A Prospective Study of Serum Lipids and Risk of Diabetic Macular Edema in Type 1 Diabetes

Miljanović, Biljana; Glynn, Robert J.; Nathan, David M.; Manson, Jo Ann E.; Schaumberg, Debra A.

doi:10.2337/diabetes.53.11.2883

Cited by 192 publications

(128 citation statements)

References 43 publications

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…In turn, lowered cholesterol and blood pressure levels might have contributed to the rescue of ocular structures. In fact, in patients from the DCCT cohort it was shown that higher serum lipids were associated with macular oedema and retinal hard exudates [31]. On the other hand, reducing blood pressure values can help regulate blood perfusion in the retinal vessels, thus decreasing shear stress and the consequent damage of the endothelial lining of the small vessels of the retina [1,32].…”

Section: Discussionmentioning

confidence: 99%

Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients

et al. 2006

View full text Add to dashboard Cite

Aims/hypothesis The effects of successful pancreas transplant alone (PTA) on chronic complications of diabetes, in particular diabetic retinopathy, remain disputed. We prospectively studied the course of diabetic retinopathy in PTA recipients and in non-transplanted (non-PTA) type 1 diabetic patients. Methods The PTA and non-PTA groups consisted respectively of 33 (follow-up: 30±11 months) and 35 patients (follow-up: 28±10 months). Best corrected visual acuity, slit lamp examination, intraocular pressure measurement, ophthalmoscopy, retinal photographs, and in selected cases angiography were performed. Diabetic retinopathy and its improvement/deterioration were assessed according to criteria proposed by the Eurodiab Study. Results At baseline, 9% of PTA and 6% of non-PTA patients had no diabetic retinopathy, 24 and 29% had non-proliferative diabetic retinopathy (NPDR), whereas 67 and 66% had laser-treated and/or proliferative diabetic retinopathy (LT/ PDR), respectively. No new case of diabetic retinopathy occurred in either group during follow-up. In the NPDR PTA group, 50% of patients improved by one grading, and 50% showed no change. In the LT/PDR PTA, stabilisation was observed in 86% of cases, whereas worsening of retinopathy occurred in 14% of patients. In the NPDR non-PTA group, diabetic retinopathy improved in 20% of patients, remained unchanged in 10%, and worsened in the remaining 70%. In the LT/PDR non-PTA group, retinopathy did not change in 43% and deteriorated in 57% of patients. Overall, the percentage of patients with improved or stabilised diabetic retinopathy was significantly higher in the PTA group. No differences were found between the two groups with regard to cataract lesions and intraocular pressure values. Conclusions/interpretation Despite a relatively short follow-up, our study shows that successful PTA can positively affect the course of diabetic retinopathy.

show abstract

Section: Discussionmentioning

confidence: 99%

Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Other major systemic risk factors include hypertension, dyslipidaemia and high body mass index, although there is substantial variation in the consistency and strength of the association with these risk factors (Miljanovic et al. 2004; Ding & Wong 2012; Yau et al. 2012).…”

Section: Introductionmentioning

confidence: 99%

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

Schreur

Asten

et al. 2018

Acta Ophthalmologica

View full text Add to dashboard Cite

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.

show abstract

“…20 Besides, a high total to high-density lipoprotein (HDL) cholesterol ratio and elevated LDL cholesterol were each associated with the development of clinically significant macular oedema. 21 Furthermore, measurement of lipoprotein subclass using nuclear magnetic resonance showed positive associations between the severity of retinopathy and triglyceride levels, and LDL particle concentration and apolipoprotein B levels (a constituent lipoprotein of very-low density, intermediate-density lipoproteins, and LDL), and a negative association with HDL cholesterol. 22 …”

Section: Do Lipids Have a Role?mentioning

confidence: 99%

Medical management of diabetic retinopathy: fenofibrate and ACCORD Eye studies

Wright

Dodson

2011

Eye

View full text Add to dashboard Cite

The approach of all ophthalmologists, diabetologists and general practitioners seeing patients with diabetic retinopathy should be that good control of blood glucose, blood pressure and plasma lipids are all essential components of modern medical management. The more recent data on the use of fenofibrate in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye studies is reviewed. In FIELD, fenofibrate (200 mg/day) reduced the requirements for laser therapy and prevented disease progression in patients with preexisting diabetic retinopathy. In ACCORD Eye, fenofibrate (160 mg daily) with simvastatin resulted in a 40% reduction in the odds of retinopathy progressing over 4 years, compared with simvastatin alone. This occurred with an increase in HDL-cholesterol and a decrease in the serum triglyceride level in the fenofibrate group, as compared with the placebo group, and was independent of glycaemic control. We believe fenofibrate is effective in preventing progression of established diabetic retinopathy in type 2 diabetes and should be considered for patients with pre-proliferative diabetic retinopathy and/or diabetic maculopathy, particularly in those with macular oedema requiring laser.

show abstract

A Prospective Study of Serum Lipids and Risk of Diabetic Macular Edema in Type 1 Diabetes

Cited by 192 publications

References 43 publications

Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients

Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients

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

Medical management of diabetic retinopathy: fenofibrate and ACCORD Eye studies

Contact Info

Product

Resources

About