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The aim of the study was to find out whether participation in earlier intervention had an effect on the occurrence of retinopathy in study participants. We also examined risk factors (age, sex, weight, fasting and 2 h glucose, fasting insulin, blood pressure, serum lipids) for early retinal changes. The study included 522 individuals (mean 55 years old, range 40–64 years) with impaired glucose tolerance who were randomized into intervention (weight loss, healthy diet, and physical activity, N = 265) and control groups (N = 257). Intervention lasted for median of four years in 1993–2000, after which annual follow-up visits at study clinics were conducted. In the years 2002–2006 (at least five years after stopping intervention), fundus photography was offered for all study participants in four of five study clinics. Photographs were assessed by two experienced ophthalmologists (A.A. and K.K.), masked for the group assignment. After exclusion of poor quality photographs, the data of 211 individuals (N = 113 for intervention and N = 98 for control group) were included in the present study. The occurrence of microaneurysms was significantly higher in the control (37/98, 38%) than in the intervention group (27/113, 24%; p = 0.029). In the model, including age, sex, diabetes diagnosis before the retinal assessment, body mass index (BMI), and treatment group, the odds ratio for microaneurysms was markedly lower in intervention group (OR 0.52; 0.28–0.97, p = 0.039). The only risk factor that predicted the occurrence of microaneurysms was serum triglycerides at baseline (mean ± SD 1.9 ± 0.9 vs. 1.6 ± 0.7, mmol/L, with and without microaneurysms, respectively, p = 0.003). Triglycerides associated with decreased microaneurysms in regression analysis for age, sex, fasting glucose, and intervention group (OR 1.92, p = 0.018). Lifestyle intervention in overweight and obese individuals with impaired glucose tolerance showed decreased occurrence of retinal microaneurysms. Elevated serum triglycerides were associated to the development of early diabetic microangiopathy.

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PurposeTo study the success of fundus photography in screening of diabetic retinopathy (DR) in children <18 years with type 1 diabetes (T1D) in producing gradable images.MethodsPhotographic success of black‐and‐white macula and optic disc‐centered fundus images of both eyes of each patient was graded by one observer (TG) using a slightly modified classification of ARIC. All images were taken with a digital 60° Canon CF‐60UD camera. Photography as a whole was graded as ‘complete success’ if the images of both eyes were at minimum of fairly good quality (i.e. gradable), and ‘partial success’ if the images of only one eye reached this level.ResultsOf the 213 patients photographed for the first time in 2009–2013 at the Department of Pediatrics, 121 (57%) were males. The median age of diagnosis was 8 (range, 1–16) years and at the first photography 11 (9–17) years. At the first photography, the median duration of T1D was 2.3 (range, 0.2–9.6) years and the median HbA1c was 8.5% (range, 6.3–13.8).At least partial success was reached in 153 (72%; 95%CI, 65–78) patients and complete success in 97 (46%; 95%CI, 39–52) patients. Complete success was equally common among those aged 9–10, 11–12, and 13–17 years (45%, 46% and 47%). The macula‐centered images of 177 (83%; 95%CI, 77–88) patients, and the optic‐disc centered images of 103 (48%; 95%CI, 41–55) patients were gradable in both eyes. Age at the first photography was not associated with success (p = 0.20).ConclusionsLess than half of the first fundus images achieved complete success, but over 70% achieved at least partial success when photography was performed at the age of 9–17 years. No significant associations were identified. Photography is a reliable method for screening of DR also in pediatric setting.