Risk factors for the development of retinopathy in children and adolescents with Type 1 (insulin-dependent) diabetes mellitus

Abstract

In our preceding paper, the prevalence and development of retinopathy in 231 Type 1 diabetic children and adolescents were reported to be associated with the duration of diabetes and its age at onset. This paper analyses the relationships between the development of retinopathy and the following factors: age, sex, puberty, blood pressure, insulin dosage, HLA antigens, long-term glycaemic control, and serum cholesterol and triglycerides. All these variables were longitudinally evaluated in a cohort of 322 insulin-dependent patients aged 16.2 +/- 4.9 years with diabetes for 7.4 +/- 5.2 years, including those 231 subjects whose eyes were examined once or repeatedly by ophthalmoscopy and fluorescein angiography. Long-term glycaemic control from the onset of diabetes to the retinal examination was assessed by both an arbitrary score comprising different parameters and by mean values of glycosylated haemoglobin, and was categorised as good, fair, and poor. With life-table analysis, the overall median individual risk for developing early retinal changes (9.1 years) was found to be significantly influenced by glycaemic control. Minimal lesions developed earlier (8.0 years) with poor control, but later with fair (10.5 years) and good glycaemic control (12.5 years) (p less than 0.01). Mean HbA1 values below 10% delayed the onset of both incipient (10.8 years) and background retinopathy (16.6 years), while values above 10% advanced it (8.0 and 11.8 years respectively) (p less than 0.05 and less than 0.008). By multivariate regression and stepwise discrimination analyses, only 4 out of 14 variables were found to exert significant independent influences on the development of retinopathy: diabetes duration, long-term glycaemic control, serum triglycerides and age.(ABSTRACT TRUNCATED AT 250 WORDS)

Active prevention in diabetic eye disease

“…No significant difference was found between the sexes in the incidence of any retinopathy, background retinopathy and proliferative retinopathy. This is in concordance with other incidence studies (Weber et al 1986;Klein et al 1989a). …”

The association of hyperlipidemia with retinopathy in diabetic patients aged 15‐50 years in the county of Umeå

“…Dornans group did not find any relationship between serum triglyceride levels and severity of retinopathy in insulindependent diabetic patients (Dornan et al 1982) and a study by Agardh (1988), gave the same results. On the other hand, Weber et al found that serum triglycerides were strongly associated with degree of retinopathy in children and adolescents with diabetes mellitus type 1 (Weber et al 1986). Other studies (Eckel et al 1981;West et al 1980) support the latter finding with a relationship between higher levels of triglycerides and more severe retinopathy.…”

“…Serum cholesterol levels were in some studies found to correlate to more severe retinopathy (Dornan et al 1982;Eckel et al 1981;Mouton & Gill 1988 ;Scanu & Fless 1990;Weber et al 1986) while in other studies such a relationship was not found (Weber et al 1986;West et al 1980). Dornan et al (1982) measured serum lipid levels in small groups of insulin-dependent diabetic patients and controls.…”

“…Levels of different serum lipids have been measured in subjects with diabetes mellitus in different studies, but the correlation with retinopathy has not been consistent. Increased levels of total serum cholesterol were in some studies related to more severe retinopathy (Dornan et al 1982;Eckel et al 1981;Klein et al 1991;Mouton & Gill 1988) while in others it was not (Weber et al 1986;West et al 1980). High serum triglyceride levels have been found to correlate to more pronounced retinopathy (Eckel et al 1981;Weber et al 1986) as well as not (Agardh et al 1988;Dornan et al 1982).…”

Blood glucose control and microvascular complications ? what do we do now?

“…After the introduction of HbAlc as a reliable measure of long-term blood glucose control, several studies confirmed this association [12][13][14][15][16][17]. In the Wisconsin study [12], a clear relationship between one single HbAlc measurement and the progression of retinopathy during the following 10 years was demonstrated.…”