Prevalence of Chronic Complications After Inaugural Admission in Intensive Care Unit for Type 1 Diabetes in the SFDT1 Cohort: The INAUGURAL Study

AIMS: Inaugural presentation at type 1 diabetes onset, as ketoacidosis, has been associated with poorer glycaemic control, but its relationship to diabetes-related complications remains unclear. We assessed the association between inaugural intensive care unit (ICU) admission and long-term diabetes-related outcomes in adults. MATERIALS AND METHODS: This cross-sectional analysis used data from the Société Francophone du Diabète-Cohorte Diabète de Type 1 (SFDT1) cohort. We compared participants with and without an inaugural ICU admission regarding chronic complications, recent acute events, and cardiometabolic risk factors. Models were adjusted for age, sex, diabetes duration, smoking status, socioeconomic vulnerability, education, insulin therapy, HbA1c, and centre; interaction terms were tested. RESULTS: Among 3548 adults with type 1 diabetes (median duration 20 years [IQR 10-30]), 377 (10.6%) reported inaugural ICU admission. Retinopathy was more prevalent in the ICU group (36.6 vs. 31.4%; p < 0.05), including proliferative forms (11.1 vs. 7.7%; p < 0.05). These differences remained significant after adjustment (p < 0.05). An association with retinopathy was observed among individuals diagnosed before the age of 17 (OR = 1.5; 95% CI, 1.1-2.1; p = 0.015). Severe hypoglycaemia in the previous year was more frequent in the ICU group (15.4% vs. 10.5%; p < 0.01) and remained significant after adjustment (p < 0.05). No significant differences were observed for the other variables. CONCLUSIONS: In this multicentre cohort of adults with long-standing type 1 diabetes, inaugural ICU was associated with at least a 50% higher odds of severe hypoglycaemia and retinopathy, including proliferative forms. The association with retinopathy was mainly observed among individuals diagnosed at a young age. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04657783).