with regards to development of proliferative retinopathy compared with their later-affected siblings. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.


Gordin D.,University of Helsinki | Bernardi L.,University of Helsinki | Bernardi L.,University of Pavia | Rosengard-Barlund M.,University of Helsinki | And 7 more authors.
Acta Diabetologica | Year: 2016

Aims: Although oxygen is commonly used to treat various medical conditions, it has recently been shown to worsen vascular function (arterial stiffness) in healthy volunteers and even more in patients in whom vascular function might already be impaired. The effects of oxygen on arterial function in patients with type 1 diabetes (T1D) are unknown, although such patients display disturbed vascular function already at rest. Therefore, we tested whether short-term oxygen administration may alter the arterial function in patients with T1D. Methods: We estimated arterial stiffness by augmentation index (AIx) and the pulse wave velocity equivalent (SI-DVP) in 98 patients with T1D and 49 age- and sex-matched controls at baseline and during hyperoxia by obtaining continuous noninvasive finger pressure waveforms using a recently validated method. Results: AIx and SI-DVP increased in patients (P < 0.05) but not in controls in response to hyperoxia. The increase in AIx (P = 0.05), systolic (P < 0.05), and diastolic (P < 0.05) blood pressure was higher in the patients than in the controls. Conclusions: Short-term oxygen administration deteriorates arterial function in patients with T1D compared to non-diabetic control subjects. Since disturbed arterial function plays a major role in the development of diabetic complications, these findings may be of clinical relevance. © 2015, Springer-Verlag Italia.

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