Prevalence of retinopathy differs with age at onset of diabetes in a population of patients with Type 1 diabetes

Kullberg, Carin; Abrahamsson, Mariann; Arnqvist, Hans J.; Finnström, Kerstin; Ludvigsson, Johnny

doi:10.1046/j.1464-5491.2002.00839.x

Cited by 38 publications

(24 citation statements)

References 36 publications

(33 reference statements)

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“…The prevalence of DR in type 1 diabetic patients is very high (;90% after 15 years of disease duration), as shown by long-term epidemiological studies (2). Among the several known risk factors for DR development, disease duration is indeed one of the most relevant (3)(4)(5)(6), together with metabolic control (5,7). Nevertheless, a fraction of patients presenting good metabolic control (;10%) do develop DR, and still another proportion of patients with poor metabolic control, nevertheless, do not develop this complication (8).…”

mentioning

confidence: 98%

Neuroretinal Dysfunction With Intact Blood-Retinal Barrier and Absent Vasculopathy in Type 1 Diabetes

et al. 2014

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It is unknown whether independent neural damage may occur in the pre-/absent vascular diabetic retinopathy (DR). To exclude vasculopathy, it is important to measure the integrity of the blood-retinal barrier (BRB). This cross-sectional study addressed this problem in type 1 diabetic patients with normal ocular fundus and absent breakdown of the BRB (confirmed with vitreous fluorometry). These were compared with a group with disrupted BRB (with normal fundus or initial DR) and normal controls. Multifocal electroretinography and chromatic/achromatic contrast sensitivity were measured in these 42 patients with preserved visual acuity. Amplitudes of neurophysiological responses (multifocal electroretinogram) were decreased in all eccentricity rings in both clinical groups, when compared with controls, with sensitivity >78% for a specificity level of 90%. Implicit time changes were also found in the absence of initial DR. Impaired contrast sensitivity along chromatic axes was also observed, and achromatic thresholds were also different between controls and both clinical groups. The pattern of changes in the group without baseline BRB permeability alterations, as probed by psychophysical and electrophysiological measurements, does thereby confirm independent damage mechanisms. We conclude that retinal neuronal changes can be diagnosed in type 1 diabetes, independently of the breakdown of the BRB and onset of vasculopathy.

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confidence: 98%

Neuroretinal Dysfunction With Intact Blood-Retinal Barrier and Absent Vasculopathy in Type 1 Diabetes

et al. 2014

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“…They had a clinical picture of type 1 diabetes before the age of 35 years and insulin treatment ,6 months from diagnosis as described earlier (12). The patients received routine care.…”

Section: Patientsmentioning

confidence: 99%

“…Besides glycemic control and diabetes duration, there is evidence that age at onset influences the development of microangiopathy (12). Children seem to be protected from severe microvascular complications before puberty, but the effect seems to disappear with time (13).…”

mentioning

confidence: 99%

Impact of HbA1c, Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden)

et al. 2014

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OBJECTIVEHbA 1c is strongly related to the development of diabetes complications, but it is still controversial which HbA 1c level to strive for in the treatment of type 1 diabetes. The aim of the current study was to evaluate HbA 1c , followed from diagnosis, as a predictor of severe microvascular complications and to formulate HbA 1c target levels for treatment. RESEARCH DESIGN AND METHODSA longitudinal observation study followed an unselected population of 451 patients diagnosed with type 1 diabetes during 1983-1987 before the age of 35 years in a region of Southeast Sweden. Retinopathy was evaluated by fundus photography and nephropathy data collected from medical records. HbA 1c was measured starting from diagnosis and during the whole follow-up period of 20-24 years. Long-term weighted mean HbA 1c was then calculated. Complications were analyzed in relation to HbA 1c levels. RESULTSThe incidence of proliferative retinopathy and persistent macroalbuminuria increased sharply and occurred earlier with increasing long-term mean HbA 1c . None of the 451 patients developed proliferative retinopathy or persistent macroalbuminuria below long-term weighted mean HbA 1c 7.6% (60 mmol/mol); 51% of the patients with long-term mean HbA 1c above 9.5% (80 mmol/mol) developed proliferative retinopathy and 23% persistent macroalbuminuria. CONCLUSIONSLong-term weighted mean HbA 1c , measured from diagnosis, is closely associated with the development of severe complications in type 1 diabetes. Keeping HbA 1c below 7.6% (60 mmol/mol) as a treatment target seems to prevent proliferative retinopathy and persistent macroalbuminuria for up to 20 years.

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“…Many of the studies available on the prevalence of DR are relatively old, however, and improvements in diabetes care over recent decades [8] have led to a call for updated estimates of the prevalence and severity of DR. More recent studies including updated estimations of the prevalence of DR have been published (e.g. [9][10][11][12]) but are, in general, based on study populations limited to patients of specific ages or with particular duration of diabetes.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and healthcare costs of diabetic retinopathy: a population-based register study in Sweden

et al. 2010

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Aims/hypothesis The aim of the present study was to estimate the prevalence and healthcare costs of diabetic retinopathy (DR). Methods This population-based study included all residents (n=251,386) in the catchment area of the eye clinic of Linköping University Hospital, Sweden. Among patients with diabetes (n=12,026), those with and without DR were identified through register data from both the Care Data Warehouse in Östergötland, an administrative healthcare register, and the Swedish National Diabetes Register. Healthcare cost data were elicited by record linkage of these two registers to data for the year 2008 in the Cost Per Patient Database developed by Östergötland County Council. Results The prevalence of any DR was 41.8% (95% CI 38.9-44.6) for patients with type 1 diabetes and 27.9% (27.1-28.7) for patients with type 2 diabetes. Sightthreatening DR was present in 12.1% (10.2-14.0) and 5.0% (4.6-5.4) of the type 1 and type 2 diabetes populations respectively. The annual average healthcare cost of any DR was €72 (€53-91). Stratified into background retinopathy, proliferative DR, maculopathy, and the last two conditions combined, the costs were €26 (€10-42), €257 (€155-359), €216 (€113-318) and €433 (€232-635) respectively. The annual cost for DR was €106 000 per 100,000 inhabitants. Conclusions This study presents new information on the prevalence and costs of DR. Approximately one-third of patients with diabetes have some form of DR. Average healthcare costs increase considerably with the severity of DR, which suggests that preventing progression of DR may lower healthcare costs.

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Prevalence of retinopathy differs with age at onset of diabetes in a population of patients with Type 1 diabetes

Abstract: In patients with diabetes duration of 6-13 years, the prevalence of retinopathy is clearly related to glycaemic control. Furthermore, the risk of retinopathy varies with different age at onset, independently of differences in duration or glycaemic control.

Cited by 38 publications

References 36 publications

Neuroretinal Dysfunction With Intact Blood-Retinal Barrier and Absent Vasculopathy in Type 1 Diabetes

Neuroretinal Dysfunction With Intact Blood-Retinal Barrier and Absent Vasculopathy in Type 1 Diabetes

Impact of HbA1c, Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden)

Prevalence and healthcare costs of diabetic retinopathy: a population-based register study in Sweden

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