Diabetic Control and Progression of Retinopathy in Elderly Patients: Five‐Year Follow‐up Study

Morisaki, Naho; Watanabe, Shiro; Kobayashi, Junji; Kanzaki, Tetsuto; Takahashi, Kazuo; Yokote, Koutaro; Tezuka, Mariko; Tashiro, Jun; Inadera, Hidekuni; Saitō, Yasushi; Yoshida, Sho; Shigemura, Kentaro

doi:10.1111/j.1532-5415.1994.tb04941.x

Cited by 47 publications

(29 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our cumulative incidence rate of 22.2% is somewhat lower than the cumulative incidence of 32.7% reported for non-insulin-treated diabetic participants aged 60-74 years who were examined after 4 years in the WESDR. 1 However, the rate from our study is identical to the 5-year incidence of 22.2% reported from a Japanese population sample aged 60 years or older 6 and is very similar to the 4-year incidence rate of 19.2% reported from a Taiwanese study 3 and to the 5-year incidence rate from a Korean study of older-onset diabetes. 15 Our cumulative incidence rate is also close to 26.2% reported in a 4-year follow-up of a sample of non-Hispanic whites with a mean age of 59 years, 16 and lower than the 4-year rate of 30.8% incidence reported from a Swedish clinic study of 369 older-onset non-insulin-treated diabetic subjects.…”

Section: Discussionsupporting

confidence: 86%

“…Our 25.9% 5-year cumulative rate of progression is relatively similar to 4-year follow-up rates found for non-Hispanic Whites (27.2%) and Hispanics (23.0%) aged 20-74 years in the San Luis Valley Diabetic Study, 16 and to the progression rate of 23.6% reported from the Japanese study 6 and slightly lower than the 30.3% progression rate recorded in Taiwan. 3 However, in comparison to the WESDR, our 15.1% rate for progression of two or more steps after 5 years is substantially lower than the 29.1% rate reported for progression in WESDR diabetic subjects aged 34-74 years after 4 years.…”

Section: Discussionsupporting

confidence: 84%

See 1 more Smart Citation

Five-year incidence and progression of diabetic retinopathy in a defined older population: the Blue Mountains Eye Study

Luisa

Mitchell

Rochtchina

et al. 2007

Eye

View full text Add to dashboard Cite

Aims To determine 5-year incidence and progression of diabetic retinopathy in an older Australian population-based cohort. Methods During the period 1992-1994, the Blue Mountains Eye Study examined 3654 residents aged 49 þ years (82.4% of those eligible), living in two urban postcode areas, west of Sydney, Australia. Participants were subsequently invited to attend 5-year follow-up exams. After excluding 543 (14.8%) who died during the follow-up period, 2334 persons (75.0%) were re-examined during 1997-1999. The examination included a comprehensive questionnaire, blood pressure measurement, standardised refraction, Zeiss stereo retinal photographs, and estimation of fasting blood glucose. Diabetic retinopathy was graded from the retinal photographs, using the modified Early Treatment Diabetic Retinopathy Scale classification (15-step scale). Results Of participants with diabetes diagnosed at baseline, 150 were re-examined, including 139 with gradable fundus photographs. The cumulative 5-year incidence of diabetic retinopathy was 22.2% before 95% confidence interval (CI) 14.1-32.2%. Retinopathy progression (1 þ steps) was documented in 25.9% (95% CI 18.8-34.0%) of participants with retinopathy and gradable photographs at both visits; in 58.3% of these cases, a 2 þ -step progression was documented. Progression to proliferative retinopathy occurred in only 4.1% of those with retinopathy at baseline. The only baseline risk factors associated with retinopathy progression, after adjusting for age and gender, were increase in fasting blood glucose, odds ratio (OR) 1.2 (95% CI 1.1-1.4)/ mmol/l, and increase in diabetes duration, OR 2.3 (95% CI 1.0-5.3)/10 years. Conclusions These data provide 5-year cumulative incidence of diabetic retinopathy in a defined older population. Increase in diabetes duration and elevated baseline fasting blood glucose level predicted retinopathy incidence.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 84%

Five-year incidence and progression of diabetic retinopathy in a defined older population: the Blue Mountains Eye Study

Luisa

Mitchell

Rochtchina

et al. 2007

Eye

View full text Add to dashboard Cite

show abstract

“…The effect is most evident at the hyperglycemic range of possible glucose values. For example, a decrease in GHb of ϳ1.0% (from 9.5 to 8.5%) is associated with nearly a 33% reduction in the progression rate of retinopathy (48). Our meta-analysis indicates that depression is associated with higher GHb, i.e., with hyperglycemia.…”

Section: Rctsmentioning

confidence: 82%

Depression and poor glycemic control: a meta-analytic review of the literature.

et al. 2000

View full text Add to dashboard Cite

Hyperglycemia has been linked to the development of diabetic complications (1). Treatments that lower blood glucose levels reduce the risks of retinopathy, neuropathy, and nephropathy in patients with type 1 (2,3) or type 2 (4,5) diabetes. Accordingly, maintenance of good glycemic control is the focus of diabetes therapy, and the importance of other clinical factors is judged largely in relation to their effects on this parameter.Clinical and subclinical expressions of depression are present in Ͼ25% of patients with type 1 or type 2 diabetes (6-14) and have adverse effects on functioning and quality of life (15,16). The existing literature is not consistent and clear with regard to the association between depression and poor glycemic control. Such an association would suggest the possibility that depression treatment might have favorable effects on diabetic outcomes. We surveyed the scientific literature, identified studies that measured the association of depression (either by symptoms or the diagnosis) with glycemic control, and performed a metaanalysis to assess the reliability and strength of any association. RESEARCH DESIGN ANDMETHODS -Medline and PsycINFO were used to locate studies published in the last 25 years that reported the association of depression with glycemic control in adult diabetic subjects. The reference lists of these articles were examined to identify additional studies, and this led to the consideration of several unpublished papers and manuscripts. Inclusion and exclusion criteriaStudies were limited to adult participants (Ն18 years of age), to those that assessed glycemic control using a measure of glycohemoglobin (denoted as GHb within this article) (17,18), and to those that measured depression and GHb coincident to the study evaluation. Studies with Ͻ25 patients, those neither published nor available in English, and those that ascertained only a history of depression were excluded. Subjects in the included studies were patients diagnosed with type 1 or type 2 diabetes; studies of subjects with impaired glucose tolerance, borderline diabetes, or gestational diabetes were not considered. Studies were included without regard to the way the depression-glycemic control association was tested. In some studies, depression was the independent variable and glycemic control the dependent variable. Other studies used the reverse approach, and some reported only the correlation between the 2 variables.Study procedures and statistical analysis Study characteristics were recorded, and the studies were categorized by methodology. Type of diabetes and method of depression assessment were recorded, and effect sizes (ESs) were examined in relation to these factors. The diagnosis of depression (major depressive disorder) was established by using structured or semistructured clinical interviews and the diagnostic criteria in use at the time of the study (e.g., American Psychiatric Association' s Diagnostic and Statistical Manual of Mental Disorders [19,20] Depression and Poor Glycemic ControlA meta-an...

show abstract

“…However, the value of diabetes control has not been established in this group (7). The beneficial effect of glycemic control for the prevention of diabetic retinopathy has been documented only in two small-scale studies (8,9). An association of poor metabolic control and longer duration of diabetes with stroke and coronary heart disease was observed in another cohort (10,11).…”

mentioning

confidence: 99%

Prospective Analysis of Mortality, Morbidity, and Risk Factors in Elderly Diabetic Subjects

et al. 2003

View full text Add to dashboard Cite

OBJECTIVE -To clarify mortality and morbidity of intensively managed elderly diabetic individuals and to explore factors predicting mortality and diabetes-related end points. RESEARCH DESIGN AND METHODS-A total of 390 elderly (Ն65 years of age) outpatients with type 2 diabetes ( 173 men and 217 women, mean age 73.0 years) were analyzed. The mean HbA 1c upon entry was 6.8% (332 receiving oral hypoglycemics and/or insulin) and blood pressure upon entry was 136/74 mmHg (219 receiving antihypertensive drugs). The patients have been followed-up for 3 years with HbA 1c Ͻ7.0% and blood pressure Ͻ145/80 mmHg as targets, with mortality and an aggregate of fatal and nonfatal diabetes-related events as end points. Mortality rate and causes of mortality, as well as risk factors for mortality and morbidity, were determined. RESULTS -The mortality rate, 2.9% per year, was comparable to that of the age-and sex-matched general population. Stroke was a leading cause of mortality after malignancy. By the univariate Cox proportional hazards model, only high serum creatinine and prior stroke were highly significant and strong risks for both end points. In those without prior stroke and receiving antihypertensive agents, the incidence of the diabetes-related end point based on their systolic blood pressure (SBP) quartile was U-shaped, with the nadir at the 3rd (SBP,(137)(138)(139)(140)(141)(142)(143)(144)(145)(146)(147) and the peak at the 1st (SBP Յ 125 mmHg) quartile.CONCLUSIONS -In well-controlled elderly diabetic subjects, there was no excessive mortality compared to the age-and sex-matched general population. Renal dysfunction and prior stroke were independent risks for mortality and morbidity. In those without prior stroke, a risk of too much lowering of blood pressure was suggested. Diabetes Care 26:638 -644, 2003

show abstract

Diabetic Control and Progression of Retinopathy in Elderly Patients: Five‐Year Follow‐up Study

Abstract: Control of diabetes mellitus is the most important factor associated with prevention of progression of retinopathy in elderly patients.

Cited by 47 publications

References 22 publications

Five-year incidence and progression of diabetic retinopathy in a defined older population: the Blue Mountains Eye Study

Five-year incidence and progression of diabetic retinopathy in a defined older population: the Blue Mountains Eye Study

Depression and poor glycemic control: a meta-analytic review of the literature.

Prospective Analysis of Mortality, Morbidity, and Risk Factors in Elderly Diabetic Subjects

Contact Info

Product

Resources

About