Prevalence of retinopathy and its risk factors in a Japanese population

Abstract

Aims/Introduction: To determine the prevalence and risk factors of retinopathy and validity of the current diagnostic cut-offs for diabetes by using data of health check-up examinees. Materials and Methods: The study comprises 1,864 Japanese who participated in the general health check-up program and did not have a previous history of cardiovascular disease. Non-mydriatic 45°digital fundus photographs were taken twice annually. Multivariate logistic regression model was used to identify risk factors for retinopathy in participants without previously diagnosed diabetes. Results: The overall prevalence of retinopathy in participants with and without previously diagnosed diabetes were 23.3% (28/120) and 4.2% (74/1,744), respectively. Univariate logistic regression analysis identified age, systolic blood pressure (SBP), fasting plasma glucose (FPG) and hemoglobin A1c (HbA 1c ) as risk factors for retinopathy. Multivariate logistic regression analysis showed that FPG or both HbA 1c and SBP were significant, positive and independent risk factors for retinopathy. The prevalence of retinopathy increased with deterioration of glucose categories (P < 0.001 for FPG or HbA 1c ). However, a statistically significant increased risk of retinopathy remained only in participants with FPG ≥ 7.0 mmol/L or HbA1c ≥ 6.5% compared with those with the lowest quartile of glucose in the participants without previously diagnosed diabetes after adjusting for age and SBP. Conclusions: The prevalence of retinopathy was 4.2%, and FPG or both HbA 1c and SBP were positive and independent risk factors for retinopathy in health check-up examinees without previously diagnosed diabetes. The FPG 7.0 mmol/L or HbA 1c 6.5% seems to be appropriate to diagnose diabetes in view of its association with retinopathy. (J Diabetes Invest,

Are There Clinical Implications of Racial Differences in HbA1c? A Difference, to Be a Difference, Must Make a Difference

“…If the observed systematically higher HbA 1c levels in African Americans as compared with whites stem from racial differences not in glucose exposure but from nonglycemic factors, then HbA 1c should be a weaker predictor of diabetic complications in African Americans, especially compared with fasting glucose. The current diabetes diagnostic cut point of HbA 1c 6.5% is supported by epidemiologic evidence for a high prevalence of retinopathy beginning above this threshold (1,55,56), with key studies in multiethnic U.S. study populations (56,57), Malay adults in Singapore (58), and Australian (59), Pima Indian (60), Egyptian (55,61), Korean (62), Chinese (63), and Japanese (64,65) populations. In analyses of data from the National Health and Nutrition Examination Survey (NHANES), investigators have directly compared the prognostic value of clinical categories of HbA 1c in populations of Mexican Americans, African Americans, and whites.…”

Diagnosing type 2 diabetes using Hemoglobin A1c: a systematic review and meta-analysis of the diagnostic cutpoint based on microvascular complications

“…Retinopathy lesions graded according to a modified Airlie House classification system, as used in the ETDRS; retinopathy > 14, no retinopathy < 14 on ETDRS severity level Mean age 56 years 6.5 10 Cho [ 34 ], South Korea Optimal HbA1c cutoff for detecting diabetic retinopathy 40–69 years Mean age 63.3 ± 8.6 South Korea 63.3 5.7 Single-field 45 degrees non-mydriatic fundus photography of each eye. Retinopathy classified as mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, proliferative diabetic retinopathy (PDR) or prior panretinal photocoagulation ((PRP) according to the International Clinical Diabetic retinopathy Disease Severity Scale 5.8 5.9 6 6.1 6.3 6.5 11 Fukushima [ 35 ], Japan Prevalence of retinopathy and its risk factors in a Japanese population Mean age: retinopathy absent 51 ± 8; retinopathy present 53 ± 7 years 52 6.1 Two retinal photographs per subject used for retinal grading. Retinopathy defined by the presence of microaneurysms, any retinal hemorrhage, soft and hard exudates Japanese 6.5 12 Selvin [ 6 ], USA Glycated hemoglobin and the risk of kidney disease and retinopathy in adults with and without diabetes Mean age 56.7 ± 2.7 USA: White and Black, results not separated 56.7 5.7–6.4 6.1 One 45 degree non-mydriatic digital images obtained from a random eye.…”

“…164 full-text articles were then assessed for eligibility; of those 135 were excluded because of insufficient details of the relationship of the microvascular complication to the HbA1c values less than 6.5% (48 mmol/mol). Twenty nine publications remained eligible for inclusion in the systematic review, 22 relating to retinopathy (Table 1) [6,9,11,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]; 4 relating to nephropathy (Table 2) [28,38,47,48] and 3 relating to neuropathy (Table 3) [38,49,50]. No additional relevant references were identified in the hand searching of the reference lists of the 29 included studies.…”

Safety, Pharmacokinetics, and Pharmacodynamics of Single and Multiple Luseogliflozin Dosing in Healthy Japanese Males: A Randomized, Single-Blind, Placebo-Controlled Trial

“…The major symptom of type 2 diabetes mellitus (T2DM), which accounts for approximately 90% of all cases, is chronic hyperglycemia. This leads to microvascular and macrovascular complications, including myocardial infarction and death [ 4 – 6 ]. Previous large clinical trials have emphasized the importance of intensive glycemic control, showing that it could reduce these complications [ 7 – 10 ].…”