Factors protective against retinopathy in insulin-dependent diabetics free of retinopathy for 30 years

Abstract

To investigate which factors might protect against the development of retinopathy 40 insulin-dependent diabetics who had remained free from retinopathy despite diabetes of long duration (mean±l SD 30±10 years) were compared with 40 patients who had background and 47 who had proliferative retinopathy (mean durations of disease 16+ 5 and 19 ± 5 years respectively). The three groups had had similar mean ages at onset of diabetes. The mean of all postprandial blood glucose measurements at hospital clinics from diagnosis of diabetes to detection of retinopathy, or to the most recent negative eye examination, was 9 9±2-1 mmol/l (178±38 mg/100 ml) in the group with no retinopathy, 11 8±21 mmol/l (213±38 mg/100 ml) in those with background retinopathy, and 12 4±2-1 mmol/l (223±38 mg/100 ml) in those with proliferative retinopathy (p <0 0001). This difference was not reflected in present concentrations of haemoglobin Alc, probably because glycaemic control had been improved after the development of retinopathy. In the groups with background and proliferative retinopathy there were significant negative correlations between mean blood glucose concentrations and the number of years that had elapsed from diagnosis of diabetes to detection of retinopathy, suggesting that the development of both grades of retinopathy depends on the degree and duration of glycaemic exposure.The patients with no retinopathy had attended clinic more frequently (p <0 025), more of them had required

Coping Behaviors of Severe Diabetics

“…Since data from this study reveal that the development of retinop athy is simultaneous with the occurrence of nephropathy and neuropathy, it could be supposed that either nephropathy or neurop athy acts as causative agent to retinopathy. However, previous studies [1,8] which sup port the present study suggest that retinopa thy is merely coincidental with nephropathy and has no causative effect. And the patho genesis of neuropathy is also considered to be different from that of retinopathy [15].…”

“…It is a wellestablished fact that the frequency of diabetic retinopathy among diabetics depends upon both the duration of diabetes and the pa tient's level of diabetic control [1][2][3][4][5][6][7][8]. It has also been confirmed that if the duration of the disease in 2 patients with diabetes melli tus is equal, the frequency of occurrence of diabetic retinopathy depends on the level of diabetic control [5,9,10].…”

“…Many previous studies [5,8,9] and a recent study [10] have found that an elevated glucose level strongly correlates with a higher incidence of diabetic retinopathy in patients with the same duration of the disease. These reports support the present study in confirm ing that the severe diabetics had neglected medical care as well as diet therapy longer than had the mild diabetics.…”

“…As the most powerful risk factor for diabetic retinopathy the duration of diabetes has been reported [1][2][3][4][5][6][7][8]. However, the present study was undertaken to control this factor so that the duration of both groups was equal.…”

The influence of early diabetes on the pattern electroretinogram

“…The possibility of identifying the earliest alterations in retinas of diabetic patients prior to fundus changes is important since a diagnostic test that could be performed to detect early retinopathy could eventually provide a means of protecting the patient against retinopathy itself when effective early prophylactic treatments become available [1].…”