The Incidence of Retinopathy 10 Years After Diagnosis in Young Adult People With Diabetes

Abstract

OBJECTIVE—To estimate the prevalence and severity of diabetic retinopathy (DR) 10 years after diagnosis in a nationwide population-based cohort study of young adult diabetic patients in Sweden. RESEARCH DESIGN AND METHODS—The Diabetes Incidence Study in Sweden (DISS) aims to register all incident cases of diabetes aged 15–34 years in Sweden. In 1987–1988, 806 cases were reported, and 627 (78%) of them were followed up with regard to retinopathy 8–10 years later. The assessment was based on retinal photographs in most cases (86%). RESULTS—Ten years after diagnosis, retinopathy was found in 247 patients (39%). The retinopathy was mild in 206 (33%), whereas 30 (4.8%) patients had moderate nonproliferative DR (NPDR) and 11 (1.8%) had proliferative DR (PDR). Patients with retinopathy had worse glycemic control during the years than patients without (HbA1c 8.1 ± 1.5% and 6.8 ± 1.2%, respectively; P < 0.001). In a Cox regression analysis, time to retinopathy was related to high HbA1c (P < 0.001) and high BMI (P = 0.001). Patients with type 2 diabetes had an increased prevalence of severe retinopathy (NPDR or PDR) compared with those with type 1 diabetes (14 of 93 [15%] versus no or mild 24 of 471 [5%], respectively; P < 0.001). CONCLUSIONS—Despite modern diabetes management, 39% of young adult diabetic patients developed retinopathy within the first 10 years of the disease. Nevertheless, compared with the prevalence of retinopathy (63%), after a similar duration of diabetes before the Diabetes Control and Complications Trial, this prevalence was clearly lower. Current treatment aimed to achieve strict glycemic control has reduced the risk for developing retinopathy.

Fulminant type 1 diabetes as a high risk group for diabetic microangiopathy—a nationwide 5-year-study in Japan

“…For example, the cumulative incidence of retinopathy in fulminant type 1 diabetic patients was 9.8%, significantly higher than the 0% in type 1A patients. The high incidence is notable compared with the result of the nationwide population-based Diabetes Incidence Study in Sweden (DISS) [11]. DISS resembled our study because all patients were adolescents and adults who were followed from disease onset and had mean HbA 1c of 7.5% at follow-up.…”

“…This classification corresponds to levels 10, 21/10 to 31/31, 41/<41 to 51/51 and 60+/<60+ to 60+/60+, as defined in the Wisconsin study [9][10][11]. Retinopathy was defined as the appearance of SDR or more severe grade in one eye.…”

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

“…Over recent decades, diabetes care has improved in terms of decreased mean HbA 1c and mean systolic blood pressure [8], changes that have been shown to have a preventive effect on diabetic complications [32,33]. Previous research [34,35] has shown a similar effect on the incidence of DR in Sweden. However, for type 2 diabetes, this explanation is contradicted by two Swedish population-based studies from the same time period [25,36].…”

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

“…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).…”