Adult Stature and Diabetes Complications in Patients With Type 1 Diabetes: The FinnDiane Study and the Diabetes Control and Complications Trial

Johan Wadén; Carol Forsblom; Lena M. Thorn; Markku Saraheimo; Milla Rosengård-Bärlund; Outi Heikkilä; Kustaa Hietala; Ken Ong; Nicholas Wareham; Per-Henrik Groop


Diabetes. 2009;58(8):1914-1920. 

In This Article

Abstract and Introduction


Objective: Short adult stature has previously been associated with cardiovascular disease, but its relationship with the microvascular complications of diabetes is uncertain. Therefore, we evaluated the association between adult stature and prevalence and incidence of diabetic microvascular complications.
Research Design and Methods: This cross-sectional and longitudinal study comprises 3,968 adult patients with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study and 1,246 adult patients from the Diabetes Control and Complications Trial (DCCT). In FinnDiane, diabetic nephropathy was defined as urinary albumin excretion ≥300 mg/24 h, dialysis, or renal transplantation. Retinopathy was divided into background and proliferative (laser-treated) retinopathy. In the DCCT, original nephropathy (class 1-6) and retinopathy (Early Treatment of Diabetic Retinopathy Study) classifications were used.
Results: In the FinnDiane study, patients in the lowest quartile of adult height had increased risks of prevalent diabetic nephropathy (odds ratio [OR] 1.71, 95% CI 1.44-2.02) and prevalent laser-treated retinopathy (1.66, 1.43-1.93) compared with other patients. Similarly, in the DCCT, patients in the lowest quartile of adult height had increased risks of incident diabetic nephropathy class 4-6 (hazard ratio 2.70, 95% CI 1.59-4.59) and incident proliferative retinopathy (2.06, 1.15-3.71). In the FinnDiane study, the associations were largely explained by childhood exposure to diabetes. However, in the DCCT, where a greater proportion of patients had diabetes onset >18 years, the association with nephropathy was independent of childhood diabetes exposure.
Conclusions: Short adult stature is associated with microvascular complications in patients with type 1 diabetes. These findings are compatible with either childhood diabetes exposure or "common soil" or both as potential explanations.


Despite advances in the treatment of patients with type 1 diabetes, diabetic complications are still a major concern as the main cause of morbidity and mortality in patients with type 1 diabetes. The most devastating complication is diabetic nephropathy, which is associated with a markedly increased risk of end-stage renal failure, cardiovascular disease,[1] and premature death.[2]

To prevent or delay the development of diabetic complications, the identification of high-risk patients who would benefit from intensive treatment and follow-up is crucial. Established risk factors for diabetic nephropathy include poor glycemic control, duration of diabetes, microalbuminuria, hypertension, male sex, ethnicity, and smoking.

Epidemiological observations indicate that short adult stature is associated with adverse health outcomes, particularly with cardiovascular disease.[3] Short stature has also been associated with hypertension and early arterial stiffening,[4] impaired glucose tolerance,[5] type 2 diabetes,[6] gestational diabetes,[7] and pre-eclampsia.[8] Short stature may be a marker of unfavorable fetal development and subsequent impaired growth in early childhood, factors that are associated with chronic disease in adulthood.[9] The pathogenesis of diabetic complications shares several potential mechanisms with these conditions, mainly endothelial dysfunction, chronic low-grade inflammation, and insulin resistance. We recently showed that pre-eclampsia is a risk factor for later development of diabetic nephropathy in women with type 1 diabetes.[10] However, the association between short stature and diabetic complications is uncertain.[11,12] Therefore, we evaluated this association in two large cohorts of patients with type 1 diabetes: the Finnish Diabetic Nephropathy (FinnDiane) Study and the Diabetes Control and Complications Trial (DCCT).


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