Increased Incidence of Retinopathy in Diabetics with Elevated Blood Pressure

Knowler, William C.; Bennett, Peter H.; Ballintine, Elmer J.

doi:10.1056/nejm198003203021201

Cited by 368 publications

(131 citation statements)

References 8 publications

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“…Systolic blood pressure, associated with baseline retinopathy [28,34] and retinopathy progression [6], was also a powerful independent predictor of SVI. The relation between arterial pressure, retinopathy and the potential for visual impairment has been noted in many other studies [22,31,35,36]. Most recently, tight control of raised blood pressure in Type II diabetes has been shown to slow the progression of retinopathy and reduce the need for photocoagulation compared with less tight pressure control [41].…”

Section: Discussionmentioning

confidence: 91%

The incidence of visual impairment and its determinants in the WHO multinational study of vascular disease in diabetes

Miki

Lee

et al. 2001

Diabetologia

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In industrial societies more than 12 % of new cases of blindness are attributable to diabetes and the risk of blindness is about 30 times higher in people with diabetes than in the general population [1,2, 3]. The WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD), designed to compare the vascular complications of diabetes in different ethnic groups using standardised methods, included an estimate of visual function in the baseline assessment [28]. This was repeated in the follow-up study [4], conducted at 10 of the original 14 centres, providing an opportunity to ascertain incidence and progression of visual impairment and its risk factors in these cohorts. Diabetologia (2001) Methods. Visual function was ascertained at followup in 2994 (77.9 %) of the 3845 eligible participating survivors of the 4709 originally recruited for the WHO MSVDD using the same baseline enquiry method. The associations between incident severe visual impairment, follow-up prevalence of all grades of impairment and baseline risk factors were examined by univariate and stepwise multiple logistic regression analysis. Results. Overall, 8.4 year incidence of severe visual impairment was 1.94 % and showed statistically significant univariate correlations with age at diagnosis, diabetes duration, systolic blood pressure, fasting blood glucose and cholesterol, insulin treatment and strongly with baseline retinopathy. Baseline retinopathy, systolic pressure and cholesterol were statistically significant in multivariable analysis. Differences between centres (0.3 % to 3.45 %) were not significant. Ultimate prevalence of all grades of impairment differed between centres and within almost all of them was correlated in multivariable analysis with baseline retinopathy and proteinuria. Conclusion/interpretation. Comparisons of incident severe visual impairment between centres are restricted by selective mortality, low incidence rates and relatively small numbers in each centre but before retinopathy, baseline systolic pressure and cholesterol predicted severe visual impairment. Followup prevalence of all degrees of impairment varied among centres and were associated with prior retinopathy and renal disease at baseline. [Diabetologia (2001)

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Section: Discussionmentioning

confidence: 91%

The incidence of visual impairment and its determinants in the WHO multinational study of vascular disease in diabetes

Miki

Lee

et al. 2001

Diabetologia

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“…Grading was based on the fundoscopic findings of the worst eye at each exam. The "none" group included eyes with hard exudates only, as previously they have been shown to be common in Pima Indians without diabetes [11]. The "non-proliferative" group comprised those with at least a single microaneurysm in one eye but no signs of proliferative retinopathy.…”

Section: Methodsmentioning

confidence: 99%

Homocysteine as a risk factor for nephropathy and retinopathy in Type 2 diabetes

Looker¹,

Fagot-Campagna

Gunter

et al. 2003

Diabetologia

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Aims/hypothesis. The aim of this study was to examine the relation between serum total homocysteine concentrations and microvascular complications in Pima Indians with Type 2 diabetes. Methods. Homocysteine concentrations were measured in frozen sera of 396 diabetic participants in a longitudinal study who were 40 years of age or older and who had attended one or more examinations between 1982 and1985. Retinopathy was assessed by fundoscopy and nephropathy by an albumin:creatinine ratio greater than 300 mg/g. The incidence rate ratio for a 5 µmol/l difference in homocysteine was calculated using proportional hazard regression. Results. The incidence of each complication was assessed in subjects without that complication at baseline and with more than one follow-up examination: 229 for nephropathy, 212 for retinopathy and 266 for proliferative retinopathy. There were 101 incident cases of nephropathy, 113 of retinopathy and 40 of proliferative retinopathy during a mean follow-up of 8.6, 7.5 and 8.9 years, respectively. Incidence of nephropathy was associated with homocysteine concentrations: IRR=1.42 (95% CI, 1.09-1.84, p=0.01); this remained statistically significant controlled for age, sex and duration of diabetes (p=0.03), but not when controlled for baseline renal function (p=0.4). Homocysteine concentrations were not associated with the incidence of any retinopathy IRR=1.14 (95%CI 0.89-1.46, p=0.3) but were associated with the incidence of proliferative retinopathy IRR=1.62 (95% CI 1.16-2.28, p=0.005); this association remained statistically significant when controlled for baseline renal function and diabetes duration (p=0.02). Conclusions/interpretation. Increased homocysteine concentrations are associated with an increased risk for incidence of nephropathy and proliferative retinopathy; the relation with incidence of nephropathy seems to be explained by an association with baseline albuminuria status concentrations, whereas the relation with incidence of proliferative retinopathy does not. [Diabetologia (2003) 46:766-772]

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“…The prevalence in this study is somewhat lower (25.5%). Reported incidence rates for diabetic retinopathy vary; the UK Prospective Diabetes Study (UKPDS) reported a 6-year cumulative incidence of 22% (3), whereas the WESDR study reported a 34 -47% 4-year cumulative incidence (36). Among the Pima Indians, we previously reported a 4-year cumulative incidence of 16.8% (38).…”

Section: Diabetes Vol 56 April 2007mentioning

confidence: 99%

Genome-Wide Linkage Analyses to Identify Loci for Diabetic Retinopathy

et al. 2007

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Hyperglycemia and long duration of diabetes are widely recognized risk factors for diabetic retinopathy, but inherited susceptibility may also play a role because retinopathy aggregates in families. A genome-wide linkage analysis was conducted in 211 sibships in which >2 siblings had diabetes and retinal photographs were available from a longitudinal study. These sibships were a subset of 322 sibships who had participated in a previous linkage study of diabetes and related traits; they comprised 607 diabetic individuals in 725 sibpairs. Retinal photographs were graded for presence and severity of diabetic retinopathy according to a modification of the Airlie House classification system. The grade for the worse eye was adjusted for age, sex, and diabetes duration and analyzed as a quantitative trait. Heritability of diabetic retinopathy in this group was 18% (95% CI 2-36). A genome-wide linkage analysis using variance components modeling found evidence of linkage on chromosome 1p. Using single-point analysis, the peak logarithm of odds (LOD) was 3.1 for marker D1S3669 (34.2 cM), whereas with multipoint analysis the peak LOD was 2.58 at 35 cM. No other areas of suggestive linkage were found. We propose that an area on chromosome 1 may harbor a gene or genes conferring susceptibility to diabetic retinopathy.

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Increased Incidence of Retinopathy in Diabetics with Elevated Blood Pressure

Cited by 368 publications

References 8 publications

The incidence of visual impairment and its determinants in the WHO multinational study of vascular disease in diabetes

The incidence of visual impairment and its determinants in the WHO multinational study of vascular disease in diabetes

Homocysteine as a risk factor for nephropathy and retinopathy in Type 2 diabetes

Genome-Wide Linkage Analyses to Identify Loci for Diabetic Retinopathy

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