HLA-A, B, C, DR, Bf, and C2 Alleles in Insulin-Dependent Diabetes Mellitus with Proliferative Retinopathy

Bertrams, J.; Dewald, Georg; Spitznas, Manfred; Rittner, Ch.

doi:10.1016/s0171-2985(80)80050-7

Cited by 25 publications

(15 citation statements)

References 12 publications

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“…This is in agreement with some previous studies (7,9) but at variance with other reports which detected an increased frequency of HLA-DR4 in patients with proliferative retinopathy (2,5,8). It is not surprising that we did not find an increase in the frequency of HLA-DR4 in the retinopathy group as our previous study (6) did not show an increase in the frequency of HLA-B15 which is in linkage disequilibrium with HLA-DR4 (3).…”

Section: Discussionsupporting

confidence: 94%

“…Barbosa etal. (1) identified an association of HLA-B15 and proliferative retinopathy in diabetic patients whose disease commenced between 15 and 40 years of age. Dornan et al (5) and Bertrams et al (2) found an association between HLA-DR4 and proliferative diabetic retinopathy. In a previous report (6) we were unable to show a significant difference in the HLA-A and HLA-B antigen frequency of two groups of patients with insulin dependent diabetes mellitus, one group having severe proliferative diabetic retinopathy and the other group no retinopathy.…”

Section: Introductionmentioning

confidence: 97%

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HLA-DR antigen association with proliferative diabetic retinopathy

1985

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 97%

HLA-DR antigen association with proliferative diabetic retinopathy

1985

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“…It appears that the gene or genes for susceptibility to proliferative retinopathy may be located close to, and are in linkage disequilibrium with, genes in the HLA-DR region. Although others previously have reported that DR4 is associated with proliferative retinopathy (20)(21)(22)(23)(24)(25), this is the first study conducted in a large population-based cohort. Participation in the first examination of the WESDR study was high (82%) among eligible youngeronset diabetic people (1).…”

Section: Discussionmentioning

confidence: 87%

“…With the advent of DR typing, attention shifted to these antigens, partly because of their stronger associations with IDDM development. Results have not been consistent, with some detecting no association (18,19) and others reporting a DR4 association (20)(21)(22)(23)(24)(25). The inconsistent results may be caused by small sample sizes, use of referral or specialty clinic populations, or other methodological differences.…”

mentioning

confidence: 99%

Genetic Marker Associations With Proliferative Retinopathy in Persons Diagnosed With Diabetes Before 30 yr of age

et al. 1992

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It has been suggested that HLA-DR4 is a marker of genetic predisposition to proliferative retinopathy. To investigate this relationship and potential associations between other polymorphic genes and proliferative retinopathy, a sample (n = 428) of participants in the population-based Wisconsin Epidemiologic Study of Diabetic Retinopathy was selected for typing for HLA-A, -B, -C, and -DR and a panel of other polymorphic genes. The presence of proliferative retinopathy was determined from grading of stereoscopic color fundus photographs taken at 2 examinations, 4 yr apart. In logistic regression models with repeated measures, persons with HLA-DR4 who were negative for DR3 were five times more likely to have proliferative retinopathy than those negative for both antigens after adjusting for other potential risk factors (Odds ratio = 5.43, 95% Confidence Interval (Cl) = 1.04, 28.30). HLA-C2, AK-2, and MNSs-S also were associated positively with proliferative retinopathy, and HLA-DR8 was associated inversely with this complication of diabetes in each case before adjusting for the number of comparisons. These data suggest that the genetically determined immunopathic mechanisms leading to diabetes, and in linkage disequilibrium with DR4, may independently contribute to the development of proliferative retinopathy.

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“…Some studies indicate that genetically determined factors influence susceptibility to microvascular complications (2)(3)(4)(5)(6)(7)(8)(9), whereas others find that elevated blood glucose levels are the major cause of these complications (10)(11)(12)(13)(14)(15)(16)(17). The Diabetes Control and Complications Trial, a randomized controlled clinical trial, is being conducted to assess the relationship between glycemic control and the development, progression, or amelioration of early vascular complications in people with IDDM (18,19).…”

mentioning

confidence: 99%

Attitudes and Behaviors of Primary Care Physicians Regarding Tight Control of Blood Glucose in IDDM Patients

Tuttleman

Lipsett²,

Harris³

1993

Diabetes Care

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OBJECTIVE--To evaluate attitudes and practices of primary-care physicians toward tight blood glucose control in IDDM. RESEARCH DESIGN AND METHODS--A mail and telephone questionnaire survey was conducted on a systematic, stratified sample of 1429 family-practice physicians, general practitioners, internists, and pediatricians in active practice in the United States who treated patients with IDDM. Physicians were asked about methods they used for clinical and laboratory assessment of blood glucose control and about their attitudes and beliefs in treating IDDM. They were asked also what they consider to be acceptable ranges for blood glucose and HbA1 in IDDM patients. A score was developed reflecting three criteria for tight blood glucose control: fasting glucose 70-120 mg/dl (3.9-6.7 mM), 2-h postprandial glucose < 180 mg/dl (< 10 mM), and HbA1 < or = 8% (the nondiabetic value was specified as 5-7%). Physicians were accorded one point when their acceptable range agreed with an intensive treatment criterion (range for score 0-3). RESULTS--Only 31% of physicians agreed with all three criteria for tight control of blood glucose; 37% agreed with none or only one of the standards. Pediatricians were particularly low in their agreement with the HbA1 standard. Physicians who agreed with one of the three criteria often did not agree with the other two. With increasing value for the score, there was a greater proportion of physicians whose management practices (e.g., frequent measurement of HbA1, multiple insulin injections, patient SMBG, use of dietitian/educator in care of patients) are conducive toward tight control of blood glucose. However, even among physicians with a score of 3, HbA1 was ordered infrequently, three or more insulin injections/day was prescribed rarely, patient SMBG was less than fully endorsed, and both a dietitian and diabetes educator were used by a minority of physicians. CONCLUSIONS--It appears that primary-care physicians are not fully aware of recommended criteria for intensive treatment of blood glucose in IDDM patients or of the importance of multiple insulin injections, use of HbA1, and patient SMBG. Physician practice behaviors are less than optimal for intensive management of IDDM patients, even among physicians who agree with all three standards for intensive treatment of blood glucose in IDDM.

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HLA-A, B, C, DR, Bf, and C2 Alleles in Insulin-Dependent Diabetes Mellitus with Proliferative Retinopathy

Cited by 25 publications

References 12 publications

HLA-DR antigen association with proliferative diabetic retinopathy

HLA-DR antigen association with proliferative diabetic retinopathy

Genetic Marker Associations With Proliferative Retinopathy in Persons Diagnosed With Diabetes Before 30 yr of age

Attitudes and Behaviors of Primary Care Physicians Regarding Tight Control of Blood Glucose in IDDM Patients

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