30-Year Trends in Microvascular Complications and Treatment in Adolescents With Type 1 Diabetes

Calligaro, LI; Liew, G; Cho, YH; Allen, DW; Pryke, A; Cusumano, J; Chan, A; Craig, ME; Donaghue, KC

doi:10.2337/dc26-0388

Type 1 diabetes

30-Year Trends in Microvascular Complications and Treatment in Adolescents With Type 1 Diabetes

Diabetes CarePublished 8 Jul 2026Repeated cross-sectional study

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Authors' conclusion

Diabetes complications decreased then plateaued over time.

Study context

Population: Adolescents aged 12–20 years with T1D, diabetes duration ≥5 years
Participants: 2,761 adolescents5,487 visits

Exposure: Decades T1 vs T2 vs T3
Outcome: Microvascular complications: retinopathy, albuminuria, peripheral and autonomic nerve function (pupil size and HRV)

Methodological detailsgeneralized estimating equations

Generalized estimating equations

Main finding

As reported in the abstract

Microvascular complications by decade

Retinopathy: T1 40%, T2 21%, T3 20%: P < 0.001
Early elevation of mean albumin-to-creatinine ratio (ACR): T1 35%, T2 29%, T3 28%: P = 0.009
Peripheral nerve abnormality: T2 35%, T3 28%: P = 0.007
HRV abnormality: T2 37%, T3 38% (unchanged): P = 0.884
Albuminuria: T1 6%, T2 4%, T3 4% (unchanged): P = 0.164

Observational data: associations, not effects.

Further findings

HbA1c <7.0%

T17.4%

T29.6%

T314.1%

Outcome	← Lower odds with twice-daily insulin ←→ Higher odds with twice-daily insulin →	OR	P value
Retinopathy, twice-daily insulinvs MDI/CSIIMultivariable model	0.512	1.59 (95% CI 1.23–2.06)	P < 0.001
Early elevation of AER, twice-daily insulinvs MDI/CSIIMultivariable model	0.512	1.26 (CI 1.06–1.48)	P = 0.007
	0.512Odds ratio (log scale)

Higher HbA1c coefficient of variation (CV) and complications (adjusted for mean intrapersonal HbA1c)

	← Lower odds ←→ Higher odds →	OR (CI)	P value
Early elevation of AER/ACR	0.512	1.27 (1.05–1.53)	P = 0.015
Albuminuria	0.512	1.26 (1.04–1.52)	P = 0.018
HRV abnormality	0.512	1.49 (1.08–2.05)	P = 0.015
	0.512Odds ratio (log scale)

HbA1c <7.0%

Multiple daily injection (MDI)/continuous subcutaneous insulin infusion (CSII) use increased over time

Original publication

30-Year Trends in Microvascular Complications and Treatment in Adolescents With Type 1 Diabetes. Diabetes Care. Published 8 July 2026. doi:10.2337/dc26-0388

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