Risk factors for development and progression of diabetic retinopathy in Dutch patients with type 1 diabetes mellitus

Abstract

PurposeTo investigate risk factors for the development and progression of diabetic retinopathy (DR) and long‐term visual outcomes in Dutch patients with type 1 diabetes mellitus (T1DM).MethodsCumulative incidences were calculated for DR, vision‐threatening DR (VTDR), defined as (pre)proliferative DR and diabetic macular oedema, and best‐corrected visual acuity (BCVA) <0.5 and <0.3 at the most recent eye examination. The following factors were assessed: duration of diabetes, age of onset of T1DM, gender, mean HbA1c, HbA1c variability (defined as coefficient of variation of five separate HbA1c measurements), mean arterial blood pressure, body mass index, albuminuria and lipid profile. We used multivariable Cox regression models to identify factors associated with DR development and progression to VTDR.ResultsWe found 25‐year cumulative incidences of 63% for DR, 21% for VTDR, 2% for BCVA <0.5, and 1% for BCVA <0.3. Mean HbA1c (HR 1.023, p < 0.001), HbA1c variability (HR 1.054, p < 0.001), age of onset of T1DM (HR 1.024, p < 0.001), HDL cholesterol (HR 0.502, p = 0.002) and total cholesterol (HR 1.210, p = 0.029) showed an independent association with faster development of any form of DR. The mean HbA1c (HR 1.023, p < 0.001) and the presence of albuminuria (HR 2.940, p = 0.028) were associated with faster progression to VTDR.ConclusionThese data show relatively low cumulative incidences of DR, VTDR and visual impairment. Higher mean HbA1c, HbA1c variability, age of onset of T1DM and total cholesterol were independently associated with the risk of DR development, and a protective association was found for HDL cholesterol in subjects with T1DM. Mean HbA1c and presence of albuminuria were associated with progression of DR.

Progression of Diabetic Retinopathy and Declining Renal Function in Patients with Type 2 Diabetes

“…The duration of diabetes, albuminuria, and HbA1c were associated with the progression of DR from no DR to NPDR. Younger age was an independent risk factor for progression of NPDR to PDR, which is different from other previous studies [ 26 , 30 , 31 ]. In a population-based study, younger age at diagnosis was associated with increasing risk of incidence and progression of DR [ 32 ].…”

“…In the previous studies, development from no DR to NPDR was estimated to take about 14 years, while DR progression rate was considerably fast, around 4 years, for patients who progressed to sever e form of DR [ 24 , 25 ]. Schreur et al and Tseng et al also reported that risk factors associated with DR onset and progression in diabetes patients are different [ 26 , 27 ]. In the studies, patients with baseline preexisting DR had older age, longer DM duration, higher FPG, and higher HbA1c level than ones with no baseline DR.…”

Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications

“…Due to the wide confidence intervals and the high heterogeneity, further studies are needed to confirm these conclusions. Recently, Schreur et al performed a long duration of follow-up study and found that long-term HbA1c variability (defined as CV) was one of the risk factors for the development and progression of DR in patients with T1DM [ 81 ].…”

Differences in Risk Factors for Diabetic Retinopathy in Type 1 and Type 2 Diabetes Mellitus Patients in North-East Poland

“…Other recognized risk factors for DR include: lipid metabolism disorders, hypertension, diabetic kidney disease, pregnancy, puberty, cataract surgery or history of kidney-pancreas or only kidney transplant [11,12]. In recent decades a number of publications assessing risk factors for DR for only one DM type [13] have appeared, yet only a few of them have analyzed dependence on diabetes type. The aim of this study was thus to determine particular risk factors for DR and assess their correspondence to type 1 and 2 diabetes.…”