Incidence and risk factors of severe non‐proliferative/proliferative diabetic retinopathy: More than a decade follow up in the Tehran Lipids and Glucose Study

Abstract

Aims/Introduction To examine the incidence rate of severe non‐proliferative and proliferative diabetic retinopathy (severe‐NPDR/PDR) and determine its potential risk factors. Materials and Methods The study consisted of 1,169 participants (675 women) with type 2 diabetes mellitus, aged ≥20 years. A trained interviewer collected information about the history of pan‐retinal photocoagulation as a result of diabetic retinopathy. Multivariable Cox proportional hazards regression models were applied. Results We found 187 cases (126 women) of severe‐NPDR/PDR during a median follow‐up period of 12.7 years; the corresponding incidence rate was 13.6 per 1,000 person‐years. Being overweight (hazard ratio [HR], 95% confidence interval [CI] 0.60, 0.39–0.92) and obese (HR 0.48, 95% CI 0.27–0.83) were associated with lower risk, whereas being smoker (HR 1.75, 95% CI 1.12–2.74), having fasting plasma glucose levels 7.22–10.0 mmol/L (HR 2.81, 95% CI 1.70–4.62), fasting plasma glucose ≥10 mmol/L (HR 5.87, 95% CI 3.67–9.41), taking glucose‐lowering medications (HR 2.58, 95% CI 1.87–3.56), prehypertension status (HR 1.65, 95% CI 1.05–2.58) and newly diagnosed hypertension (HR 1.96, 95% CI 1.06–3.65) increased the risk of severe‐NPDR/PDR. Among newly diagnosed diabetes patients, being male was associated with a 59% lower risk of severe‐NPDR/PDR (HR 0.41, 95% CI 0.21–0.79). Furthermore, patients who had an intermediate level of education (6–12 years) had a higher risk of developing PDR (HR 1.86, 95% CI 1.05–3.30) compared with those who had <6 years of education. Conclusions Among Iranians with type 2 diabetes mellitus, 1.36% developed severe‐NPDR/PDR annually. Normal bodyweight, being a smoker, out of target fasting plasma glucose level, prehypertension and newly diagnosed hypertension status were independent risk factors of severe‐NPDR/PDR. Regarding the sight‐threatening entity of advanced diabetic retinopathy, the multicomponent strategy to control diabetes, abstinence of smoking and tight control of blood pressure should be considered.

Prevalence of and Factors Associated with Diabetic Retinopathy in Patients with Diabetes Mellitus at Siriraj Hospital – Thailand’s Largest National Tertiary Referral Center

“…However, our study did not find an independent association between hypertension and DR in multiple logistic regression analysis. This is in contrast to a recent study conducted in Iran 36 that reported prehypertension and newly diagnosed hypertension to be independent risk factors for PDR.…”

“…Cigarette smoking was found to be associated with PDR in our study. This is in agreement with the results from the recent study from Iran, 36 which found that being smoker increased the risk of PDR.…”

Association between estimated glomerular filtration rate slope and cardiovascular disease among individuals with and without diabetes: a prospective cohort study

“…Blood samples were collected for fasting plasma glucose (FPG), 2-h post-load plasma glucose (2-hPG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and creatinine levels. The history of pan-retinal photocoagulation (PRP), which was carried out during the exposure period was considered as a surrogate for incident severe non-proliferative and proliferative diabetic retinopathy (NPDR/PDR) [ 22 ]. GFR was estimated by use of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation as follows:…”

Experimental Models to Study Epithelial-Mesenchymal Transition in Proliferative Vitreoretinopathy

“…Clinically, PVD membranes exert a vitreoretinal traction which may lead to retinal detachment and are responsible for most of secondary retinal detachments following initial surgical repair. The incidence of PVD is expected to rise in the coming decades due to the increase of diseases and risk factors responsible for PVD development [4,[6][7][8][9][10][11][12]. However, surgical peeling of these membranes by specialized surgical teams remains the sole therapeutic option to this day, limiting patients' access to treatment and burdening healthcare systems.…”