A community-based follow-up study on diabetic retinopathy among type 2 diabetics in Kinmen

Abstract

The purpose of this follow-up study was conducted to assess the incidence and risk factors of diabetic retinopathy (DR) among type 2 diabetics in Kinmen, Taiwan. A penal of eye screening regimes were performed yearly for 971 type 2 diabetics by two senior ophthalmologists using indirect ophthalmoscopy and 45-degree color fundus photography to examine fundus after dilating pupils from 1999 to 2002. 74.7% (725/971) of diabetics had been screened at least two times during this period. Among the 548 type 2 diabetics who had no DR at first screening, 93 subjects developed any type of DR. The 3-year 18.2% cumulative incidence was (95% CI: 14.8-21.5%) and incidence density was 6.62% per year (95% CI: 5.36-8.06% per year). Using Cox regression model, HbAlc revealed the significantly dose response relationship to the development of DR (chi2-test for trend = 9.41, p < 0.05) after controlling for confounding factors. Other independent predictors related to the development of DR included duration of diabetes (RR: 1.09, 95% CI: 1.05-1.13), higher systolic blood pressure (>140 vs. < 140 mm Hg, RR: 1.96, 95% CI: 1.23-3.12), and higher triglyceride (> 200 vs. < 200 mg/dl, RR: 1.60, 95% CI: 1.01-2.54). In conclusion, in addition to poor glycemic control of which is the most significant risk factor for the development of DR, longer duration of diabetes, higher systolic blood pressure, and elevated serum triglyceride levels were also associated with the development of DR among type 2 diabetics in Kinmen.

Retinopathy among Chinese subjects with type 2 diabetes mellitus in Shanghai: A community‐based follow‐up study

“…Consistent with previous studies, we demonstrated that the serum triglyceride level was also an independent factor associated with both the incidence and regression of DR in Chinese diabetic patients. Our data showed that the incidence of DR in patients with hyperlipidaemia was 1.46‐fold that of patients with normal serum triglycerides, which was consistent with the findings of a population‐based study performed in Kinmen . Correspondingly, the independent association between low serum triglyceride levels and DR regression supported data from a previous randomized case trial in which oral atorvastatin therapy reduced the severity of hard exudates from macular oedema in type 2 diabetic patients with dyslipidemia .…”

“…Our data showed that the incidence of DR in patients with hyperlipidaemia was 1.46-fold that of patients with normal serum triglycerides, which was consistent with the findings of a population-based study performed in Kinmen. 39 Correspondingly, the independent association between low serum triglyceride levels and DR regression supported data from a previous randomized case trial in which oral atorvastatin therapy reduced the severity of hard exudates from macular oedema in type 2 diabetic patients with dyslipidemia. 40 As demonstrated in the abovementioned studies, lipid metabolism plays an important role alongside glucose metabolism in both the incidence and regression of DR.…”

“…Our univariate analyses showed that patient age and duration of diabetes were significantly related to DR. The United Kingdom Prospective Diabetes Study likewise demonstrated that DR progression was associated with older age, whereas other studies found no such association on univariate analyses . Additionally, certain studies have shown that the duration of diabetes is positively associated with DR, while other studies found no such relationship .…”

“…The United Kingdom Prospective Diabetes Study likewise demonstrated that DR progression was associated with older age, 42 whereas other studies found no such association on univariate analyses. 30,39 Additionally, certain studies have shown that the duration of diabetes is positively associated with DR, 34,38 while other studies found no such relationship. 12,35 Nevertheless, neither of these two factors showed any independent associations with DR in our own multivariate analyses.…”

Assessing the Natural Course of Diabetic Retinopathy: A Population-Based Study in Kinmen, Taiwan

“…Seventeen cases were deceased; 229 cases had moved away or refused further participation. 11 The baseline information for type 2 diabetic subjects with diabetic retinopathy at the initial screening is shown in Table 1. …”