Long term complications in juvenile diabetes mellitus

..........................................................................................................................1 Swedish summary / Svensk sammanfattning................................................................3 Original publications.......................................................................................................5 Background......................................................................................................................7 Classification of diabetes mellitus...............................................................................7 Pathogenesis of Type 1 diabetes mellitus ...................................................................7 Epidemiology ..............................................................................................................8 Late complications ......................................................................................................8 History...................................................................................................................8 Classification.........................................................................................................9 Macrovascular complications................................................................................9 Microvascular complications ..............................................................................10 Diabetic nephropathy ....................................................................................10 Diabetic retinopathy ......................................................................................12 Diabetic neuropathy ......................................................................................13 Risk factors..........................................................................................................16 C-peptide ...................................................................................................................20 Mortality....................................................................................................................22 Ethical considerations ...............................................................................................23 Aims of the study ...........................................................................................................25 Methods .......................................................................................................................27 Study population .......................................................................................................27 Design .......................................................................................................................30 Definitions and laboratory methods ..........................................................................31 Retinopathy .........................................................................................................31 Nephropathy ........................................................................................................31 Neuropathy ..........................................................................................................31 Metabolic control ................................................................................................32 Cardiovascular risk factors..................................................................................33 C-peptide secretion..............................................................................................33 Partial remission..................................................................................................34 Diabetic ketoacidosis...........................................................................................34 Statistical analysis .....................................................................................................34 Results .......................................................................................................................35 Incidence of diabetic retinopathy and nephropathy ..................................................35 Risk factors for retinopathy and nephropathy ...........................................................38 Metabolic control ......................................................................................................39 Diabetic complications in patients with intensive treatment from onset of diabetes 41 Clinical characteristics of patients at onset of diabetes during 25 years ...................42 Secular trend of diabetes partial remission and C-peptide secretion ........................42 C-peptide secretion and metabolic control................................................................45 Mortality....................................................................................................................47 Discussion.......................................................................................................................49 Study population .......................................................................................................49 Statistical methods.....................................................................................................49 Definitions of long term complications.....................................................................50 Laboratory methods...................................................................................................51 Incidence and prevalence of long term complications ..............................................51 Risk factors................................................................................................................53 Clinical picture at diagnosis ......................................................................................55 C-peptide secretion and partial remission .................................................................56 Conclusion......................................................................................................................57 Future research ..........................................................................................................58 Acknowledgements........................................................................................................59 References ......................................................................................................................61 Papers I IV