This cross-sectional analysis used data from the Société Francophone du Diabète-Cohorte Diabète de Type 1 (SFDT1) cohort to evaluate whether an inaugural intensive care unit (ICU) admission at the time of type 1 diabetes onset is associated with long-term diabetes-related outcomes in adults. Previous reports have linked ketoacidosis at presentation to worse subsequent glycaemic control, but the relationship between inaugural critical-care admission and chronic diabetes complications remained unclear. The INAUGURAL study aimed to compare adults with and without reported inaugural ICU admission with respect to chronic complications, recent acute events, and cardiometabolic risk factors.
The analysis included 3548 adults with type 1 diabetes drawn from the SFDT1 cohort. Median diabetes duration in the sample was 20 years with an interquartile range of 10 to 30 years. Participants were grouped according to whether they reported an inaugural ICU admission at diagnosis; 377 individuals (10.6%) reported such an admission. The study compared prevalence of chronic microvascular complications, recent acute events such as severe hypoglycaemia, and measured cardiometabolic risk factors between the two groups.
Comparative models were adjusted for potential confounders: age, sex, diabetes duration, smoking status, socioeconomic vulnerability, education level, insulin therapy, HbA1c, and study centre. Interaction terms were tested, although the abstract does not list which interactions were significant beyond the age-at-diagnosis subgroup reported for retinopathy. All reported between-group differences cited in this summary reflect results that remained significant after these adjustments unless otherwise noted.
Of the 3548 adults analysed, 377 (10.6%) reported an inaugural ICU admission. The cohort had a long median duration of diabetes (20 years), which supports assessment of chronic complications. The abstract reports comparative prevalence estimates for selected outcomes, with statistical comparisons and adjusted analyses performed to account for measured confounders.
Prevalence of retinopathy was higher in participants who had an inaugural ICU admission compared with those who did not (36.6% vs. 31.4%; p < 0.05). The prevalence of proliferative retinopathy was also higher in the ICU group (11.1% vs. 7.7%; p < 0.05). These differences persisted after multivariable adjustment, indicating an association independent of the listed covariates. A subgroup analysis by age at diagnosis identified a significant association between inaugural ICU admission and retinopathy among individuals diagnosed before age 17 (odds ratio 1.5; 95% CI 1.1–2.1; p = 0.015).
Severe hypoglycaemia in the previous year was reported more frequently among participants with inaugural ICU admission (15.4% vs. 10.5%; p < 0.01). This difference remained significant after adjustment for the covariates described above. For other chronic complications, recent acute events not specified in the abstract, and cardiometabolic risk factors evaluated in the analysis, no significant differences were observed between the ICU and non-ICU groups according to the abstract.
In this multicentre cohort of adults with long-standing type 1 diabetes, reporting an inaugural ICU admission at diabetes onset was associated with approximately 50% higher odds of both retinopathy (including proliferative forms) and severe hypoglycaemia. The retinopathy relationship was particularly noted in the subgroup of individuals diagnosed in childhood or adolescence (before age 17). These findings suggest that an initial presentation severe enough to require ICU care may identify a population at elevated long-term risk for specific microvascular complications and for severe hypoglycaemic events.
The source material for this rewrite is the abstract published on PubMed. The abstract is truncated: the final sentence that begins "The association with retinopathy was mainly obse..." is incomplete in the provided source. Therefore, more detailed information on mechanisms, additional subgroup findings, absolute risk differences, incidence rate calculations, definitions used for complications, ascertainment methods, or sensitivity analyses were not reported in the source text and cannot be inferred. Full-text review would be required to evaluate temporality, potential residual confounding, and detailed methodology.
Among 3548 adults with long-standing type 1 diabetes in the SFDT1 cohort, 10.6% reported an inaugural ICU admission. Those reporting inaugural ICU admission had higher adjusted prevalence of retinopathy (including proliferative retinopathy) and higher odds of severe hypoglycaemia in the prior year. No other significant differences across the other evaluated chronic or cardiometabolic outcomes were reported in the abstract. Because the abstract is truncated and lacks full methodological detail in the provided source, readers should consult the full publication for complete results and context.