Long-Term Glycemic Control Has a Nonlinear Association to the Frequency of Background Retinopathy in Adolescents With Diabetes: Follow-up of the Berlin Retinopathy Study

Danne, Thomas; Weber, Bruno; Hartmann, Reinhard; Enders, I; Burger, Walter; Hövener, G

doi:10.2337/diacare.17.12.1390

Cited by 98 publications

(66 citation statements)

References 17 publications

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“…The strongest risk factors for retinopathy include glycemic control and diabetes duration, as most other studies have shown (19)(20)(21)(22)(23)(24). We also demonstrate that there is no glycemic threshold at which incidence of retinopathy escalates sharply, reflecting our cross-sectional findings (25) and other cohort studies (19,20,26). This is in contrast with a report of a glycemic threshold effect at 8%, based on a reevaluation of published data (6).…”

Section: No Datasupporting

confidence: 72%

Markers of Insulin Resistance Are Strong Risk Factors for Retinopathy Incidence in Type 1 Diabetes: The EURODIAB Prospective Complications Study

Chaturvedi¹,

Sjoelie²,

Porta³

et al. 2001

Diabetes Care

193

118

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OBJECTIVE -To determine the incidence of retinopathy and the relative importance of its risk factors in type 1 diabetes. RESEARCH DESIGN AND METHODS-This is a 7.3-year follow-up of 764 of 1,215 (63%) people with type 1 diabetes across Europe, aged 15-60 years at baseline with no retinopathy (the EURODIAB Prospective Complications Study). Retinal photographs were taken at baseline and follow-up and risk factors were assessed to a standard protocol.RESULTS -Retinopathy incidence was 56% (429/764, 95% CI 52-59%). Key risk factors included diabetes duration and glycemic control. We found no evidence of a threshold effect for HbA 1c on retinopathy incidence. Univariate associations were observed between incidence and albumin excretion rate, cholesterol, triglyceride, fibrinogen, von Willebrand factor, ␥-glutamyltransferase, waist-to-hip ratio, and insulin dose. No associations were observed for blood pressure, cardiovascular disease, or smoking. Independent risk factors, as assessed by standardized regression effects, were HbA 1c (1.93, P = 0.0001), duration (1.32, P = 0.008), waist-to-hip ratio (1.32, P = 0.01), and fasting triglyceride (1.24, P = 0.04).CONCLUSIONS -Retinopathy incidence in type 1 diabetes remains high. Key risk factors include diabetes duration and glycemic control, with no evidence of a threshold for the latter. Other independent risk factors, such as waist-to-hip ratio and triglyceride levels, both markers of insulin resistance, were strongly related to incidence.

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Section: No Datasupporting

confidence: 72%

Markers of Insulin Resistance Are Strong Risk Factors for Retinopathy Incidence in Type 1 Diabetes: The EURODIAB Prospective Complications Study

Chaturvedi¹,

Sjoelie²,

Porta³

et al. 2001

Diabetes Care

193

118

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“…However, the absolute risk was very low below HbA 1c 8.0% (64 mmol/mol) (23). Other authors have suggested a glycemic threshold of HbA 1c of ;8-9% (65-75 mmol/mol) (24)(25)(26). A distinction should, however, be made between mild and severe diabetes complications.…”

Section: Discussionmentioning

confidence: 99%

“…In total, 24 P , 0.001 for HbA 1c and grade of retinopathy and nephropathy. Data were analyzed using one-way ANOVA and Bonferroni post hoc test.…”

Section: Hba 1cmentioning

confidence: 99%

Impact of HbA1c, Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden)

et al. 2014

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OBJECTIVEHbA 1c is strongly related to the development of diabetes complications, but it is still controversial which HbA 1c level to strive for in the treatment of type 1 diabetes. The aim of the current study was to evaluate HbA 1c , followed from diagnosis, as a predictor of severe microvascular complications and to formulate HbA 1c target levels for treatment. RESEARCH DESIGN AND METHODSA longitudinal observation study followed an unselected population of 451 patients diagnosed with type 1 diabetes during 1983-1987 before the age of 35 years in a region of Southeast Sweden. Retinopathy was evaluated by fundus photography and nephropathy data collected from medical records. HbA 1c was measured starting from diagnosis and during the whole follow-up period of 20-24 years. Long-term weighted mean HbA 1c was then calculated. Complications were analyzed in relation to HbA 1c levels. RESULTSThe incidence of proliferative retinopathy and persistent macroalbuminuria increased sharply and occurred earlier with increasing long-term mean HbA 1c . None of the 451 patients developed proliferative retinopathy or persistent macroalbuminuria below long-term weighted mean HbA 1c 7.6% (60 mmol/mol); 51% of the patients with long-term mean HbA 1c above 9.5% (80 mmol/mol) developed proliferative retinopathy and 23% persistent macroalbuminuria. CONCLUSIONSLong-term weighted mean HbA 1c , measured from diagnosis, is closely associated with the development of severe complications in type 1 diabetes. Keeping HbA 1c below 7.6% (60 mmol/mol) as a treatment target seems to prevent proliferative retinopathy and persistent macroalbuminuria for up to 20 years.

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“…Animal studies of DR [148][149][150] , large randomised control trials (RCT) such as the DCCT [151][152][153] and epidemiological data 154;155 , emphasise the critical relationship between glycaemic control to the development and progression of DR. Chronic hyperglycaemia is now accepted as the common pathway leading to DR [156][157][158][159] .…”

mentioning

confidence: 99%

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

Foreman

Keel

Xie

et al. 2017

Medical Journal of Australia

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Long-Term Glycemic Control Has a Nonlinear Association to the Frequency of Background Retinopathy in Adolescents With Diabetes: Follow-up of the Berlin Retinopathy Study

Cited by 98 publications

References 17 publications

Markers of Insulin Resistance Are Strong Risk Factors for Retinopathy Incidence in Type 1 Diabetes: The EURODIAB Prospective Complications Study

Markers of Insulin Resistance Are Strong Risk Factors for Retinopathy Incidence in Type 1 Diabetes: The EURODIAB Prospective Complications Study

Impact of HbA1c, Followed From Onset of Type 1 Diabetes, on the Development of Severe Retinopathy and Nephropathy: The VISS Study (Vascular Diabetic Complications in Southeast Sweden)

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

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