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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Endocrinol. | doi: 10.3389/fendo.2019.00747

LOWER INSULIN-DOSE ADJUSTED A1c (IDAA1c) IS ASSOCIATED WITH LESS COMPLICATIONS IN INDIVIDUALS WITH TYPE 1 DIABETES TREATED WITH HEMATOPOETIC STEM-CELL TRANSPLANTATION AND CONVENTIONAL THERAPY

  • 1PostGraduate Program in Medical Sciences, Department of Clinical Medicine, Universidade Federal do Ceará, Brazil
  • 2Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (HUWC-UFC), Brazil
  • 3Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto; Department of Internal Medicine, University of São Paulo Ribeirão Preto, Brazil
  • 4PostGraduate Program in Medical Sciences, Department of Clinical Medicine; PostGraduate Program in Public Health, Department of Community Health, Universidade Federal do Ceará, Brazil
  • 5Federal University of Rio de Janeiro, Brazil
  • 6Sociedade Brasileira de Diabetes, Brazil
  • 7Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo Ribeirão Preto, Brazil
  • 8Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School; Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo Ribeirão Preto, Brazil
  • 9PostGraduate Program in Medical Sciences, Department of Clinical Medicine; PostGraduate Program in Public Health, Department of Community Health,, Universidade Federal do Ceará, Brazil
  • 10Nord University, Norway
  • 11University of Oslo, Norway
  • 12Rio de Janeiro State University, Brazil

OBJECTIVE: To evaluate the association between insulin-dose adjusted A1C (IDAA1c) and microvascular complications (MC) and hypoglycemia in a representative Brazilian population of Type 1 diabetes mellitus (T1DM) patients.
RESEARCH DESIGN AND METHODS: This was a cross-sectional study based on a previous study, “Microvascular Complications in Type 1 Diabetes: a comparative analysis of patients treated with autologous nonmyeloablative hematopoietic stem-cell transplantation (AHST) and conventional medical therapy (CT)”. The 168 patients in that study (144 from CT plus 24 from AHST) were re-subdivided into two groups, according to their IDAA1c values (30 patients had IDAA1c ≤9; 138 had IDAA1c >9). Then, the prevalence of MC (diabetic renal disease, neuropathy, and retinopathy), hypoglycemia (blood glucose <60 mg/dL), and severe hypoglycemic (episode of hypoglycemia that required the assistance of another person to treat) events were compared between the groups. The groups were well-matched on these factors: duration of disease, sex, and age at the time of diagnosis of T1DM.
RESULTS: After an average of 8 years after diagnosis, only 6.6% (2/30) of the patients from IDAA1c ≤ 9 group developed any MC, whereas 21.0% (29/138) from the IDAA1c >9 group had at least one complication (p =0.044). Regarding hypoglycemic events, the proportion of individuals who reported at least 1 episode of hypoglycemia in the last month was 43.3% and 64.7% from the IDAA1c ≤9 and IDAA1c >9 groups, respectively (p=0.030). Regarding severe hypoglycemia, the proportion of patients presenting at least 1 episode in the last month and the rate of episode/patient/month were similar between groups (6.7% vs 13.2%; p= 0.535; and 0.1/patient/month vs 0,25/patient/month; p= 0.321).
CONCLUSION: In a representative Brazilian population of T1DM patients, those with IDAA1c ≤9 presented a lower frequency of MC, as well as fewer episodes of hypoglycemia, in the month prior to the analysis.

Keywords: Type 1 diabetes (T1D), IDAA1C, residual B-cell function, glycemic control, microvascular complications

Received: 08 Jun 2019; Accepted: 15 Oct 2019.

Copyright: © 2019 Saboia, Couri, Fernandes, Montenegro, Batista, Zajdenverg, Negrato, Malmegrim, Moraes, Dias, Oliveira, Akhtarh, GOMES and Montenegro Jr. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Renan M. Montenegro Jr, Universidade Federal do Ceará, PostGraduate Program in Medical Sciences, Department of Clinical Medicine; PostGraduate Program in Public Health, Department of Community Health,, Fortaleza, Ceará, Brazil, renanmmjr@gmail.com