A Detailed Study of Risk Factors for Retinopathy and Nephropathy in Diabetes

Abstract

Indexes of retinopathy and nephropathy were studied in a large population of diabetics using standardized methods. In each of 973 subjects, more than 100 other variables were also measured: this made It possible to take into account many confounding factors when we examined the relationships of these variables to microangiopathy. The most powerful risk factor for microangiopathy was duration of diabetes, but frequency of both retinopathy and nephropathy was impressively related to the level of plasma glucose at the time of examination. This latter relationship was independent of the effects of other variables. Risk of retinopathy was also related to factors that were probably associated with higher previous plasma glucose levels—need for insulin therapy, history of ketonuria, present level of plasma triglyceride, leanness, and younger age of onset of diabetes. In subjects with a systolic blood pressure of less than 170 mm Hg and who did not have proteinuria, no significant relationship was found between blood pressure and frequency of retinopathy, but, when the systolic pressure was greater than 169 mm Hg, rates of retinopathy were excessive, even In those subjects without proteinuria. Several other factors had no significant relationship to retinopathy or nephropathy: these included age, level of education, smoking, and plasma cholesterol. Rates of severe nephropathy were somewhat greater In men than in women, but this difference was not statistically significant. Rates of retinopathy and of mild proteinuria were similar in men and women. After adjustment for duration of diabetes, the risk of retinopathy was no higher in the 102 subjects with two diabetic parents than in the 254 who had no family history of diabetes.

Prevalence of small vessel and large vessel disease in diabetic patients from 14 centres

“…Trivial trends occur in the reverse direction for BMI and proteinuria, an association which may in part be secondary to fluid retention accompanying renal impairment. The association of SVDE with lower BMI confirms a recent report on retinopathy in Oklahoma Indians [32]. Greater prevalence of retinopathy in the more severely hyperglycaemic, thinner or insulin-dependent diabetics may exist, and further analysis is necessary before conclusions can be drawn.…”

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

“…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. In our study we found serum triglycerides to correlate rather weakly, although significantly, to degree of retinopathy with the highest levels found in the group of diabetic subjects with proliferative 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).…”

Factors associated with the development of renal complications of diabetes mellitus in São Paulo city

“…In IDDM, lipid profile disturbances (21), hypertension and/or a family history of hypertension (22,23), smoking and high body mass index have also been associ-ated with DN (24,25). Despite the considerable contribution of NIDDM to renal replacement therapy (25,26), studies on risk factors in these patients are less common (27). In Brazil, a cross-sectional study evaluated characteristics of NIDDM patients who were proteinuric (28), but epidemiological data on risk factors for ESRF are not available.…”