Diabetic Retinopathy in Oklahoma Indians With NIDDM: Incidence and risk factors

Lee, Elisa T.; Lee, Vivian S.; Kingsley, Ronald; Lu, Minjie; Russell, Dana; Asal, Nabih R.; Wilkinson, C. P.; Bradford, Reagan H.

doi:10.2337/diacare.15.11.1620

Cited by 58 publications

(38 citation statements)

References 11 publications

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“…Both American Indian cohorts showed great vulnerability to the diabetes specific microvascular disease outcomes concurring with previous reports in their high incidence of retinopathy [18,19], proteinuria [20,21] and renal failure [22]. The relatively low rates of severe visual impairment in the Oklahoma cohort could in part be explained by their greatly increased mortality risk selectively removing those with the worst retinopathy.…”

Section: Discussionsupporting

confidence: 85%

Follow-up of the WHO multinational study of vascular disease in diabetes: general description and morbidity

et al. 2001

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Aims. The incidence of retinal, renal and cardiovascular complications and their relation to baseline risk factors was documented in this follow-up study of 10 of the 14 original centres of the WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD). Methods. The incidence of specified items of vascular disease and some associated risk factors was ascertained after 7 to 9 years (11±12 years in Oklahoma, USA) follow-up, re-using baseline examination methodology in 3165 patients (66.9 %) and, through secondary information in 717 (15.2 %) of the 4729 original patients, of whom 540 (11.4 %) had died and 307 (6.5 %) were untraceable. Results. During follow-up, approximately one third of the patients developed hypertension and one third started insulin. Coronary heart disease incidence varied 10 to 20-fold among centres as did limb amputation rates. Inter-centre differences in incident retinopathy and severe visual impairment were smaller but incident clinical proteinuria and renal failure varied markedly. Vascular disease incidence of all categories was high in Native Americans though coronary heart disease incidence was relatively low in Pima Indians and absolutely low in Hong Kong and Tokyo patients. Specific vascular events and their relation with baseline risk factors are analysed in accompanying papers, summarised in the Epilogue. Conclusion/interpretation. These 10 centres reported very different incidence rates of vascular complications. Observer variation, selection biases and competing causes of mortality contributed to these differences but their validity is supported by the more objective outcome indicators. The following papers also suggest that baseline factors such as raised arterial pressure, cholesterol and fasting glucose (in the centres where it was measured) were important and potentially reversible predictors of risk. [Diabetologia (2001)

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Section: Discussionsupporting

confidence: 85%

Follow-up of the WHO multinational study of vascular disease in diabetes: general description and morbidity

et al. 2001

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“…Our statistical analyses indicate that ACR may be regarded as the risk marker through which all of these risk factors express themselves (Fig. 1), but in type II diabetes proteinuria is not generally found to be an independent predictor of subsequent incidence of retinopathy [4,27,28]. However, in Pima Indians with type II diabetes [35] and in type I diabetes [29], renal involvement did predict progression to proliferative retinopathy.…”

Section: Discussionmentioning

confidence: 71%

“…The established determinants of DR include duration of diabetes, glycaemic control and blood pressure [4,7,8,15,27,47,48]. The exact role of other possible determinants such as age at diagnosis, serum lipids, body mass index and (micro-)albuminuria in the development and progression of DR is still not known [4,13,16,27,28,35,37,41].…”

Section: Introductionmentioning

confidence: 99%

Diabetic retinopathy in newly diagnosed middle-aged and elderly diabetic patients. Prevalence and interrelationship with microalbuminuria and triglycerides

Olivarius

Nielsen

Andreasen

2001

Graefe's Arch Clin Exp Ophthalmol

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Background: The exact role of factors such as serum lipids, body mass index and (micro-)albuminuria as possible determinants of diabetic retinopathy remains to be determined. We have scrutinized the prevalence of diabetic retinopathy and its concomitants in terms of risk factors and other diabetic complications in newly diagnosed diabetic patients. Methods: A population-based sample of 1,251 newly diagnosed diabetic patients aged 40 years or over was established in general practice. Median age was 65.3 years. Funduscopy was performed by practising ophthalmologists. Blood and urine analyses were centralised. Results: The overall prevalence of diabetic retinopathy was 5.0%. Only three patients had proliferative diabetic retinopathy. As expected, diabetic retinopathy and renal involvement, as expressed by the urinary albumin/creatinine ratio, were strongly positively associated. An intriguing finding was that of an inverse relationship between fasting triglycerides and diabetic retinopathy, an association that proved to be confined to microalbuminuric patients. An inverse association between body mass index and diabetic retinopathy was found only univariately. Conclusion: The low prevalence of diabetic retinopathy cannot be explained by the screening method alone, but rather by early detection of diabetes in a non-selective patient sample. It seems that renal involvement modifies the expected relationship between diabetic retinopathy and triglycerides, but a pathophysiological mechanism is not available.

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“…Systolic blood pressure, associated with baseline retinopathy [28,34] and retinopathy progression [6], was also a powerful independent predictor of SVI. The relation between arterial pressure, retinopathy and the potential for visual impairment has been noted in many other studies [22,31,35,36]. Most recently, tight control of raised blood pressure in Type II diabetes has been shown to slow the progression of retinopathy and reduce the need for photocoagulation compared with less tight pressure control [41].…”

Section: Discussionmentioning

confidence: 92%

The incidence of visual impairment and its determinants in the WHO multinational study of vascular disease in diabetes

Miki

Lee

et al. 2001

Diabetologia

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In industrial societies more than 12 % of new cases of blindness are attributable to diabetes and the risk of blindness is about 30 times higher in people with diabetes than in the general population [1,2, 3]. The WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD), designed to compare the vascular complications of diabetes in different ethnic groups using standardised methods, included an estimate of visual function in the baseline assessment [28]. This was repeated in the follow-up study [4], conducted at 10 of the original 14 centres, providing an opportunity to ascertain incidence and progression of visual impairment and its risk factors in these cohorts. Diabetologia (2001) Methods. Visual function was ascertained at followup in 2994 (77.9 %) of the 3845 eligible participating survivors of the 4709 originally recruited for the WHO MSVDD using the same baseline enquiry method. The associations between incident severe visual impairment, follow-up prevalence of all grades of impairment and baseline risk factors were examined by univariate and stepwise multiple logistic regression analysis. Results. Overall, 8.4 year incidence of severe visual impairment was 1.94 % and showed statistically significant univariate correlations with age at diagnosis, diabetes duration, systolic blood pressure, fasting blood glucose and cholesterol, insulin treatment and strongly with baseline retinopathy. Baseline retinopathy, systolic pressure and cholesterol were statistically significant in multivariable analysis. Differences between centres (0.3 % to 3.45 %) were not significant. Ultimate prevalence of all grades of impairment differed between centres and within almost all of them was correlated in multivariable analysis with baseline retinopathy and proteinuria. Conclusion/interpretation. Comparisons of incident severe visual impairment between centres are restricted by selective mortality, low incidence rates and relatively small numbers in each centre but before retinopathy, baseline systolic pressure and cholesterol predicted severe visual impairment. Followup prevalence of all degrees of impairment varied among centres and were associated with prior retinopathy and renal disease at baseline. [Diabetologia (2001)

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Diabetic Retinopathy in Oklahoma Indians With NIDDM: Incidence and risk factors

Cited by 58 publications

References 11 publications

Follow-up of the WHO multinational study of vascular disease in diabetes: general description and morbidity

Follow-up of the WHO multinational study of vascular disease in diabetes: general description and morbidity

Diabetic retinopathy in newly diagnosed middle-aged and elderly diabetic patients. Prevalence and interrelationship with microalbuminuria and triglycerides

The incidence of visual impairment and its determinants in the WHO multinational study of vascular disease in diabetes

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