Incidence rate patterns, cumulative incidence, and time trends for moderate and severe albuminuria in individuals diagnosed with type 1 diabetes aged 0-14 years : a population-based retrospective cohort study

Background The incidence and temporal trends of moderate and severe albuminuria during recent decades are poorly described in type 1 diabetes. We aimed to assess diabetes duration-specific incidence rates, cumulative incidence, and secular trends of albuminuria in type 1 diabetes in Finland. Methods We conducted a population-based, retrospective cohort study of a stratified random sample (n=1500) of all individuals diagnosed with type 1 diabetes before age 15 years during 1970-99 in Finland. The sampling frame was the database of the Finnish Institute for Health and Welfare. Individuals with an atypical clinical course, presentation of non-diabetic kidney disease, insufficient albumin excretion rate measurements, or unavailable medical records were excluded (final sample n=1430). Study participants were followed up until death, the event of interest (moderate or severe albuminuria or kidney failure), or the most recent event-free date. Medical records retrieved up to Dec 31, 2020 were systematically reviewed for albuminuria determinations. Moderate and severe albuminuria were categorised on the basis of international reference limits (two of three consecutive urine samples). Kidney failure was defined as dialysis treatment or kidney transplant. Cohorts defined by calendar year of diabetes diagnosis (1970-79, 1980-89, and 1990-99) were assessed. Patterns of duration-specific incidences were evaluated by fitting generalised additive models to the data, which were split into multiple observations of half-year duration. Cumulative incidences were calculated with Kaplan-Meier analysis. In analyses with kidney failure as the endpoint, competing risk for mortality was incorporated. Findings In our stratified random sample, 462 individuals were diagnosed with diabetes in 1970-79, 481 were diagnosed in 1980-89, and 487 were diagnosed in 1990-99. The incidence rate pattern of severe albuminuria changed over time; a peak at 15-19 years since diabetes onset in the 1970-79 cohort was not replicated in those diagnosed later. In the combined 1980-99 diagnosis-year cohorts, the incidence rate rose during the first 14 years after diabetes onset, after which it levelled off to a plateau. Between the 1970-79 and 1980-89 diabetes diagnosis cohorts, the cumulative incidence of severe albuminuria had approximately halved (hazard ratio [HR] 0.55 [95% CI 0.42-0.72] with the 1970-79 cohort as reference, p Interpretation Our analyses show that the cumulative incidence of severe albuminuria has decreased between 1970-79 and 1980-99; however, whether this decrease solely denotes a delay in albuminuria, or also a true prevention of albuminuria, needs to be investigated further. Nevertheless, diabetic kidney disease remains a significant complication of type 1 diabetes. Due to the robust association of diabetic kidney disease with premature mortality, novel therapies to improve prognosis are needed. Copyright (C) 2022 Elsevier Ltd. All rights reserved.Peer reviewe

Exercise and nutrition in type 1 diabetes : Insights from the FinnDiane cohort

Type 1 diabetes is a challenging disease, characterized by dynamic changes in the insulin need during life periods, seasons of the year, but also by everyday situations. In particular, changes in insulin need are evident before, during and after exercise and having meals. In the midst of different life demands, it can be very burdensome to achieve tight glycemic control to prevent late diabetes complications, and at the same time, to avoid hypoglycemia. Consequently, many individuals with type 1 diabetes are faced with diabetes distress, decreasing profoundly their quality of life. Today, the nationwide Finnish Diabetic Nephropathy (FinnDiane) Study, launched in 1997, has gathered data from more than 8,000 well-characterized individuals with type 1 diabetes, recruited from 93 centers all over Finland and has established its position as the world's leading project on studying complications in individuals with type 1 diabetes. Studying risk factors and mechanisms of diabetes complications is inconceivable without trying to understand the effects of exercise and nutrition on glycemic control and the development of diabetes complications. Therefore, in this paper we provide findings regarding food and exercise, accumulated during the 25 years of studying lives of Finnish people with type 1 diabetes.Peer reviewe

Long-term population-based trends in the incidence of cardiovascular disease in individuals with type 1 diabetes from Finland : a retrospective, nationwide, cohort study

Background Cardiovascular disease is the main determinant of premature mortality in patients with type 1 diabetes. However, time trends regarding different types of cardiovascular disease in childhood-onset type 1 diabetes with a long timespan from the diagnosis of diabetes are not well established. This study aimed to investigate the cumulative incidence of cardiovascular disease in individuals with type 1 diabetes in a population-based cohort in Finland, the country with the world's highest incidence of type 1 diabetes. Methods In this retrospective, nationwide registry-based, cohort study, all patients who were diagnosed between Jan 1, 1965, and Dec 31, 1999 with type 1 diabetes when they were younger than 15 years old in Finland were followed up and monitored for the occurrence of cardiovascular disease (including coronary artery disease, stroke, peripheral artery disease, and heart failure) until the end of 2016 and for cardiovascular disease mortality until 2017. Cumulative incidences of cardiovascular disease were calculated by the Fine and Gray method according to the year of diabetes diagnosis using six diagnosis cohorts: 1965-69, 1970-74, 1975-1979, 1980-84, 1985-89, 1990-94, and 1990-95. Trends in cardiovascular disease event rates were analysed by Fine and Gray competing risks regression models using year of diabetes diagnosis as continuous variable. In addition, non-linearity in trends was assessed with restricted cubic splines. The excess risk of coronary artery disease and stroke was estimated by comparison with the risk in the Finnish general population by calculating standardised incidence ratios (SIRs) and their time trends. The data for Finnish general population were drawn from the Cardiovascular Disease Register of the National Institute of Health and Welfare. The SIRs were calculated as ratios of observed and expected number of events in individuals with type 1 diabetes during 1991-2014. Findings 11 766 individuals were included in this study. During 361 033 person-years of follow-up and a median of 29.6 years (IQR 22.3-37.9) follow-up, a total of 1761 individuals had single or multiple types of cardiovascular disease events. 2686 events (864 [32.2%] coronary artery disease events, of which 663 were acute myocardial infarctions; 497 [18.5%] strokes; 854 [31.8%] peripheral artery diseases, of which 498 were lower extremity amputations; and 471 [17.5%] heart failure events) were reported until Dec 31, 2016, and 1467 deaths until Dec 31, 2017. Cardiovascular disease risk decreased linearly by 3.8% (hazard ratio [HR] 0.96 [95% CI 0.96-0.97]; p Interpretation The risk of cardiovascular disease has decreased over time in Finland in individuals with childhood onset type 1 diabetes. However, there is still considerable excess cardiovascular disease risk in individuals with type 1 diabetes compared with the general population. These results highlight the need for studies on the mechanisms of atherosclerosis from the time of diagnosis of type 1 diabetes to facilitate early and effective prevention of cardiovascular disease in these individuals. Copyright (C) 2021 Elsevier Ltd. All rights reserved.Peer reviewe

Familial aggregation of type 1 diabetes and diabetic nephropathy in Finland

Type 1 diabetes (T1D) is a common, multifactorial disease with strong familial clustering. In Finland, the incidence of T1D among children aged 14 years or under is the highest in the world. The increase in incidence has been approximately 2.4% per year. Although most new T1D cases are sporadic the first-degree relatives are at an increased risk of developing the same disease. This study was designed to examine the familial aggregation of T1D and one of its serious complications, diabetic nephropathy (DN). More specifically the study aimed (1) to determine the concordance rates of T1D in monozygotic (MZ) and dizygotic (DZ) twins and to estimate the relative contributions of genetic and environmental factors to the variability in liability to T1D as well as to study the age at onset of diabetes in twins; (2) to obtain long-term empirical estimates of the risk of T1D among siblings of T1D patients and the factors related to this risk, especially the effect of age at onset of diabetes in the proband and the birth cohort effect; (3) to establish if DN is aggregating in a Finnish population-based cohort of families with multiple cases of T1D, and to assess its magnitude and particularly to find out whether the risk of DN in siblings is varying according to the severity of DN in the proband and/or the age at onset of T1D: (4) to assess the recurrence risk of T1D in the offspring of a Finnish population-based cohort of patients with childhood onset T1D, and to investigate potential sex-related effects in the transmission of T1D from the diabetic parents to their offspring as well as to study whether there is a temporal trend in the incidence. The study population comprised of the Finnish Young Twin Cohort (22,650 twin pairs), a population-based cohort of patients with T1D diagnosed at the age of 17 years or earlier between 1965 and 1979 (n=5,144) and all their siblings (n=10,168) and offspring (n=5,291). A polygenic, multifactorial liability model was fitted to the twin data. Kaplan-Meier analyses were used to provide the cumulative incidence for the development of T1D and DN. Cox s proportional hazards models were fitted to the data. Poisson regression analysis was used to evaluate temporal trends in incidence. Standardized incidence ratios (SIRs) between the first-degree relatives of T1D patients and background population were determined. The twin study showed that the vast majority of affected MZ twin pairs remained discordant. Pairwise concordance for T1D was 27.3% in MZ and 3.8% in DZ twins. The probandwise concordance estimates were 42.9% and 7.4%, respectively. The model with additive genetic and individual environmental effects was the best-fitting liability model to T1D, with 88% of the phenotypic variance due to genetic factors. The second paper showed that the 50-year cumulative incidence of T1D in the siblings of diabetic probands was 6.9%. A young age at diagnosis in the probands considerably increased the risk. If the proband was diagnosed at the age of 0-4, 5-9, 10-14, 15 or more, the corresponding 40-year cumulative risks were 13.2%, 7.8%, 4.7% and 3.4%. The cumulative incidence increased with increasing birth year. However, SIR among children aged 14 years or under was approximately 12 throughout the follow-up. The third paper showed that diabetic siblings of the probands with nephropathy had a 2.3 times higher risk of DN compared with siblings of probands free of nephropathy. The presence of end stage renal disease (ESRD) in the proband increases the risk three-fold for diabetic siblings. Being diagnosed with diabetes during puberty (10-14) or a few years before (5-9) increased the susceptibility for DN in the siblings. The fourth paper revealed that of the offspring of male probands, 7.8% were affected by the age of 20 compared with 5.3% of the offspring of female probands. Offspring of fathers with T1D have 1.7 times greater risk to be affected with T1D than the offspring of mothers with T1D. The excess risk in the offspring of male fathers manifested itself through the higher risk the younger the father was when diagnosed with T1D. Young age at onset of diabetes in fathers increased the risk of T1D greatly in the offspring, but no such pattern was seen in the offspring of diabetic mothers. The SIR among offspring aged 14 years or under remained fairly constant throughout the follow-up, approximately 10. The present study has provided new knowledge on T1D recurrence risk in the first-degree relatives and the risk factors modifying the risk. Twin data demonstrated high genetic liability for T1D and increased heritability. The vast majority of affected MZ twin pairs, however, remain discordant for T1D. This study confirmed the drastic impact of the young age at onset of diabetes in the probands on the increased risk of T1D in the first-degree relatives. The only exception was the absence of this pattern in the offspring of T1D mothers. Both the sibling and the offspring recurrence risk studies revealed dynamic changes in the cumulative incidence of T1D in the first-degree relatives. SIRs among the first-degree relatives of T1D patients seems to remain fairly constant. The study demonstrates that the penetrance of the susceptibility genes for T1D may be low, although strongly influenced by the environmental factors. Presence of familial aggregation of DN was confirmed for the first time in a population-based study. Although the majority of the sibling pairs with T1D were discordant for DN, its presence in one sibling doubles and presence of ESRD triples the risk of DN in the other diabetic sibling. An encouraging observation was that although the proportion of children to be diagnosed with T1D at the age of 4 or under is increasing, they seem to have a decreased risk of DN or at least delayed onset.Väitöstyön tarkoituksena oli tutkia tyypin 1 diabeteksen (T1D) sekä diabeettisen nefropatian (DN) kasautumista perheissä. Ensimmäisen osatyön tavoitteena oli tutkia monotsygoottisten että ditsygoottisten kaksosten konkordanssia T1D:n suhteen sekä määrittää geneettisten tekijöiden ja ympäristötekijöiden suhteellista osuutta T1D:n synnyssä. Toisen osatyön tarkoitus oli määrittää T1D:sta sairastavien sisarusten kumulatiivinen sairastumisriski T1D:een pitkän seuranta-ajan kuluessa. Tavoitteena oli myös selvittää riskiin vaikuttavia tekijöitä, erityisesti indeksipotilaan (probandin) sairastumisiän vaikutusta sekä eri syntymäkohorttien välisiä eroja. Kolmannen osatyön päämääränä oli tutkia, onko perheen toisella diabeetikkosisaruksella kohonnut riski sairastua diabeettiseen nefropatiaan, jos aiemmin sairastuneella sisaruksella on jo todettu tämä tauti. Tarkoituksena oli myös selvittää, vaikuttaako diabeettisen nefropatian vaikeusaste (dialyysi ja munuaisensiirto) sisarusriskiin sekä sitä, onko diabetekseen sairastumisiällä vaikutusta nefropatiariskiin. Viimeisessä osatyön tarkoitus oli tutkia T1D:ta sairastavien henkilöiden lasten diabetesriskiä longitudinaalisesti ja sitä, eroaako diabeetikkomiesten ja -naisten lasten diabetesriski. Lisäksi tutkittiin, vaikuttaako diabeetikkovanhemman sairastumisikä lapsen riskiin ja erityisesti, onko sairastumisiän vaikutus samanlainen sekä diabeetikkomiesten että diabeetikkonaisten lapsilla. Myös lasten syntymäkohortin vaikutusta tutkittiin. Kolme laajaa, väestöpohjaista aineistoa oli käytössä. Ensimmäinen aineisto sisälsi kaikki Suomessa vuosina 1958-86 syntyneet kaksosparit (nuorten kaksosten kohortti, n=22646 paria)). Toinen aineisto koostui vuosina 1965-79 T1D:een alle 18-vuotiaina sairastuneista diabeetikoista (n=5144) ja heidän sisaruksistaan (n=10168) ja kolmas aineisto koostui em. diabeetikoista ja heidän lapsistaan (n=5291). Monotsygoottisista kaksospareista 27.3 % oli konkordantteja T1D:n suhteen (molemmilla T1D), kun taas ditsygoottisista kaksospareista vain 3.8 %. Rakenneyhtälömallituksessa parhaiten sopiva malli selitti sairastumiseen liittyvää vaihtelua sekä geneettisin että yksilöllisin ympäristötekijöin ja heritabiliteetin estimaatiksi saatiin 88 %. Identtiset kaksoset sairastuivat hyvin samanikäisinä. Pisin sairastumisväli identtisillä konkordanteilla pareilla oli 6.9 vuotta. Identtisten kaksosparien sairastumisiän korrelaatio oli 0.95, kun se epäidenttisillä kaksospareilla oli 0.43. Diabeetikkojen sisarusten pitkä seuranta osoitti, että T1D:n kumulatiivinen riski 50 ikävuoteen mennessä oli 6.9 %. Riskiin vaikutti kuitenkin hyvin voimakkaasti probandin sairastumisikä. Jos probandi oli sairastunut 0-4, 5-9, 10-14 tai yli 15-vuotiaana, 40 ikävuoden kumulatiivinen riski sisaruksilla oli vastaavasti 13.2, 7.8, 4.7 ja 3.4 %. Mitä myöhäisempään syntymäkohorttiin sisarus kuului, sitä suurempi oli kumulatiivinen riski. Kuitenkin, sisarusten ja taustaväestön ilmaantuvuuksien välinen standardisoitu ilmaantuvuussuhde (SIR) oli noin 12 koko seurantajakson ajan. Perheessä myöhemmin T1D:een sairastuneella sisaruksella oli 2.3-kertainen riski sairastua DN:aan, jos ensiksi T1D:een sairastuneella oli DN. Jos probandilla oli loppuvaiheen munuaistauti (dialyysi, munuaissiirre), riski kasvoi kolminkertaiseksi. Diabetekseen sairastumisikä vaikutti riskiin siten, että suurin riski oli henkilöillä, jotka olivat sairastuneet murrosiässä tai joitakin vuosia ennen murrosikää. T1D:ta sairastavien miesten lasten kumulatiivinen riski sairastua T1D:een oli 20 ikävuoteen mennessä 7.8 %, kun taas diabeetikkonaisten lasten riski oli 5.3 %. Kaiken kaikkiaan diabeetikkomiesten lasten sairastumisriski oli 1.7-kertainen diabeetikkonaisten lasten riskiin verrattuna. Kun miesdiabeetikkojen lasten riski kasvoi sitä suuremmaksi, mitä nuorempana miesdiabeetikko oli diagnosoitu, naisdiabeetikkojen sairastumisiällä ei ollut vaikutusta lasten sairastumisriskiin. Lasten ja taustaväestön ilmaantuvuuksien välinen SIR oli noin 10 koko seurantajakson ajan, mutta kumulatiivinen riski oli sitä suurempi, mitä nuorempi syntymäkohortti oli kyseessä

Virkarikokset: Erityisesti lahjonta virkarikoksena

Valtion ja muiden julkisyhteisöjen mahdollisuus käyttää julkista valtaa kansalaisia ja muita yhteisöjä kohtaan edellyttää vastapainokseen järjestelmää, joka turvaa vallankäytön lainmukaisuuden. Virkarikoslainsäädännön tarkoituksena on määritellä virkamiesten väärinkäytökset sekä niihin liittyvät seuraamukset. Virkavastuu ja julkisen vallan käyttö ovat näin ollen vahvasti sidoksissa toisiinsa. Rikosoikeudellinen virkavastuu tarkoittaa vastuuta virkarikoksesta. Rikosoikeudellisen virkavastuun toteutuminen edellyttää, että teosta tai laiminlyönnistä on säädetty rangaistusuhka. Rikoslain 40 luvun virkarikoksia koskevat säännökset määrittelevät viranomaistoiminnan rajan sekä väärinkäytöksistä seuraavat rangaistukset. Virkarikoksista lahjusrikokset ovat vakavin väärinkäytösten muoto. Lahjusrikollisuuden seuraukset voivat olla yhteiskunnalle ja viranomaistoiminnalle merkittävät. Luottamus viranomaistoimintaan sekä yhdenvertaiseen kohteluun heikkenee jokaisen lahjustapauksen myötä. Tutkimuksessa tutkitaan virkamieheen kohdistuvan rikosoikeudellisen virkavastuun laajuutta ja virkarikoksia määritelmineen. Tutkimuksessa kysytään keihin virkarikossäännökset kohdistuvat ja mitkä seuraamukset virkarikoksista seuraavat. Tutkimuksen painopisteenä on lahjusrikokset julkisessa hallinnossa. Lahjuksen määritelmällä on tutkimuksessa tärkeä osa. Yhteiskunnallisten muutosten, kuten yksityistämisen lisääntymisen ja kunnille annettujen palvelujen tuottamisen, myötä virkamiesmääritelmä on muuttunut. Julkista valtaa uskotaan nykyään yhä enemmän henkilöille, jotka eivät ole virkasuhteessa. Tästä johtuen on ollut tarpeellista saattaa heidät rikosoikeudellisen vastuun piiriin. Vuoden 2002 virkarikosuudistus on ulottanut julkisyhteisön työntekijät sekä julkistaa valtaa käyttävät henkilöt entistä selvemmin rikosoikeudellisen vastuun piiriin. Kyseessä on hallinto-oikeudellinen, erityisesti virkamiesoikeudellinen tutkimus, josta löytyy myös rikosoikeudellisia piirteitä. Tutkimuksen ote on oikeusdogmaattinen. Tutkimuksen tehtävä on oikeuden tulkinta eli oikeusjärjestyksen sisällön selvittäminen. Tarkoituksena on tulkita rikoslain, valtion virkamieslain ja kunnallisesta viranhaltijasta annetun lain säännöksiä liittyen virkamiesten rikosoikeudelliseen vastuuseen. Myös oikeusjärjestyksen systematisointia löytyy käsitteistön erittelyn kautta. Tutkimusaineisto koostuu pääasiassa lainsäädännöstä, lainvalmisteluaineistosta, kotimaisesta oikeuskirjallisuudesta ja oikeuskäytännöstä. Oikeuskäytännön kautta pyritään tuomaan esiin erityisesti hankintaviranomaisten tekemiä lahjusrikoksia. Tutkimuksessa otetaan myös huomioon virkarikosten ja julkisten hankintojen osalta Euroopan unionin sekä kansainvälisten sopimusten vaikutus kansalliseen lainsäädäntöön. Tutkimuksen johtopäätöksenä todettiin, että yksittäisen virkamiehen on vaikea erottaa kiellettyä ja sallittua etuutta toisistaan. Lähtökohtana on, että kaikki etuudet, joilla voidaan pyrkiä tai jotka ovat omiaan vaikuttamaan vastaanottajan toimintaan palvelussuhteessa, voivat olla lahjusrikossäännöksissä tarkoitettuja etuja. Viranomaistoiminta edellyttää avoimuutta ja läpinäkyvyyttä, jotta kansalaisilla on mahdollisuus arvioida viranomaistoiminnan puolueettomuutta. Lahjusten ottamista koskevilla säännöksillä on haluttu turvata kansalaisten luottamus ja virkatointen riippumattomuus epäasiallisista vaikuttimista. Virkamiehille tarjottujen kestitysten ja matkojen tarpeellisuus tulisi arvioida kyseisen virkamiehen viranhoidon kannalta ja samalla pohtia niiden vaikutusta virkatehtäviin.fi=Opinnäytetyö kokotekstinä PDF-muodossa.|en=Thesis fulltext in PDF format.|sv=Lärdomsprov tillgängligt som fulltext i PDF-format

The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes : A Longitudinal Follow-up. Diabetes Care 2018;41:2487-2494 Response

Non peer reviewe

Perceived Stress and Adherence to the Dietary Recommendations and Blood Glucose Levels in Type 1 Diabetes

Stress may negatively impact self-management of diabetes and thereby deteriorate glycaemic control. Eating is the most frequently reported stress-release method. In this study, we investigated the association between perceived stress (PS), dietary adherence, and glycaemic control. Data from participants in the FinnDiane Study with type 1 diabetes who had completed a diet questionnaire and Cohen's perceived stress scale (PSS) were included. In addition to using a continuous PSS score, participants were divided into three groups based on the PSS scores: the first PSS quartile, low levels of PS; second and third quartiles, moderate levels of PS; and fourth quartile, high levels of PS. A diet score reflecting the level of adherence to dietary recommendations was calculated. Analyses were conducted in the whole sample and in subgroups divided by body mass index (BMI = 25 kg/m(2)). In the whole sample, high PS and continuous stress score were negatively associated with the diet score and with adherence to fish, fresh vegetable, low-fat liquid milk product, and vegetable oil-based cooking fat recommendations. The stress score was negatively associated with the diet score both in lean and in those overweight or obese. However, fish and fresh vegetable recommendations were only affected in those with corpulence. PS was not associated with mean blood glucose concentrations in the whole sample. When divided by BMI status, worse glycaemic control was observed in lean subjects reporting stress. In individuals with overweight or obesity, instead, high glucose concentrations were observed regardless of the level of perceived stress. Interventions to improve stress management could improve dietary adherence and glycaemic control and could thereby have the potential to improve long-term health and well-being of individuals with type 1 diabetes.Peer reviewe

Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study

Objective To examine short and long term time trends in mortality among patients with early onset (age 0-14 years) and late onset (15-29 years) type 1 diabetes and causes of deaths over time

Waist-Height Ratio and the Risk of Severe Diabetic Eye Disease in Type 1 Diabetes : A 15-Year Cohort Study

Context: Obesity prevalence has increased in type 1 diabetes (T1D). However, the relationship between body composition and severe diabetic eye disease (SDED) is unknown. Objective: To investigate the associations between body composition and SDED in adults with T1D. Methods: From 5401 adults with T1D in the Finnish Diabetic Nephropathy Study, we assessed 3468, and 437 underwent dual-energy X-ray absorptiometry for body composition analysis. The composite outcome was SDED, defined as proliferative retinopathy, laser treatment, antivascular endothelial growth factor treatment, diabetic maculopathy, vitreous hemorrhage, and vitrectomy. Logistic regression analysis evaluated the associations between body composition and SDED. Multivariable Cox regression analysis assessed the associations between the anthropometric measures and SDED. Subgroup analysis was performed by stages of albuminuria. The relevance ranking of each variable was based on the z statistic. Results: During a median follow-up of 14.5 (interquartile range 7.8-17.5) years, 886 SDED events occurred. Visceral/android fat ratio was associated with SDED [odds ratio (OR) 1.40, z = 3.13], as well as the percentages of visceral (OR 1.80, z = 2.45) and android fat (OR 1.28, z = 2.08) but not the total body fat percentage. Waist-height ratio (WHtR) showed the strongest association with the SDED risk [hazard ratio (HR) = 1.28, z= 3.73], followed by the waist (HR 1.01, z = 3.03), body mass index (HR 1.03, z = 2.33), and waist-hip ratio (HR 1.15, z= 2.22).The results were similar in normo- and microalbuminuria but not significant in macroalbuminuria. A WHtR >= 0.5 increased the SDED risk by 28% at the normo- and microalbuminuria stages. Conclusions: WHtR, a hallmark of central obesity, is associated with SDED in individuals with T1D.Peer reviewe