Longitudinal study examining the risk factors for proliferative retinopathy and maculopathy in type-I diabetes: The Royal College of Physicians of Edinburgh Diabetes Register Group

Abstract

Purpose The aim of this study was to determine whether there were any differences in the risk factors for developing proliferative diabetic retinopathy or maculopathy in patients with type-I diabetes. Method In all, 1632 patients aged 35 years or younger at diagnosis and treated with insulin, attending six hospital diabetes clinics in Scotland and included on the Royal College of Physicians of Edinburgh Diabetes Register were followed up for a median of 4.0 (2.5-5.5 years: interquartile range). All patients were screened at least annually for diabetic retinopathy using direct ophthalmoscopy, and positive findings were confirmed using slit lamp by an ophthalmologist. Results Duration of diabetes and HbA1c were the important risk factors for developing proliferative retinopathy, while duration of diabetes, systolic blood pressure, and HbA1c were the important factors for maculopathy. The adjusted relative incidence for proliferative retinopathy with a HbA1c in the highest quartile was 26.7, while for maculopathy it was only 2.29. Carstairs deprivation score was not associated with either retinal pathology. There was a plateau effect for systolic blood pressure of 140 mmHg and for duration of diabetes of 16 years for developing either maculopathy or proliferative retinopathy.Conclusion Duration of diabetes is a strong predictor for maculopathy and proliferative disease, but is relatively more important for proliferative disease. Raised systolic blood pressure is relatively more important for predicting maculopathy, while raised HbA1c is relatively more important for developing proliferative retinopathy.

Retinal Hemodynamics in Early Diabetic Macular Edema

“…Duration of diabetes was longer and A1C was higher in those with retinopathy and DME compared with those without retinopathy. The effects of hypertension and elevated A1C are well-documented risk factors for the development of DME (52)(53)(54)(55). Duration of diabetes is an established risk factor for retinopathy (56,57) and more specifically for macular edema (52).…”

Predictors of severity of retinopathy among subjects with early onset type 2 diabetes mellitus

“…Duration was a strong predictor for DR. 5 Leese et al found that duration of diabetes is a strong predictor for maculopathy and proliferative disease. 6 Hypertension was not associated with severity of retinopathy. Hypertension has been closely associated with the onset, progression and severity of retinopathy among early onset diabetics.…”

“…However further studies are needed to confirm this relationship with regard to the severity and type of diabetic retinopathy. 6,7,12,14 The subjects also had high triglyceride and lower high density lipoprotein levels. Role of hyperlipedemia in prognosticating the severity of retinopathy is not yet defined.…”

“…29 Though hyperlipedemia and hypertriglyceridemia has been associated with onset of retinopathy and maculopathy its effect on the development of PDR is not extensively studied. 6,8,26,30 Ding J et al reports that dyslipidemia was a significant risk factor for development of diabetic macular edema in upto 7% cases. 17…”

Απόκριση Της Παραγωγικής Διαβητικής Αμφιβληστροειδοπάθειας Στην Παναμφιβληστροειδική Φωτοπηξία Σε Σχέση Με Τα Επίπεδα Της Γλυκοζυλιωμένης Αιμοσφαιρίνης

“…Υπάρχει μάλιστα ισχυρή από-δειξη για την άμεση σχέση ανάμεσα σε έλεγχο της γλυκαιμίας και την εμφάνιση και εξέλιξη της διαβητικής αμφιβληστροειδοπάθειας (ΔΑ) 59,65,75,[182][183][184][185][186][187] .…”