Risk Factors for Incident Retinopathy in a Diabetic and Nondiabetic Population

Leiden, Hendrik A. van; Dekker, Joost; Moll, Annette C.; Nijpels, Giel; Heine, Robert J.; Bouter, Lex M.; Stehouwer, Coen D.A.; Polak, B.C.P.

doi:10.1097/00132578-200307000-00020

Cited by 36 publications

(49 citation statements)

References 6 publications

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“…The incidence of retinopathy in our population was slightly higher than that reported by the Hoorn Study (7.3% over 9 years) 20 and the Beaver Dam Study (6.0% over 5 years). 4 Our study population, however, was slightly older (aged 49-97 years) than the BDES population (aged 43-86 years), which could have accounted for the slightly higher incidence found.…”

Section: Discussioncontrasting

confidence: 76%

“…Our results are consistent with findings from the Hoorn Study. 20 The Rotterdam Study, however, reported a linear association between prevalent retinopathy and random glucose levels 46 mmol/l in their sample, which included subjects with diabetes. 31 We found that only 3.5% of baseline participants without diabetes but with retinopathy at baseline developed diabetes over the 5-year period, including those diagnosed at the 5-year examinations.…”

Section: Discussionmentioning

confidence: 94%

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Five-year incidence and progression of vascular retinopathy in persons without diabetes: the Blue Mountains Eye Study

Cugati

Luisa

Wang

et al. 2005

Eye

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Purpose To assess the 5-year incidence of vascular retinopathy and its associations in an older nondiabetic population. Methods The Blue Mountains Eye Study examined 3654 residents aged 49 þ years (82.4% response rate) during 1992-1994, and re-examined 2335 (75.1% of survivors) during 1997-1999. Retinopathy lesions (microaneurysms, haemorrhages, hard or soft exudates) were assessed from 6-field retinal photographs in persons without diabetes. Incident retinopathy was assessed in those at risk. Hypertensive status was defined following the WHO/International Society of Hypertension guidelines. Results Of the 2335 re-examined, 195 had retinopathy lesions at baseline and 1725 were at risk of retinopathy after excluding subjects with diabetes (n ¼ 261), retinal vein occlusion (n ¼ 52) or missing/un-gradable photographs (n ¼ 102). The cumulative 5-year incidence was 9.7% (95% confidence intervals (CI) 8.3-11.1%). Age was the only factor significantly associated with incident retinopathy (P for trend ¼ 0.012). Neither fasting blood glucose (age-sex-adjusted P ¼ 0.147) nor hypertension (adjusted P for trend ¼ 0.43) was associated with incident retinopathy. Of the 195 with retinopathy lesions at baseline, 3.5% developed diabetes, 13.3% progressed, and 72.3% regressed/disappeared over 5 years. Progression was positively associated with elevated blood pressure (BP) (adjusted odds ratio (OR) 1.3, 95% CI 1.1-1.6 per 10 mmHg systolic BP) and inversely associated with fasting glucose level (OR 0.36, CI 0.14-0.92 per mmol/l increase). Aspirin use was weakly associated with regression (OR 2.4, CI 1.0-6.0). Conclusions Over 5 years, retinopathy developed in 10% of older people without diabetes, while 72% of baseline lesions regressed. Age was significantly associated with the development of these lesions.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 94%

Five-year incidence and progression of vascular retinopathy in persons without diabetes: the Blue Mountains Eye Study

Cugati

Luisa

Wang

et al. 2005

Eye

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“…The association of obesity and diabetic retinopathy has not been consistently demonstrated in all studies. 15,16 In the WESDR, for example, higher BMI was related to retinopathy only in the type 2 participants with diabetes who did not use insulin. 16 In addition, there was a U-shaped relationship between both lower and higher BMI and retinopathy, which may reflect a "severe" phase of diabetes in underweight type 2 subjects, or these underweight patients may be a subset of late-onset type 1 diabetes.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Retinopathy in a Multi-ethnic Cohort in the United States

Wong

Klein

Islam

et al. 2006

American Journal of Ophthalmology

586

437

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PURPOSE-To describe the prevalence and risk factors of diabetic retinopathy in a multi-ethnic US population of whites, blacks, hispanics, and chinese. DESIGN-Cross-sectional study of 778 individuals from ages 45 to 85 years with diabetes, participating in the Multi-Ethnic Study of Atherosclerosis (MESA).METHODS-Retinal photographs were obtained with a 45° nonmydriatic digital fundus camera. Presence and severity of diabetic retinopathy were graded at a central reading center on the basis of a modification of the Airlie House classification system. All participants underwent a standardized interview, examination, and laboratory investigations.RESULTS-In this population with diabetes, the prevalence of any retinopathy was 33.2% and macular edema 9.0%. The prevalence of any diabetic retinopathy and macular edema was significantly higher in blacks (36.7% and 11.1%) and hispanics (37.4% and 10.7%) than in whites (24.8% and 2.7%) and chinese (25.7% and 8.9%) (P = .01 and P = .007, comparing racial/ethnic differences for retinopathy and macular edema, respectively). Significant independent predictors of any retinopathy were longer duration of diabetes, higher fasting serum glucose, use of diabetic oral medication or insulin, and greater waist-hip ratio. Race was not an independent predictor of any retinopathy.CONCLUSIONS-This study provides contemporary data on the prevalence of and risk factors for diabetic retinopathy among whites, blacks, hispanics, and chinese participating in the MESA.Diabetic retinopathy, the most common specific complication of type 2 diabetes, is the leading cause of blindness among Americans age 20 to 64 years. 1,2 The epidemiology of diabetic retinopathy has been previously described, largely in white populations. 3-6 In the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR), the prevalence of retinopathy in 1980 to 1982 among persons with type 2 diabetes was reported at 39% for those not receiving insulin treatment, and 70% for those receiving insulin treatment. 3 A recent review of data In contrast to whites, there are fewer population-based data on either the prevalence of or the risk factors for retinopathy in other racial/ethnic groups with diabetes in the United States. 17-20 Because diabetes prevalence appears to vary between these racial/ethnic groups, 21-23 it has been suggested that the frequency of retinopathy may also vary by race/ethnicity. The few studies conducted suggest that in comparison to studies in whites, African Americans (blacks) and hispanics have a higher prevalence of retinopathy. 24-26 These differences have been attributed in part to racial/ethnic differences in diabetes duration, glycemic control, and blood pressure levels in blacks, but not in hispanics. There are no data on the epidemiology of diabetic retinopathy in Chinese Americans (chinese).The purposes of our current study were to describe the prevalence of diabetic retinopathy among whites, blacks, hispanics, and chinese diagnosed with diabetes participating in the Multi-Ethnic Study ...

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“…Multiple studies have consistently shown HbA1c to be an independent risk factor for diabetic retinopathy. 6,7,10,21,22 A higher HbA1c is associated with both increased incidence as well as progression of diabetic retinopathy. 21 The LALES study found a 22% increase in prevalence of diabetic retinopathy with 1% increase in HbA1c.…”

Section: Glycaemic Controlmentioning

confidence: 99%

Associations between diabetic retinopathy and systemic risk factors

Wat¹,

Wong²,

Wong³

2016

Hong Kong Med J

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Introduction: Diabetes mellitus is a systemic disease with complications that include sight-threatening diabetic retinopathy. It is essential to understand the risk factors of diabetic retinopathy before effective prevention can be implemented. The aim of this review was to examine the association between diabetic retinopathy and systemic risk factors.Methods: A PubMed literature search was performed up to May 2016 to identify articles reporting associations between diabetic retinopathy and systemic risk factors; only publications written in English were included. Relevant articles were selected and analysed. Results:Patients with diabetic retinopathy were more likely to have poor glycaemic control as reflected by a higher glycated haemoglobin, longer duration of diabetes, and use of insulin therapy for treatment. For other systemic risk factors, hypertension was positively associated with prevalence and progression of diabetic retinopathy. No clear association between obesity, hyperlipidaemia, gender, or smoking with diabetic retinopathy has been established as Associations between diabetic retinopathy and systemic risk factors IntroductionDiabetic retinopathy is the leading cause of blindness in adults living in developed countries. 1 Almost all patients with type 1 diabetes mellitus (DM) and more than 60% of patients with type 2 DM will develop some degree of retinopathy after a 20-year history of diabetes.2 It has also been well established that DM increases the risk of cardiovascular disease. 3Cheng et al 4 found that the prevalence of diabetic retinopathy associated with one, two, three, or four cardiometabolic risk factors was 16.0%, 17.6%, 21.3%, or 25.1%, respectively (P=0.001). This implies a relationship between systemic health conditions and diabetic retinopathy. In order to help identify and to prevent progression of this ophthalmic complication of diabetes, a better understanding of its association with systemic risk factors is necessary. MethodsA PubMed literature search was conducted up to May 2016 using the following key words: "diabetic retinopathy", "prevalence", "epidemiology", "systemic associations", "risk factors", "diabetic Hong Kong Med J 2016;22:589-99

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Risk Factors for Incident Retinopathy in a Diabetic and Nondiabetic Population

Cited by 36 publications

References 6 publications

Five-year incidence and progression of vascular retinopathy in persons without diabetes: the Blue Mountains Eye Study

Five-year incidence and progression of vascular retinopathy in persons without diabetes: the Blue Mountains Eye Study

Diabetic Retinopathy in a Multi-ethnic Cohort in the United States

Associations between diabetic retinopathy and systemic risk factors

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