Diabetic retinopathy in type 1 diabetes—a contemporary analysis of 8,784 patients

Hammes, Hans‐Peter; Kerner, W.; Hofer, Sabine E.; Kordonouri, Olga; Raile, Klemens; Holl, Reinhard W.

doi:10.1007/s00125-011-2198-1

Cited by 135 publications

(115 citation statements)

References 49 publications

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“…In concert with the current study no association has been found between the incidence or progression of diabetic retinopathy and smoking in cross-sectional and cohort studies [16,17]. However, the association of smoking with diabetic retinopathy found in two cohort studies does reveal a discrepancy, which might in part be due to different proportion of smokers in various studies [7,18]. Smoking is known to exert a detrimental effect on macrovascular disease and it increases the risk of early death and the microvascular complications of diabetes [25,26].…”

Section: Discussionsupporting

confidence: 50%

“…In their cohort study, smoking status or pack-years were not associated with the incidence or progression of diabetic retinopathy or progression of proliferative retinopathy [17]. However, a significant association between diabetic retinopathy and smoking has been detected in German cohort studies (OR 1.3, 95% CI 1.13-1.48, p=0.0002 in a study by Hammes for any retinopathy and OR 1.44, 95% CI 1.10-1.88, p=0.0075 in study by Muhlhauser for retinopathy and pack years) [18,19] and in DCCT study (R= 0.09, P <0 .001) [7]. Furthermore, in the UKPDS study, the incidence and development of diabetic retinopathy were associated with non-smoking status (OR 0.63, 95% CI 0.48-0.82) [20].…”

Section: Physical Activitymentioning

confidence: 95%

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Alcohol Consumption, but Not Physical Activity or Smoking, Contribute To Advanced Forms of Diabetic Retinopathy: A Case-Control Study

Savolainen¹

2011

J Clinic Experiment Ophthalmol

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IntroductionThe well-known risk factors for the development of diabetic retinopathy are the duration of diabetes and diabetes control. Diabetes control plays a key role in the prevention of diabetic retinopathy [1] and it is known to influence the incidence and progress of diabetic retinopathy independent of age, diabetes type, diabetes duration and the severity of retinopathy [2,3]. Other modifiable risk factors, e.g. blood pressure, dyslipidemia and lifestyle factors such as smoking, alcohol use and physical activity, may also have a major impact in preventing diabetic retinopathy.There is some evidence that physical activity or exercise can have a protective impact against diabetic retinopathy. Physical activity has been shown to be protective or at least not promote development of diabetic retinopathy in type 1 diabetes [4]. In addition, work-related physical activity seems to confer some protection against the risk of diabetic retinopathy (OR 0.66, 95 % CI 0.51-0.85) as shown in the recent study by Tikellis et al. [5]. In the FinnDiane study, low-intensity physical activity was independently associated with an increased risk of proliferative retinopathy (OR 1.49, 95 % CI 1.15-1.93), but there was no association with the frequency of activity [6]. However, in some studies, the exercise level did not correlate with the progression of diabetic retinopathy [7] or proliferative diabetic retinopathy [8].The scanty information that exists on the association between alcohol and diabetic retinopathy is inconsistent. In a five-year prospective study, the risk of suffering any severity of diabetic retinopathy was significantly increased with daily alcohol consumption of 30 g or more (RR 2.25, 95% CI 1.15-4.42) [9]. In WESDR-study [10] a cross sectional-study revealed that moderate alcohol use decreased the prevalence of diabetic retinopathy in type 1 diabetics (OR 0.49, 95% CI 0.27-0.92), but in prospective population-based studies no such association was found [11,12]. In a recent study, moderate consumption of alcohol was not associated with either the presence (OR 0.91, 95% CI 0.62-1.35) or progression (OR 0.84, 95% CI 0.46-1.55) of diabetic retinopathy in patients with type 2 diabetes [13]. Furthermore, the study by Giuffre et al. observed no association in their multivariate model (OR 0.43, 95% CI 0.11-1.67 for alcohol consumption under 20 years), AbstractBackground: Modifiable risk factors, like dyslipidemia and lifestyle factors such as smoking, alcohol use and physical activity, may have an impact in the prevention of diabetic retinopathy despite diabetes control and duration. Previous studies on the significance of alcohol consumption, physical activity/exercise and smoking, however, in diabetic retinopathy are conflicting. We investigated these lifestyle factors and their mutual interaction in diabetic retinopathy.

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Section: Discussionsupporting

confidence: 50%

Section: Physical Activitymentioning

confidence: 95%

Alcohol Consumption, but Not Physical Activity or Smoking, Contribute To Advanced Forms of Diabetic Retinopathy: A Case-Control Study

Savolainen¹

2011

J Clinic Experiment Ophthalmol

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“…This confirms earlier reports of associations between increasing age of onset of T1DM and development and progression of DR (Hammes et al. 2011; Hietala et al. 2013a; Forga et al.…”

Section: Discussionmentioning

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

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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.

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“…3,4,10 All patients who had at least one visit in 2009 were included. Sociodemographic data including the district of residence, laboratory measures, and clinical data are documented longitudinally.…”

Section: Methodsmentioning

confidence: 99%

Lower Frequency of Insulin Pump Treatment in Children and Adolescents of Turkish Background with Type 1 Diabetes: Analysis of 21,497 Patients in Germany

Icks

Razum

Rosenbauer

et al. 2012

Diabetes Technology & Therapeutics

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Aim: This study investigated insulin pump therapy in pediatric patients with type 1 diabetes and Turkish origin compared with those without migration background in Germany. Subjects and Methods: Using a nationwide documentation program, we estimated the prevalence of insulin pump therapy in patients < 20 years of age with Turkish origin and those without migration background. Logistic regression was used to adjust for age, sex, diabetes duration, body mass index SD score (BMI-SDS), glycated hemoglobin, number of outpatient visits, number of daily blood glucose self-measurements, and area-based socioeconomic conditions. Results: In 1,695 pediatric type 1 diabetes patients with Turkish background and 19,802 patients without migration background (respectively: 51.2% and 53.0% boys; mean age, 12.4 -4.1 and 12.6 -4.2 years; mean diabetes duration, 4.7 -3.9 and 5.3 -4.0 years), fully adjusted prevalences of insulin pump therapy were 18.5% and 30.9%, respectively (odds ratio 0.51, 95% confidence interval 0.43-0.60, P < 0.001). Age, sex, BMI-SDS, outpatient visits, and blood glucose self-control were significantly associated with the prevalence of insulin pump therapy but did not alter the difference substantially. Conclusions: The prevalence of insulin pump therapy is roughly half among pediatric diabetes patients with Turkish background compared with those without migration background. Several covariates could not explain this difference. Individual characteristics or access barriers within the healthcare system may play a role. Further research is needed.

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Diabetic retinopathy in type 1 diabetes—a contemporary analysis of 8,784 patients

Cited by 135 publications

References 49 publications

Alcohol Consumption, but Not Physical Activity or Smoking, Contribute To Advanced Forms of Diabetic Retinopathy: A Case-Control Study

Alcohol Consumption, but Not Physical Activity or Smoking, Contribute To Advanced Forms of Diabetic Retinopathy: A Case-Control Study

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

Lower Frequency of Insulin Pump Treatment in Children and Adolescents of Turkish Background with Type 1 Diabetes: Analysis of 21,497 Patients in Germany

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