Clinical Course and Risk Factors of Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus in Korea

Abstract

BackgroundWe investigated clinical course and risk factors for diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).MethodsA total of 759 patients with T2DM without DR were included from January 2001 to December 2004. Retinopathy evaluation was performed at least annually by ophthalmologists. The severity of the DR was classified into five categories according to the International Clinical Diabetic Retinopathy Severity Scales.ResultsOf the 759 patients, 523 patients (68.9%) completed the follow-up evaluation. During the follow-up period, 235 patients (44.9%) developed DR, and 32 patients (13.6%) progressed to severe nonproliferative DR (NPDR) or proliferative DR (PDR). The mean duration of diabetes at the first diagnosis of mild NPDR, moderate NPDR, and severe NPDR or PDR were 14.8, 16.7, and 17.3 years, respectively. After adjusting multiple confounding factors, the significant risk factors for the incidence of DR risk in patients with T2DM were old age, longer duration of diabetes, higher mean glycosylated hemoglobin (HbA1c), and albuminuria. Even in the patients who had been diagnosed with diabetes for longer than 10 years at baseline, a decrease in HbA1c led to a significant reduction in the risk of developing DR (hazard ratio, 0.73 per 1% HbA1c decrement; 95% confidence interval, 0.58 to 0.91; P=0.005).ConclusionThis prospective cohort study demonstrates that glycemic control, diabetes duration, age, and albuminuria are important risk factors for the development of DR. More aggressive retinal screening for T2DM patients diagnosed with DR should be required in order to not miss rapid progression of DR.

The related risk factors of diabetic retinopathy in elderly patients with Type 2 diabetes mellitus: A cohort study

“…32 One study in China also found that the higher systolic blood pressure, higher HbA1c, higher fasting plasma glucose, higher LDL-c and lower TG were important factors to increase the risk of DR. 33 However, another study in China also showed that higher systolic blood pressure, higher HbA1c, and lower body mass index were associated with the presence of DR. 34 A study from South Korean also confirmed that higher HbA1c was the significant risk factor for the incidence of DR risk in patients with T2DM. 28 Comparing to those results, the increased risk of DR was caused by higher HbA1c and higher LDL-c which were consistent with our study, but TG and CHOL-T were not. Thus, well control and manage for HbA1c and LDL-c should significantly decrease the chance of developing DR in diabetes or prevent from the progression of diabetic retinopathy in diabetes patients.…”

“…Therefore, the prevalence of DR in patients would rise substantially when the patient's diabetic durations were over 10 years. 27 Some studies also found that the longer duration of diabetes, the higher chance of retinopathy appeared; with impact on the risk of DR. 17,24,28 The result of those studies were corresponding to our study. Therefore, well controlled earlier could prevent and delay the progression of DR in patients with diabetes.…”

Incidence of sight‐threatening diabetic retinopathy in people with Type 2 diabetes mellitus and numbers needed to screen: a systematic review

“…). A total of 17 studies met the inclusion criteria (Table ). Fourteen studies were based on predominantly white populations in one of 10 different Western countries.…”

“…The STDR incidence rates of people without retinopathy at last screening session varied from 0.27 to 1.5 per 100 person‐years (Table ). The studies reported different types of STDR, therefore, results are only partially comparable.…”

“…Aneurysms and small retinal haemorrhages may progress to mild, non‐proliferative diabetic retinopathy or background diabetic retinopathy (ETDRS 20–35, NSC R1), or to moderate to severe non‐proliferative diabetic retinopathy (ETDRS 43–53, NSC R2), and ultimately to proliferative diabetic retinopathy (ETDRS ≥61, NSC R3) . It is estimated that this progressive pattern takes on average ~17 years . Regression from mild non‐proliferative diabetic retinopathy (R1) to no visible retinopathy occurs in up to 46% of cases .…”