Diabetic polyneuropathy and the risk of developing diabetic retinopathy: a nationwide, population‐based study

Abstract

ABSTRACT.Purpose: To assess the relationship between diabetic polyneuropathy (DPN) and the risk of diabetic retinopathy (DR). Methods: From 1997 to 2010, we identified 5031 newly diagnosed DPN patients and 20 124 controls matched for sex, age, and index year. Cox proportional hazards regression analyses were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of DR between the DPN patients and the non-DPN group. The adjusted hazard ratio was calculated and adjusted for age, sex, duration of diabetes and comorbidities of hypertension, cardiovascular disease and diabetic nephropathy. Results: The incidence rate of DR was 5.87-fold higher in the DPN patients than in the non-DPN group (44.0 vs. 7.22 per 1000 person-years), with an adjusted HR of 5.41(95% CI = 4.92-5.94). The DPN-to-non-DPN DR incidence rate ratio decreased with age (adjusted HR = 6.63 for subgroup younger than 65 years and adjusted HR = 3.91 for subgroup aged 65 years or older). Compared with the non-DPN group, the DPN patients had a 5.63-fold risk of non-proliferative DR (adjusted HR = 5.63, 95% CI = 5.11-6.21) and a 3.67-fold risk of proliferative DR (adjusted HR = 3.67, 95% CI = 2.57-5.23). Conclusion: The patients with DPN had an increased risk of developing DR and advanced DR compared with the non-DPN group, particularly among the subgroup aged younger than 65 years.

Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

“…Similarly, in a retrospective population‐based study in Taiwan, patients with DPN exhibited an increased risk of DR and advanced DR compared with a matched cohort of patients with diabetes who did not have DPN . Notably, when stratified according to DR severity, the risk of DPN was greater in patients with PDR than in those with NPDR . A significant association has also been found between diabetic maculopathy and neuropathy in both patients with T1DM and patients with T2DM, taking into account both peripheral neuropathy and CAN …”

“…Other studies, including a prospective analysis of patients with T2DM in Malaysia, showing that neuropathy is an independent risk factor for progression of retinopathy, found neuropathy to be a predictor of DR onset and progression. Similarly, in a retrospective population‐based study in Taiwan, patients with DPN exhibited an increased risk of DR and advanced DR compared with a matched cohort of patients with diabetes who did not have DPN . Notably, when stratified according to DR severity, the risk of DPN was greater in patients with PDR than in those with NPDR .…”

“…If this were the case, screening for CAN in patients who have diabetes with DR could help identify high-risk groups, for monitoring and early detection of clinical progression to CVD. Outcomes from the reviewed studies also demonstrate that DR is a significant risk factor for DPN, 38,40,41,51 and that the risk of developing this complication is greater in the presence of PDR than with early-stage retinopathy. 41 As for the relationship between DR and the macrovascular complications of diabetes, risk estimates from several large prospective studies indicate that DR is a strong predictor of stroke, and that progression of DR significantly increases the risk of this complication.…”

“…If this were the case, screening for CAN in patients who have diabetes with DR could help identify high‐risk groups, for monitoring and early detection of clinical progression to CVD. Outcomes from the reviewed studies also demonstrate that DR is a significant risk factor for DPN, and that the risk of developing this complication is greater in the presence of PDR than with early‐stage retinopathy …”

Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression

“…Previously, we reported that DPN and DR were correlated: patients with DPN presented an elevated risk of developing DR and PDR [35]. Similarly, Barr et al reported a correlation between these 3 microvascular complications and indicated that patients with DPN exhibit (relative to control) a 4-fold increase in DR rate and a 2-fold increase in the rate of microalbuminuria [36].…”