Systemic risk factors contribute differently to the development of proliferative diabetic retinopathy and clinically significant macular oedema

Abstract

Aims/hypothesis The purpose of screening for diabetic retinopathy is to detect either of the two sight-threatening complications: proliferative diabetic retinopathy (PDR) or clinically significant diabetic macular oedema (DME). The aim of the study was to evaluate whether systemic risk factors affect the risk of developing these two complications differently. Methods Survival analysis with death as a competing risk was used to describe the effect of sex, age and time of onset of diabetes, systolic (SBP) and diastolic (DBP) BPs, and the weighted exposure and CV of HbA 1c for the development of PDR and DME from all 2773 patients treated for diabetic retinopathy in a defined population from the Aarhus area, Denmark, between 1 July 1994 and 1 July 2019. Results Increasing HbA 1c above normal increased the risk of developing both PDR and DME (p < 0.04), and values below normal increased the risk of developing PDR (p < 0.013). Increasing DBP increased the risk of developing both PDR and DME (p < 0.0001), whereas increasing SBP increased the risk of developing DME (p < 0.0001), but not PDR (p > 0.08). The risk of developing PDR increased with decreasing age of onset of diabetes (p < 0.0001), whereas the risk of developing DME was maximal for a known onset of diabetes at about 30 years of age and decreased significantly for both lower and higher ages of onset (p < 0.0001). The risk of developing both PDR and DME was lower in women than in men (p < 0.004) and was reduced with lower variability of repeated HbA 1c measurements (p < 0.0001). Conclusions/interpretation Systemic risk factors such as metabolic regulation, arterial BP and the age of onset of diabetes contribute differently to the development of PDR and DME. The overall risk of developing treatment-requiring diabetic retinopathy should be calculated from the risks of reaching each of the two complications separately.

Prevalence of diabetic macular edema and risk factors among diabetic patients at the University of Gondar Tertiary Eye Care and Training Center, North West Ethiopia

“…Poor glycemic control (16,17,19), uncontrolled blood pressure (15,18) and high lipid level (cholesterol level and LDL) (12,15,17) have been associated with the development of DME in some studies but our study did not show any association. The small sample size and our inability to determine HgA1c and lipid level for all patients might have contributed to this discrepancy.…”

“…Different factors have been found to be associated with DME including type-I diabetes (12,13,14) poor glycemic control (15,16,17,18), longer duration of DM (1,3,12,16), systemic hypertension (3,8,13,16,17,18,19), dyslipidemia (12,20), insulin therapy (3,6), proteinuria (3,15,20) and cataract surgery (15,17,21).…”

Retinal venular oxygen saturation is associated with non‐proliferative diabetic retinopathy in young patients with type 1 diabetes

“…We analysed SBP and DBP because a recent study has shown that systolic‐ and diastolic blood pressures play particular roles for the risk of developing diabetic retinopathy and that the risk of Hba1c is related to fluctuations in this parameter more than to the level of HbA1c (Bek, 2020).…”

The risk for developing vision‐threatening retinopathy after cataract surgery in diabetic patients depends on the postoperative follow‐up time

“…At each screening examination, the clinical history was updated and registered, including the time of onset of diabetes and previous treatment for diabetic retinopathy and other ocular diseases (Jeppesen et al. 2004; Bek 2020a).…”

“…The principles followed for photocoagulation of DME and PDR have been described previously (Bek et al 2000;Bek & Erlandsen 2006). At each screening examination, the clinical history was updated and registered, including the time of onset of diabetes and previous treatment for diabetic retinopathy and other ocular diseases (Jeppesen et al 2004;Bek 2020a).…”