Predicting Development of Proliferative Diabetic Retinopathy

Abstract

OBJECTIVEIdentifying individuals most at risk for diabetic retinopathy progression and intervening early can limit vision loss and reduce the costs associated with managing more advanced disease. The purpose of this study was to identify factors associated with progression from nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR).RESEARCH DESIGN AND METHODSThis was a retrospective cohort analysis using a claims database of all eye care recipients age ≥30 years enrolled in a large managed-care network from 2001 to 2009. Individuals with newly diagnosed NPDR were followed longitudinally. Multivariable Cox regression analyses identified factors associated with progression to PDR. Three- and five-year probabilities of retinopathy progression were determined.RESULTSAmong the 4,617 enrollees with incident NPDR, 307 (6.6%) developed PDR. After adjustment for confounders, every 1-point increase in HbA1c was associated with a 14% (adjusted hazard ratio 1.14 [95% CI 1.07–1.21]) increased hazard of developing PDR. Those with nonhealing ulcers had a 54% (1.54 [1.15–2.07]) increased hazard of progressing to PDR, and enrollees with nephropathy had a marginally significant increased hazard of progressing to PDR (1.29 [0.99–1.67]) relative to those without these conditions. The 5-year probability of progression for low-risk individuals with NPDR was 5% (range 2–8) and for high-risk patients was 38% (14–55).CONCLUSIONSAlong with glycemic control, nonophthalmologic manifestations of diabetes mellitus (e.g., nephropathy and nonhealing ulcers) are associated with an increased risk of diabetic retinopathy progression. Our retinopathy progression risk score can help clinicians stratify patients who are most at risk for disease progression.

The progress in understanding and treatment of diabetic retinopathy

“…Adiponectin has been shown to be significantly higher in T1D patients with severe diabetic retinopathy than in those without, even after adjustment for occurrence of microalbuminuria (Hadjadj et al, 2005). As retinopathy has multiple risk factors it is likely, as is increasingly used for cardiovascular disease and suggested for diabetic nephropathy (Elley et al, 2010;van Dieren et al, 2011;Vergouwe et al, 2010), and more recently for retinopathy (Harris Nwanyanwu et al, 2013) from genetic data Williams et al, 2012). In terms of genetic association the diabetic retinopathy field is less advanced than that for nephropathy, although there have been a number of worthwhile studies (reviewed by (Kuo et al, 2014)).…”

Diabetic Retinopathy and Diabetic Macular Edema

“…A study to identify risk factors associated with the progression to proliferative DR (PDR) identified HbA 1c , diabetic nephropathy, and nonhealing foot ulcers as three risk factors that can help predict progression to PDR. From this, the authors derived a risk score [9]. However, most of the risk for retinopathy is not accounted for by traditional clinical indices [10].…”

Angiogenic Factors and Cytokines in Diabetic Retinopathy

“…For example, the presence of diabetic foot ulcers is positively correlated with DR as well as with several signs of systemic inflammation, including markedly elevated serum TNF-α levels [160,161]. Recently, Nwanyanwu et al retrospectively studied a group of 4,617 insurance beneficiaries initially diagnosed with nonproliferative DR and found that the presence of non-healing foot ulcers was the best single risk indicator for their progression to PDR [162]. These ulcers were associated with a 54% increase in the chance of progression.…”