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

Abstract

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)

Longitudinal study examining the risk factors for proliferative retinopathy and maculopathy in type-I diabetes: The Royal College of Physicians of Edinburgh Diabetes Register Group

“…In the DCCT, HbA1c was also an important risk factor for the development and progression towards proliferative disease and maculopathy, with intensive control of blood glucose lowering the incidence of both. 3 Our study helps confirm the association of raised blood pressure as a risk factor for retinopathy in type-I diabetes which has been demonstrated elsewhere, 8,18 but an interventional study to demonstrate the benefits of blood pressure lowering is required.…”

“…However, in univariate analysis, high cholesterol concentrations were associated with maculopathy, but not with proliferative eye disease. Some longitudinal studies have established an association between serum cholesterol and triglycerides with the development of any retinopathy, 7,8,10 and some have associated serum cholesterol concentrations with visual loss 9,18 in a small number of individuals with diabetes. Cholesterol concentrations are also associated with the development of hard exudates.…”

QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up

“…If insulin was needed for treatment within 1 year of diagnosis, subjects were considered to have type 1 diabetes [18], the remaining subjects were classified as having type 2 diabetes. These comparably simple clinical definitions with acknowledged inadequacies were used because of the constraints on information available and the need for consistency with earlier reports [19][20][21]. At baseline, a standardised clinical examination was performed, including a detailed questionnaire with information on diabetes diagnosis, the duration and treatment, as well as on symptoms of vascular and cardiac disease.…”

Fatores de risco para retinopatia diabética

“…A cegueira está associada à fase avançada da RD representada pela RD proliferativa e suas manifestações: hemorragia pré-retiniana ou vítrea, proliferação fibrovascular e descolamento tracional de retina, neovasos de íris e glaucoma neovascular (3) . Quanto mais grave o estágio da RD, maior é o risco de surgimento de redução grave de visão, sendo a incidência cumulativa em 8,4 anos cerca de 2% (11) . Além disso, a incidên-cia de RD proliferativa é aproximadamente o dobro em pacientes com DM tipo 1 quando comparados a pacientes com DM tipo 2 (11) .…”

“…Quanto mais grave o estágio da RD, maior é o risco de surgimento de redução grave de visão, sendo a incidência cumulativa em 8,4 anos cerca de 2% (11) . Além disso, a incidên-cia de RD proliferativa é aproximadamente o dobro em pacientes com DM tipo 1 quando comparados a pacientes com DM tipo 2 (11) . A proporção de pacientes com RD aumenta progressivamente com a duração de DM, sendo que a maioria dos pacientes, em especial pacientes com DM tipo 1, vão apresentar algum grau de RD após cerca de 20 anos de duração de DM.…”