Clinical profile of long-term survivors and non-survivors with type 1 diabetes in India.

Objective To compare the clinical profile of long-term survivors and non-survivors with T1D(T1D) in India. Research design and methods This is a retrospective study of 76 individuals with T1D who had survived for at least 40 years ('survivors') and 51 individuals with T1D who had died with shorter duration of diabetes ('non-survivors'), from diabetes clinics in different cities of India. Prevalence of complications in both groups and causes of death of the non-survivors were analyzed. Retinopathy was diagnosed by retinal photography; chronic kidney disease (CKD) by urinary albumin excretion (micro- or macroalbuminuria) and estimated glomerular filtration rate; peripheral vascular disease (PVD) by Doppler measurement of ankle-brachial pressure index; coronary artery disease (CAD) based on history of myocardial infarction or coronary revascularization and neuropathy by biothesiometry. Results Mean glycated hemoglobin (8.4±1.5 vs 10.7±2.2%, p<0.001), serum low density lipoprotein-cholesterol (91±29 vs 107±22mg/dl, p=0.004) and systolic blood pressure (135±16 vs 153±37mmHg, p=0.003) were lower, and high density-lipoprotein cholesterol (51±11 vs 43±15mg/dl, p=0.002) higher, among survivors compared to non-survivors. Diabetic retinopathy, CKD, neuropathy, PVD and CAD were more frequent among non-survivors. CAD [25.5%] and renal failure [23.5%] were the most frequent causes of death. Conclusions In this first report of long-term survivors with T1DM from India, we report that survivors had better glycemic and blood pressure control, more favorable lipid profiles and lower prevalence of complications compared to non-survivors. However, there could be other protective factors as well, which merit further studies.