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

Lee, E. T.; Keen, H.; Bennett, P. H.; Fuller, JH; Lu, Minjie

doi:10.1007/pl00002936

Cited by 108 publications

(83 citation statements)

References 13 publications

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“…This mortality follow-up is based on deaths in the original cohorts reported up to January 1 st 1988. The number of deaths is therefore greater than that reported in the WHO MSVDD general description and morbidity paper [26] which only included deaths up to January 1 st , 1983. The centres were asked to verify the life or death status for the patients in their groups on this date and to provide as much information as possible for the patients who had died.…”

Section: Methodsmentioning

confidence: 81%

Mortality and causes of death in the WHO multinational study of vascular disease in diabetes

et al. 2001

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Section: Methodsmentioning

confidence: 81%

Mortality and causes of death in the WHO multinational study of vascular disease in diabetes

et al. 2001

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“…Incidence of any retinopathy varied approximately twofold and of PDR approximately threefold compared with the tenfold variation in some manifestations of macrovascular disease incidence observed in the WHO MSVDD [13]. This strongly suggests that whereas diabetic microvascular and macrovascular disease could share some common risk factors, other determinants could dominate the differential risks.…”

Section: Discussionmentioning

confidence: 91%

“…This simple analytical approach further acknowledges the limitations of direct ophthalmoscopy for more precise quantitative epidemiological estimates of worsening, such as those made possible by the photographic methods now in use. Analytical groupings, definitions of retinopathy and baseline variables and the statistical methods used have been described in detail [12,13]. In every centre, the presence of non-proliferative retinopathy at baseline was a strong (p < 0.01) univariate predictor of incident PDR (data not shown) and was not included in multivariate analysis because of its close aetiological relation.…”

Section: Methodsmentioning

confidence: 99%

The appearance of retinopathy and progression to proliferative retinopathy: the WHO multinational study of vascular disease in diabetes

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Aims/hypothesis. We aimed to estimate incidences of any retinopathy and proliferative diabetic retinopathy (PDR) by direct ophthalmoscopy and relate them to baseline risk factors in re-examined diabetic survivors from 10 centres of the WHO Multinational Study of Vascular Disease in Diabetes. Methods. After a mean follow-up of 8.4 years (11.7 years in Oklahoma), 2877 (71.6 %) survivors were resubmitted to standardised direct ophthalmoscopy as at baseline. The presence of any retinopathy and PDR were recorded at each centre and their incidence estimated in those without retinopathy and PDR at baseline. The independent associations of these incidences with baseline risk factors are expressed as odds ratios derived from multiple logistic regression analyses, within individual centres (which included fasting plasma glucose in 8 and triglyceride in 5) and in pooled data. Results. Of the 4662 original patients, 465 (10.4 %) of those without and 77 (43.0 %) of those with baseline PDR had died (p < 0.001). Any retinopathy was newly reported at follow-up in 47.7 % and PDR in 9.7 % of those free of them at baseline, with reported incidences varying substantially among centres. Incident retinopathy appeared earlier in the known course of diabetes but incidence rates rose more slowly with duration in patients with Type II (non-insulin-dependent) diabetes mellitus than in those with Type I (insulin-dependent) diabetes mellitus. In pooled data and in some individual centres, any retinopathy incidence gave significantly positive odds ratios with age, diabetes duration, systolic pressure, plasma cholesterol, BMI, insulin treatment and proteinuria, and with fasting plasma glucose in the centres where it was measured. Positive odds ratios for PDR were similarly obtained for age, duration, insulin treatment, cholesterol, proteinuria and fasting glycaemia. Smoking status odds ratios were negative for both outcomes. Conclusion/interpretation. Incidence of ophthalmoscopically ascertained any retinopathy varied about twofold and of PDR about threefold among centres. Although, in part attributable to differences between observers, variation in incidence in all centres and in some cases within centres was associated with a number of baseline risk factors. Such associations are not likely due to observer variation or selection biases and emerged despite the imprecision of clinical ophthalmoscopy. Improved detection and control of these risk factors should reduce the impact of diabetic retinopathy and its consequences. [Diabetologia (2001)

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“…Methods of patient selection and examination for the WHO MSVDD have been described in the first paper in this series [5] and in detail previously [6,7]. The risk factors for renal failure included in this analysis were cigarette smoking, blood pressure, serum cholesterol and triglyceride, plasma glucose, proteinuria, retinopathy and ECG abnormalities.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

et al. 2001

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Diabetes accounts for one third or more of all new end stage renal disease in the United States and accounts for at least 16 % of all new patients going onto renal replacement therapy in Europe [1]. The most common cause of end stage renal disease in diabetes is diabetic glomerulosclerosis (nephropathy).Previous studies have shown that hyperglycaemia is an important risk factor for diabetic renal disease [2,3]. More controversy exists on the extent to which systolic blood pressure and lipid disturbances are risk factors for renal disease rather than being a consequence of it. Data on risk factors for renal disease in prospective studies of diabetes are sparse. The Diabetologia (2001) Results. In 959 subjects with Type I (insulin-dependent) diabetes mellitus and 2559 with Type II (noninsulin-dependent) diabetes mellitus, the average follow-up was 8.4 years ( 2.7). By the end of the follow-up period 53 patients in the Type I diabetic group and 134 patients in the Type II diabetic group had developed renal failure (incidence rate 6.3:1000 person years). Increasing age and duration of diabetes were associated with renal failure in Type II and Type I diabetes. In Type II diabetes duration of diabetes was a more important risk factor than age. In both Type I and Type II diabetic retinopathy and proteinuria were strongly associated with renal failure. Systolic blood pressure was associated with renal failure in Type I but not in Type II diabetic patients. ECG abnormalities at baseline, self-reported smoking and cholesterol were not associated with renal failure. Triglycerides were measured in a subset of centres. Among those with Type II, but not Type I diabetes, triglycerides were associated with renal failure independently of systolic blood pressure, proteinuria or retinopathy. In Type II diabetes fasting plasma glucose was associated with renal failure independently of other risk factors. Conclusion/interpretation. We have confirmed the role of proteinuria and retinopathy as markers of renal failure and the importance of hyperglycaemia in renal failure in Type I and Type II diabetes. Plasma triglycerides seem to be an important predictor of renal failure in Type II diabetes. In Type I diabetes systolic blood pressure is an important predictor of renal failure. [Diabetologia (2001)

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

Cited by 108 publications

References 13 publications

Mortality and causes of death in the WHO multinational study of vascular disease in diabetes

Mortality and causes of death in the WHO multinational study of vascular disease in diabetes

The appearance of retinopathy and progression to proliferative retinopathy: the WHO multinational study of vascular disease in diabetes

Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

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