Complication-Free Duration and the Risk of Development of Retinopathy in Elderly Diabetic Patients

Abstract

Background: Determining which diabetic patients are at risk for complications and targeting these patients for intensive therapy may avoid the unwanted consequences of hypoglycemia in low-risk patients. Since aging is associated with a decrease in the incidence of diabetic retinopathy, we assessed whether long complicationfree duration can define elderly patients at lower risk for future development of diabetic retinopathy. Methods: In a 10-year clinic-based study, we studied 833 type 2 diabetic patients who were free of diabetic retinopathy and older than 50 years, followed up for more than 4 years. Data included demographic and clinical information on arrival, updated every 3 to 6 months, and yearly direct ophthalmoscopic examination after pupillary dilation by experienced ophthalmologists. All the data were prospectively compiled on relational databases. End points studied were presence of retinopathy, nephropathy, peripheral neuropathy, peripheral vascular disease, hyperlipidemia, and hypertension. Results: Of the patients without retinopathy at the age of 50 years, 10% developed retinopathy during 4 years of follow-up. These patients had longer duration and younger onset of diabetes than the group without retinopathy at the 4-year follow-up. Clustering of microvascular and macrovascular complications was noted. Discriminant analysis showed the following factors to be significant and independent predictors of the development of retinopathy in the elderly: duration of diabetes, body mass index, age, and glucose control. Conclusions: A long complication-free period does not define elderly patients with type 2 diabetes who are at lower risk for future development of retinopathy. On the contrary, the increase in disease duration is significantly associated with the development of retinopathy in this age group, as described in younger patients.

Is Prevalence of Retinopathy Related to the Age of Onset of Diabetes? Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Report No. 5

“…The Blue Mountains study, which reported similar findings, also found that hyperglycemia was associated with moderate to severe retinopathy [22] . Cohen et al [23] found that the most important predictor of retinopathy in the older age group was the known duration of diabetes. The UK Prospective Diabetes Study reported that the age at diagnosis was not significantly associated with baseline prevalence of retinopathy, which was close to 20%.…”

Longitudinal Studies of Incidence and Progression of Diabetic Retinopathy Assessed by Retinal Photography in Pima Indians

“…Hyperglycemia (16 -19) and longer duration of diabetes (3,16,18,19) are probably the most commonly reported associations with incidence of retinopathy. The presence of macroalbuminuria has been reported as a risk factor for the incidence of retinopathy (16,18), although not in all studies (20). We did not find a statistically significant association between hypertension and incidence or progression of retinopathy.…”

A game changer for eye care for diabetes

“…The authors concluded that diabetes duration was a significant, independent variable for development of retinopathy 262 . A study of 926 patients with type 1 and type 2 diabetes recruited from 7 hospital clinics in different geographic regions of Malaysia reported a similar finding.…”

“…A prospective Israeli cohort study of 833 patients with T2DM from a diabetic outpatient clinic reported that patients who developed retinopathy were younger at their mean onset of diabetes (age 48.7 years) and had longer mean diabetes duration (13.2 years) than patients who did not develop retinopathy (mean age 53.4 years; mean duration 6.1) 262 . The authors concluded that diabetes duration was a significant, independent variable for development of retinopathy 262 .…”