Microvascular Complications in Patients with Type 1 Diabetes

Type 1 diabetes is associated with the development of microvascular complications including nephropathy, retinopathy, peripheral and autonomic neuropathies. Diabetic autonomic neuropathy is a serious yet under-recognised complication. It is thought that the presence of autonomic neuropathy heralds more widespread implications both in terms of cardiovascular risk and its close relationship to other microvascular complications. This study hopes to determine the relationship between autonomic neuropathy, markers of microvascular disease and cardiovascular risk. This cross-sectional analysis of the study population at a single site will consist of an initial visit when the patient will present to the clinic in a fasting state. At this visit the patient will have the following procedures: 1. Two measures of autonomic function (pupilometry and R-R variability). 2. Pulse wave analysis 3. HbA1c, EUC, B-type natriuretic peptide (BNP) and lipid levels 4. Retinal photography 5. Neurothesiometry 6. Electronic Blood pressure 7. Fitting of a 24 hour ambulatory blood pressure monitor 8. A timed overnight urine measurement of Albumin Excretion Rate 9. A 24 hour urine collection to measure Creatinine Clearance 10. Ankle Brachial Index measurement The patient will be asked to return in 12 months time and have a repeat of all the procedures.