Therapie der proliferativen diabetischen Retinopathie

Proliferative diabetic retinopathy is a serious complication of diabetic retinopathy and, without treatment, leads to complications ranging from massive loss of visual acuity to functional blindness. With timely diagnosis within the framework of suitable screening measures, the risk of blindness can be massively reduced by appropriate treatment. Panretinal photocoagulation remains the gold standard of therapy. Intravitreal anti-vascular endothelial growth factor (VEG) therapy has advantages over panretinal photocoagulation alone at least in the first 2–3 years of therapy, in particular as a result of the resolution of neovascular changes and macular oedema. If persistent vitreous haemorrhage or tractive retinal detachment occurs, vitrectomy is indicated, which must not be delayed if the central retina is threatened.     

Epidemiologie der diabetischen Retinopathie

The risk of microvascular complications in people with diabetes rises with long-term increases of blood glucose levels. The prevalence of diabetic retinopathy is dependent on disease duration, selection of patients, risk factors (age, HbA_1c [hemoglobin A_1c], hypertension), diagnostic criteria, study design, and period of data collection. In primary care, the prevalence of retinopathy in patients with type 2 diabetes is about 10% and considerably lower than in secondary and tertiary care with 20–25%. In patients with type 1 diabetes there is nearly no difference in the prevalence of retinopathy with 24% in primary care and 27–30% in secondary and tertiary care. Even in people who do not have diabetes, about 10% show transformations of the retina that could be interpreted as mild stages of diabetic retinopathy and do not impair vision. Advanced stages of retinopathy can deteriorate visual acuity, which affects about a sixth of all cases of diabetic retinopathy. The prevalence of severe forms of retinopathy that result in blindness has distinctly declined due to optimized diagnosis and treatment of retinopathy and maculopathy.     

Prevalence and risk factors of diabetic retinopathy in a rural population of South India

The purpose of this study is to study the prevalence and associated risk factors of diabetic retinopathy (DR) in type 2 diabetics in a rural setup by means of outreach screening camps. A total of 1270 diabetic patients were enrolled into the study from outreach screening camps conducted in rural areas of Kolar district by Sri Devaraj Urs Medical College attached to Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka. Detailed history with reference to age, duration of diabetes, hypertension, smoking and alcohol consumption was taken. Detailed ocular examination was done. Prevalence and associated risk factors were noted. Among the 1270 diabetic patients who were screened, 235 (18.5 %) patients had evidence of diabetic retinopathy. This included 167 (71.1 %) patients with mild to moderate non-proliferative diabetic retinopathy (NPDR), 41 (17.4 %) patients with severe NPDR, 19 (8.1 %) patients with proliferative diabetic retinopathy (PDR) and 60 (4.7 %) patients with maculopathy. The independent risk factors of DR which were statistically significant were older age (76.6 %), longer duration of diabetes (54.5 %), alcohol consumption (6.4 %), family history of diabetes (43 %) and insulin intake (27.7 %). Diabetes and its related complications are no longer restricted to the urban and the rich, with studies proving that prevalence rates are almost equivalent to urban population; strategies for prevention, early diagnosis and treatment need to be planned and implemented at the earliest if the burden of diabetic blindness is to be tackled effectively.     

Cardiovascular risk profile,diabetes specific factors,and prevalent microvascular eye complications in sub-Saharan Africans with type 2 diabetes

The aim of this study is to examine the association between cardiovascular risk profile, diabetes-specific factors, and prevalent retinopathy in sub-Saharan Africans with type 2 diabetes. We enrolled 213 (41 % women) diabetic adults from the Cameroon National Obesity Center in 2008. Prevalent retinopathy was based on history and digital mydriatic retinal photography. Cardiovascular risk profile was assessed, and global absolute coronary risk was estimated with the UK Prospective Diabetes Study (UKPDS) and Framingham coronary risk equations. Logistic regressions were used to relate risk factors to prevalent retinopathy and discrimination and calibration assessed. Fifty-four patients (25.4 %) had prevalent of retinopathy. Patients with retinopathy had more often hypertension (88 vs 43 %, p = 0.003), and age at diagnosis, known duration of diabetes, blood glucose, and systolic blood pressure were associated with retinopathy. Estimated 10-year coronary risks by the Framingham and UKPDS had low discrimination for retinopathy, with C-statistic (95 % confidence interval) of 0.593 (0.504–0.682) and 0.603 (0.518–0.688), respectively. New equations developed from this sample had better discrimination and calibration, with a maximum C-statistic of 0.881 (0.828–0.933). Cardiovascular risk profile was poorly correlated with prevalent retinopathy in this population. Strategies based upon routinely assessed diabetes-related factors can improve the selection of patients at high risk of retinopathy for costly confirmatory investigations.

     

A 3–19-year follow-up study on diabetic retinopathy in patients diagnosed in childhood and treated with conventional therapy

Few data are available from follow-up studies on diabetic retinopathy in patients diagnosed with insulin-dependent (Type 1) diabetes mellitus in childhood and treated with conventional therapy. We report the results of conventional insulin therapy on development of diabetic retinopathy in 100 children and adolescents (47 females and 53 males), aged 8.3 ± 3.5 (1.2–16.4) years at diagnosis of disease. Oral or intravenous fluorescein angiography was performed during a 3–19 year follow-up in all patients. Retinopathy was staged according to the criteria of the Italian Society of Diabetology (SID). During follow-up, retinopathy was observed in 28 patients (28 %). At the end of follow-up, retinopathy was present in 23 patients and had disappeared in 5. Life-table analysis showed a median disease-free interval of 10.8 years. At 10 years from diagnosis the percentage of patients free of retinopathy was 66 %. Poor metabolic control, age, and degree of pubertal development at diagnosis were the most important risk factors. © 1997 John Wiley & Sons, Ltd.     

Medikamentöse Therapie der diabetischen Retinopathie – Die diabetologische Perspektive

Primary prevention of and secondary intervention in diabetic retinopathy is based on the main pathogenetic factors, glycemia and blood pressure, whereas targeting dyslipidemia to inhibit progression is controversial. The overall effect of euglycemia on retinopathy is moderate and point of no return exists in type-1 diabetes (moderate non-proliferative diabetic retinopathy) beyond which euglycemia (target hemoglobin type A_1c [HbA_1c] of 7%, 53?mmol/mol) does not produce any further benefit to the retina. In type-2 diabetes (T2D), the window of opportunity is even smaller. Individuals with mild non-proliferative diabetic retinopathy benefit most. Recent data on the treatment of T2D with long-acting glucagon-like peptide 1 (GLP-1) receptor agonists underline the need to examine the retina due to early worsening in those with a considerable fall in HbA_1c (>1%) within a short period of time (<3 months; euglycemic reentry) in the case of preexisting retinopathy or unknown status. The same applies for T2D patients prior to bariatric surgery. The effect of blood pressure control is undisputed, but requires consideration on a case-by-case basis. Blood pressure according to Riva-Rocci (RR) of 140/80?mm Hg should be aimed for. Diabetic retinopathy demands precise communication between disciplines, particularly in the case of high-risk patients.     

Bildgebung der diabetischen Retinopathie

With important innovations in imaging procedures a differentiated analysis and more sophisticated stratification of diabetic retinopathy will be introduced. The use of ultrawide-field imaging covers a greater surface area of the retina in contrast to conventional camera systems. In 9–15% of eyes affected by diabetic retinopathy additional lesions can be detected and up to 50?% of changes lie outside the classical 7 ETDRS fields. The central retina, however, determines visual acuity and reading ability. Optical coherence tomography (OCT) enables the evaluation of the vitreoretinal interface and the detection of edema not visible in stereophotographs and (partly) also in stereoscopic funduscopy. The examination provides additional information on retinal thickness and structural integrity, both having great relevance for the prognosis and treatment options. Using OCT angiography not only the superficial retinal plexus can be evaluated, but also the deep capillary plexus of the foveal region. Besides quantification of vessel density, there is a possibility to better capture the non-perfused areas more precisely. Sharper images of neovascularization on the retinal surface are possible. Automated retinal image analysis systems (ARIAS) might comprise a high reproducibility and standardization. In future, rapid diagnosis and assessment of large image volumes will be possible.     

Sight-threatening retinopathy is associated with lower mortality in type 2 diabetic subjects: a 10-year observation study

AIMS: To study associations between diabetic retinopathy and development of stroke, myocardial infarction and death in type 2 diabetic patients. METHODS: During a 10-year observation period, 363 type 2 diabetic patients (diagnosis > or =30 years of age) attending an outpatient clinic were studied regarding the prevalence and incidence of retinopathy and associated risk factors, i.e., (HbA(1c), blood pressure, albuminuria, plasma creatinine, age, sex and diabetes duration) in relation to the development of myocardial infarction, stroke and death. The degree of retinopathy was classified as no retinopathy, background or sight-threatening retinopathy, i.e., clinically significant macular edema, severe non-proliferative or proliferative retinopathy. RESULTS: During the study period, 62 patients had had myocardial infarction, 54 stroke and 99 patients died. Patients with sight-threatening retinopathy at baseline (n=41) had a 2.2-fold increased (p<0.01) risk for death compared to patients with no or background retinopathy, even when controlled for medical risk factors. When adjusted for medical risk factors, patients with no retinopathy at baseline (n=226) who remained without retinopathy or developed background retinopathy (n=187) during the study period, had a 3.6-fold increased risk for death (95% CI, 1.1, 11.8), (p=0.03), compared to patients who developed sight-threatening retinopathy (n=39), while the incidence of myocardial infarction did not differ. More patients who developed sight-threatening retinopathy were treated with ACE inhibitors than patients who did not (41% versus 24%; p=0.03). CONCLUSION: Despite more medical risk factors, patients who developed sight-threatening retinopathy had lower mortality compared to patients with no or background retinopathy at follow-up. More patients who developed sight-threatening retinopathy were treated with ACE inhibitors but this seemed not to have influenced the lower mortality rate in this group, whereas the use of ACE inhibitors in patients who did not develop sight-threatening retinopathy was connected with lower mortality rate.     

Optimal HbA1c cutoff for detecting diabetic retinopathy

The associations between high glucose levels and diabetic retinopathy have been the basis for the diagnosis of diabetes. We aimed to provide updated data on the relationship between HbA1c and diabetic retinopathy, and to assess the diagnostic accuracy of the proposed HbA1c cutoff for detecting diabetic retinopathy. This cross-sectional study included 3,403 adults from the 2009 to 2010 Ansung Cohort Study. Retinopathy was assessed with single-field nonmydriatic fundus photography and graded according to the International Clinical Diabetic Retinopathy Disease Severity Scale. HbA1c was measured by standardized assay using high performance liquid chromatography. Based on deciles distribution, the prevalence of retinopathy was very low until the HbA1c range of 48–51 mmol/mol (6.5–6.8 %). The optimal HbA1c cutoff for detecting any diabetic retinopathy was 49 mmol/mol (6.6 %), moderate or severer retinopathy was 52 mmol/mol (6.9 %) from receiver operating characteristic curve analysis. The proposed HbA1c threshold of 48 mmol/mol (6.5 %) from American Diabetes Association produced comparable accuracy for identifying both any and moderate/severer retinopathy. This study confirmed that the proposed HbA1c threshold of 48 mmol/mol (6.5 %) allowed the proper detection of diabetic retinopathy. Our data support the judicious use of HbA1c for the diagnosis of diabetes and detecting diabetic retinopathy as well.     

Prevalence and risk factors of chronic complications of type 2 diabetic inpatients in Hubei Province of central China: results from a multiple-hospital study

The aims of this study are to investigate the prevalence of chronic complications in hospitalized patients with type 2 diabetes mellitus (T2DM) in Hubei Province of central China and identify its risk factors. The retrospective study was conducted in eight hospitals from four cities in Hubei Province from January 1, 2013 to December 31, 2014. All participants’ medical records were collected, and the demographic characteristics, clinical features, metabolic parameters, and the occurrence of chronic complications associated to T2DM were analyzed. The risk factors of T2DM-associated chronic complications were identified using multivariate logistic stepwise regression analysis. A total of 3469 subjects with T2DM were enrolled. Among the subjects included, 28.9 % developed diabetic retinopathy, 39.2 % developed diabetic nephropathy, 53.0 % developed diabetic neuropathy, 25.8 % developed coronary heart disease (CHD), 17.4 % developed cerebral vascular diseases (CVD), and 10.4 % developed vascular disease of the lower extremities. The prevalence of chronic complications varied significantly among the four cities (P?<?0.01). Multivariate logistic regression analysis showed that systolic blood pressure >125 mmHg and diabetes duration >5 years were common risk factors for microvascular (nephropathy and retinopathy) and macrovascular (CHD and CVD) complications. Meanwhile, family history of diabetes was risk factor for retinopathy, HbA1c >7.0 % was risk factor for retinopathy and CHD, LDL-C level >3.12 mmol/L was risk factor for nephropathy and CHD, triglyceride level >1.7 mmol/L was risk factor for nephropathy and CVD, and age at admission >45 years was risk factor for CHD and CVD. Chronic complications are highly prevalent in inpatients with T2DM in Hubei Province of central China. Future efforts directed at blood glucose control and management of hypertension and lipid disorders are required to prevent and reduce the occurrence of chronic complications of T2DM.     

The Effect of Glycaemic Control and the Introduction of Insulin Therapy on Retinopathy in Non-insulin-dependent Diabetes Mellitus

To study the progression of diabetic retinopathy in relation to diabetes treatment and glycaemic control in patients with non-insulin dependent (Type 2) diabetes mellitus (NIDDM), we performed a prospective study in a cohort of 1378 diabetic patients, aged ⩾40 years at diagnosis, of whom 333 were treated with insulin, and 1045 with oral antihyperglycaemic agents or diet alone. In the latter group 174 patients changed to insulin therapy during follow-up. We used the Wisconsin scale to grade retinopathy, recorded blindness (visual acuity ⩽0.1) and visual impairment (visual acuity 0.2–0.4), and measured the average HbA_1c for each patient during a mean 3.1-year study period. In a multivariate analysis, patients who changed treatment from oral agents or diet alone to insulin therapy had a relative risk of 2.0 (95 % confidence interval 1.7–2.3) for progression of retinopathy ⩾3 levels compared with all other patients in the study. The increase in risk remained even after controlling for mean HbA_1c (relative risk 1.6; 95 % confidence interval 1.3–1.9). Progression ⩾3 levels was significantly associated with a higher incidence of macular oedema and deterioration of visual acuity (p < 0.001). The relative risk for blindness/visual impairment due to retinopathy was 2.7 (95 % confidence interval 1.8–4.0) in the group with changed treatment compared with all the other patients in the study. Poor glycaemic control (HbA_1c %) before the start of insulin therapy and any retinopathy at baseline were significant risk factors for progression in the group with changed treatment (both p < 0.01). In the whole study group, poor glycaemic control was significantly associated with retinopathy progression ⩾3 levels; the relative risk for those having mean HbA_1c above the median being 1.7 (95 % confidence interval 1.4–2.1), compared to those with a HbA_1c value below the median. Moderate non-proliferative diabetic retinopathy at baseline was also associated with progression (relative risk 2.5; 95 % confidence interval 1.4–4.5). In contrast, insulin treatment at baseline was not associated with an increased risk of retinopathy progression. In conclusion, while hyperglycaemia was a risk factor for the progression of retinopathy in all patients, change of treatment from oral drugs to insulin was associated with a 100 % increased risk of retinopathy progression and a 3-fold increased risk of blindness/visual impairment. © 1997 by John Wiley & Sons, Ltd.     

Kardiovaskuläre Erkrankungen bei Diabetes

Over the past decade, a large number of scientific publications have identified inflammation as a major causal factor in diabetes mellitus and atherosclerosis. Compared to nondiabetic patients, activation of inflammatory cytokines and cells are increased in patients with diabetes. This is partly caused by hyperglycemia and insulin resistance/deficiency.In this review, the key factors of diabetes-associated inflammation are described and potential anti-inflammatory therapies that could potentially reduce the risk of diabetic macroangiopathy are discussed.The multifactorial therapy of diabetes mellitus consisting of blood sugar, cholesterol and high blood pressure control could be supplemented by anti-inflammatory therapies in the future.     

Indikationen für implantierbare Loop-Rekorder bei Kanalopathien und ventrikulären Tachykardien

Implantable loop recorders (ILR) do not play a pivotal role in the current guidelines on ventricular arrhythmias except in identifying rhythm–symptom correlations if ventricular arrhythmias are assumed. Before a decision for a pure diagnostic implantable device is made, a thorough arrhythmic risk assessment is of major importance due to the potential lethal outcome of ventricular arrhythmias. Nevertheless, some clinical circumstances exist where long-term monitoring by an ILR may add significant information in electrical heart diseases, in patients with ventricular arrhythmias, or structural heart diseases and a potential risk of ventricular arrhythmias. As medical therapy (β-blocker therapy) plays an important role in long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardias (cpVT), the ILR can be used to control therapy in patients at risk. In electrical diseases without pharmacologic therapeutic options (e.?g., Brugada syndrome), the ILR may be used in low-risk patients with atypical syncope as benign faints may occur without association to the underlying disease. Evidence on cardiomyopathies with preserved left ventricular function and nonsustained VT or premature ventricular complexes is scarce. The ILR may also add long-term information on the individual risk in these circumstances. In very rare diseases like infiltrative disease or muscular dystrophies, the ILR may also provide evidence on risk stratification. In summary, ILR in electrical heart diseases and in patients with ventricular tachycardia remains a very individual decision taking into account various clinical, electrocardiographic, and genetic parameters. The following review aims at highlighting possible indications and clinical scenarios for ILR in ventricular tachycardias and electrical heart diseases with—probably debatable—case presentations.     

Renal and retinal microangiopathy after 15 years of follow-up study in a sample of Type 1 diabetes mellitus patients

PURPOSE: In the present study, the objective is to determine the epidemiological risk factors in the appearance of diabetic retinopathy and nephropathy in 112 Type 1 diabetic patients after 15 years. METHODS: A 15-year follow-up study was done in a cohort of 112 consecutive Type 1 (IDDM) diabetes mellitus patients without diabetic retinopathy or nephropathy at enrolment in 1990. We studied the incidence of diabetic retinopathy and/or microalbuminuria. The epidemiological risk factors included in the study were gender, diabetes duration, HbA(1c) levels, arterial hypertension, levels of triglycerides and fractions of cholesterol (HDL-cholesterol and LDL-cholesterol). RESULTS: The incidence of diabetic retinopathy was 55.40% at the end of study; the risk factors associated were duration of diabetes mellitus (P<.001), high levels of HbA(1c) (P=.009), presence of arterial hypertension (P=.007) and high levels of LDL-cholesterol (P=.002). The incidence of microalbuminuria was 41.07% and that of overt nephropathy, 19.60%; the risk factors associated were high levels of HbA(1c) (P<.001) and presence of arterial hypertension (P=.023). At the end of study, four groups of patients were formed: patients without microalbuminuria or retinopathy, patients with microalbuminuria only, patients with retinopathy only and patients with retinopathy and microalbuminuria. From the results of the discriminate analysis, we may assume that for the development of retinal lesions only, in the diabetes mellitus, the duration of the disease, the high levels of HbA(1c) and the arterial hypertension are most important, and for the development of renal and retinal lesion simultaneously, the important factor is poor control of glycemia measured by levels of HbA(1c) and arterial hypertension. CONCLUSIONS: In conclusion, microalbuminuria correlated well with severe forms of diabetic retinopathy, and at the end of the study, two groups of patients had been configured: the first group had developed only diabetic retinopathy, and the second, their patients with diabetic retinopathy together with renal lesion (microalbuminuria). For the first group, the duration of diabetes mellitus was the most important risk factor, and for the second group, the levels of HbA(1c) and blood pressure were the most important.     

Trends in yield and effects of screening intervals during 17 years of a large UK community‐based diabetic retinopathy screening programme

Aims To describe changes in risk profiles and yield in a screening programme and to investigate relationships between retinopathy prevalence, screening interval and risk factors. Methods We analysed a population of predominantly Type 2 diabetic patients, managed in general practice, and screened between 1990 and 2006, with up to 17 years’ follow‐up and up to 14 screening episodes each. We investigated associations between referable or sight‐threatening diabetic retinopathy (STDR), screening interval and frequency of repeated screening, whilst adjusting for age, duration and treatment of diabetes, hypertension treatment and period. Results Of 63 622 screening episodes among 20 788 people, 16 094 (25%) identified any retinopathy, 3136 (4.9%) identified referable retinopathy and 384 (0.60%) identified STDR. The prevalence of screening‐detected STDR decreased by 91%, from 1.7% in 1991–1993 to 0.16% in 2006. The prevalence of referable retinopathy increased from 2.0% in 1991–1993 to 6.7% in 1998–2001, then decreased to 4.7% in 2006. Compared with screening intervals of 12–18 months, screening intervals of 19–24 months were not associated with increased risk of referable retinopathy [adjusted odds ratio 0.93, 94% confidence interval (CI) 0.82–1.05], but screening intervals of more than 24 months were associated with increased risk (odds ratio 1.56, 95% CI 1.41–1.75). Screening intervals of < 12 months were associated with high risks of referable retinopathy and STDR. Conclusions Over time the risk of late diagnosis of STDR decreased, possibly attributable to earlier diagnosis of less severe retinopathy, decreasing risk factors and systematic screening. Screening intervals of up to 24 months should be considered for lower risk patients.     

UKPDS 50: Risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis

Aims/hypothesis. To determine risk factors related to the incidence and progression of diabetic retinopathy over 6 years from diagnosis of Type II (non-insulin-dependent) diabetes mellitus. Methods. This report describes 1919 patients from within the United Kingdom Prospective Diabetes Study (UKPDS), with retinal photographs taken at diagnosis and 6 years later and with complete data available. Photographs were centrally graded for lesions of diabetic retinopathy using the modified Early Treatment of Diabetic Retinopathy Study Final scale. Risk factors were assessed after 3 months diet from the time of diagnosis of diabetes. Patients were seen every 3 months in a hospital setting. Biochemical measurements were done by a central laboratory. End points of vitreous haemorrhage and photocagulation were confirmed by independent adjudication of systematically collected clinical data. The main outcome measures were incidence and progression of retinopathy defined as a two-step Early Treatment of Diabetic Retinopathy Study (ETDRS) final scale change. Results. Of the 1919 patients, 1216 (63 %) had no retinopathy at diagnosis. By 6 years, 22 % of these had developed retinopathy, that is microaneurysms in both eyes or worse. In the 703 (37 %) patients with retinopathy at diagnosis, 29 % progressed by two scale steps or more. Development of retinopathy (incidence) was strongly associated with baseline glycaemia, glycaemic exposure over 6 years, higher blood pressure and with not smoking. In those who already had retinopathy, progression was associated with older age, male sex, hyperglycaemia (as evidenced by a higher HbA_{1 c}) and with not smoking. Conclusion/interpretation. The findings re-emphasise the need for good glycaemic control and assiduous treatment of hypertension if diabetic retinopathy is to be minimised. [Diabetologia (2001) 44: 156–163] Received: 13 June 2000 and in revised form: 15 September 2000     

Mortality in Diabetic Patients Participating in an Ophthalmological Control and Screening Programme

The aim of this follow-up study has been to assess retinopathy and change of treatment to insulin therapy as risk factors for mortality in diabetic patients participating in a control and screening programme for retinopathy. A total of 3220 diabetic patients, 483 with an age at diagnosis <30 years, and 2737 with an age at diagnosis >30 years, were included. Retinopathy was graded on fundus photographs using the Wisconsin Scale, and the visual acuity was assessed. The average HbA_1c value was calculated for each patient for the previous 8 years to estimate long-term glycaemic control. Mortality data were obtained from death certificates. Two hundred and sixty-three diabetic patients (8.2 %) died during the mean follow-up time of 3.4 years, 13 (2.7 %) of those with younger-onset (<30 years) and 250 (9.1 %) of those with older-onset (>30 years) diabetes. Of them, 148 (56.3 %) died from cardiovascular and 23 (8.7 %) from cerebrovascular disorders. After adjusting for differences in age and sex, more severe retinopathy and the use of antihypertensive drugs were associated with a decreased overall survival rate as well as an increased mortality from cardiovascular and cerebrovascular diseases. A statistically significant association between HbA_1c values in the highest quartile, i.e. >8.4 %, and cardiovascular and all cause mortality did not remain when retinopathy was entered into the multivariate analyses. Duration of diabetes, but not change of treatment to insulin therapy, was associated with higher cardiovascular mortality in patients whose diabetes was diagnosed after the age of 30 years. We conclude that severe retinopathy, use of antihypertensive drugs, and poor glycaemic control predicted death from cardiovascular disease in diabetic patients participating in an ophthalmological screening programme. © 1997 John Wiley & Sons, Ltd.     

High prevalence of proliferative retinopathy in diabetic patients with low pancreatic B-cell capacity

A retrospective study on the role of pancreatic B-cell insulin secretory capacity in the development of proliferative diabetic retinopathy was performed in 160 diabetic patients with a duration of diabetes of more than 10 years (mean 19.5 +/- 7.9 years). Pancreatic B-cell insulin secretory capacity was assessed in terms of the quantity of C-peptide excreted into urine per day (24-h urinary C-peptide). When the patients were divided into three groups according to the quantity of 24-h urinary C-peptide (group I, C-peptide less than 30 micrograms, n = 49; group II, 30 micrograms less than or equal to C-peptide less than 80 micrograms, n = 76; and group III, C-peptide greater than or equal to 80 micrograms, n = 35), the prevalence of proliferative diabetic retinopathy was much higher in group I (26.5%) than in group II (5.3%) or group III (2.9%). The incidence of proliferative diabetic retinopathy during the follow-up period (mean 9.8 +/- 4.8 years) was also highest in group I (20.0%, 2.7%, and 2.9% in groups I, II, and III, respectively). Other factors which might affect the development of proliferative diabetic retinopathy, including duration of diabetes and past glycemic control, were comparable in these three groups. In contrast, a division of the patients according to glycemic control revealed a strong correlation between glycemic control and background diabetic retinopathy whereas no such correlation was apparent with proliferative diabetic retinopathy. These data are consistent with the view that low pancreatic B-cell insulin secretory capacity may be a risk factor for the development of proliferative diabetic retinopathy.     

Prevalence and 25?year incidence of proliferative retinopathy among Danish type 1 diabetic patients

Aims/hypothesis  This study aimed to evaluate the prevalence of retinopathy in long-surviving type 1 diabetic patients. It also investigated the 25 year incidence of proliferative retinopathy and associated risk factors in a Danish population-based cohort. Methods  A population-based cohort of 727 type 1 diabetic patients from Fyn County, Denmark, was identified in 1973. In 1981–1982, baseline retinopathy was graded and other risk factors were assessed in 573 patients. Twenty-five years later, 308 patients were still alive. Of these, 201 (65.3%) were re-examined at follow-up in 2007–2008. Results  The median age and duration of diabetes at follow-up were 58.8 and 43 years, respectively. At follow-up, the prevalence of diabetic retinopathy was 97.0%. Non-proliferative retinopathy was found in 45.8%, and 51.2% had proliferative retinopathy. The 25 year incidence of proliferative retinopathy was 42.9% among patients at risk. In a multivariate analysis, baseline HbA₁ (OR 2.14 per 1% increase, 95% CI 1.06–4.31) and non-proliferative retinopathy (OR 4.61, 95% CI 1.94–11.0) were the only risk factors for incident proliferative retinopathy. The long-term incidence of proliferative retinopathy was not associated with baseline duration of diabetes, proteinuria, smoking, body mass index, maculopathy or systolic or diastolic blood pressure. Conclusions/interpretation  Retinopathy among long-surviving type 1 diabetic patients is almost universal. Proliferative retinopathy was found in half of these patients. In addition, the 25 year incidence of proliferative retinopathy was high. Baseline glycaemic regulation and non-proliferative retinopathy were identified as risk factors for incident proliferative retinopathy.