Methodology and early findings of the Diabetes Management Project: a cohort study investigating the barriers to optimal diabetes care in diabetic patients with and without diabetic retinopathy

Background: The Diabetes Management Project is investigating the clinical, behavioural and psychosocial barriers to optimal diabetes care in individuals with and without diabetic retinopathy. Design: Prospective cohort. Participants: Two hundred and twenty‐three and 374 patients without and with diabetic retinopathy, respectively. Methods: All individuals underwent a comprehensive dilated eye test, anthropometric measurements, blood and urine samples, and psychosocial questionnaires. Main Outcome Measures: Good glycaemic control was defined as glycosylated haemoglobin < 7%, good blood pressure control as systolic and diastolic values ≤130 and 80 mmHg, respectively, and good diabetes control as glycosylated haemoglobin < 7% and blood pressure values ≤130 and 80 mmHg. Results: Four hundred and one males (65.4%) and 212 females (34.6%) aged 26–90 years (mean age ± standard deviation = 64.6 ± 11.6) were examined. The median glycosylated haemoglobin for all participants was 7.5% (interquartile range = 1.7%). Average systolic and diastolic blood pressure values were 139.7 mmHg (standard deviation = 18.8) and 92.7 mmHg (standard deviation = 30.9), respectively. Initial data analyses indicate that over two‐thirds of participants with diabetes have poor glycaemic control, which was worse in those with diabetic retinopathy compared with those without (76.3% vs. 49.3%; P < 0.001). Blood pressure control was similar for those with and without diabetic retinopathy, with almost a third (28.5%) of the total sample having poor blood pressure control. Overall, those with diabetic retinopathy had poorer diabetes control than those without (24.3% vs. 13.7%; P = 0.002). Conclusions: Our findings substantiate the implementation of the Diabetes Management Project, developed to assess factors associated with suboptimal diabetes care.     

Retinal white blood cell flux and systemic blood pressure in patients with type 1 diabetes

Aims

There is evidence that altered retinal blood flow and altered retinal blood flow regulation play a role in the development and progression of diabetic retinopathy. We compared the association between systemic blood pressure and retinal white blood cell flux in patients with type 1 diabetes and healthy control subjects.

Methods

The study was performed in 100 patients with type 1 diabetes with no or minimal diabetic retinopathy and a group of 313 age-matched healthy controls. Inclusion criteria were systolic blood pressure ≤160 mmHg and diastolic blood pressure ≤95 mmHg. None of the subjects took vasoactive medication except insulin. The blue field entoptic technique was used to assess retinal white blood cell flux, velocity and density in the perimacular region. Pressure–flow relationships were calculated for both groups to assess differences in blood flow regulation.

Results

Retinal white blood cell flux was comparable between the two study groups. Both type 1 diabetic patients and healthy subjects showed a significant positive correlation between retinal white blood cell flux and mean arterial pressure (diabetic patients: r?=?0.48; p?<?0.05, healthy subjects r?=?0.28). The correlation coefficients between mean arterial pressure and white blood cell flux were significantly higher in patients with diabetes than in the healthy control group (p?=?0.0459).

Conclusion

Retinal white blood cell flux, as assessed with the blue-field entoptic technique, is not significantly different between type 1 diabetic patients with no or minimal retinopathy and healthy control subjects. Type 1 diabetic subjects do, however, show an abnormal association between systemic blood pressure and retinal white blood cell flux. This indicates altered autoregulation in early diabetic retinopathy.     

Glycaemic control and control of risk factors in diabetes patients in an ophthalmology clinic: what lessons have we learned from the UKPDS and DCCT studies?

PURPOSE: The Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study (UKPDS) have studied glycaemic control as well as other risk factors in preventing the progression of diabetic end-organ disease, including diabetic retinopathy. We wished to determine to what extent a cross-section of diabetes patients attending our eye clinic met the targets laid down by recent landmark studies. METHODS: We prospectively assessed 44 consecutive diabetes patients attending outpatient clinics for assessment of diabetic retinopathy. Each patient had HbA1c levels, serum cholesterol and blood pressure checked. A proforma was completed for each patient. RESULTS: Of the 44 patients studied, 11 had type 1 diabetes mellitus (DM) and 33 had type 2 DM (11 insulin-dependent DM [IDDM], 22 non-insulin-dependent DM [NIDDM]). The mean age of type 1 DM patients was 43 years; that of type 2 DM patients was 62 years. Five of 11 (46%) type 1 DM patients had poorly controlled diabetes (HbA1c > 9%) compared with four of 33 (12%) type 2 DM patients. Overall, 27 of 44 (62%) patients were on antihypertensive medication. The prevalence of poorly controlled blood pressure (> 150/85 mmHg treated; > 160/90 mmHg untreated) was 16 of 44 (36%) patients overall, and was higher for type 2 DM patients (13/33, 39%) than for type 1 DM patients (3/11, 27%). Random serum cholesterol levels > 5.2 were found in 10 of 44 (23%) patients overall (4/11 [36%] type 1 and 6/33 [18%] type 2 DM patients). CONCLUSIONS: Control of HbA1c, hypertension and hypercholesterolaemia can slow progression of retinopathy and other DM end-points. Many of our patients were poorly controlled in terms of these risk factors. More attention should be addressed to these primary preventative factors in the management of diabetes patients.     

糖尿病视网膜病变患者血清circFTO和miR-141-3p表达情况及其与病变分期的关系

目的:探讨血清circFTO、miR-141-3p水平变化与糖尿病视网膜病变患者不同疾病分期的关系。方法:选取2019-10/2022-11本院收治的198例2型糖尿病患者为研究对象,根据不同分期将患者分为非糖尿病视网膜病变(NDR)组70例、非增殖期糖尿病视网膜病变(NPDR)组66例、增殖期糖尿病视网膜病变(PDR)组62例;同期选取67例本院体检正常的志愿者作为对照组。采用实时荧光定量PCR(qRT-PCR)法检测血清circFTO和miR-141-3p水平;采用Pearson相关性分析检验糖尿病视网膜病变患者血清circFTO、miR-141-3p与各指标间的相关性;采用多因素Logistic回归分析探讨糖尿病视网膜病变的影响因素。结果:PDR组circFTO、收缩压(SBP)、舒张压(DBP)高于对照组、NDR组、NPDR组,miR-141-3p、高密度脂蛋白胆固醇(HDL-C)低于对照组、NDR组、NPDR组(P<0.05)。NDR组、NPDR组、PDR组空腹血糖(FPG)、糖化血红蛋白(HbA1c)高于对照组(均P<0.05)。PDR组病程高于NDR组和NPD...     

Retinal blood flow and systemic blood pressure in healthy young subjects

BACKGROUND: The aim of the present study was to investigate the association between systemic blood pressure and retinal blood flow in healthy young subjects. METHODS: Three independent study cohorts were included. A cross-sectional study was performed in 420 young male subjects with systolic blood pressure < 160 mmHg and diastolic blood pressure <100 mmHg. Retinal white blood cell flux (n=210) and blood velocity in the central retinal artery (n=210) were measured. In addition, a longitudinal study was performed in 40 young male subjects in whom retinal and systemic haemodynamic parameters were measured thrice within 6 weeks. Retinal white blood cell flux was measured with the blue-field entoptic technique. Blood flow velocity in the central retinal artery was measured by means of colour Doppler imaging. RESULTS: Retinal white blood cell flux (r=0.262; P<0.001) and mean flow velocity in the central retinal artery (r=0.174, P=0.010) were significantly associated with mean arterial pressure in the cross-sectional study. In the longitudinal study retinal white blood cell flux and mean flow velocity in the central retinal artery were also correlated with systemic blood pressure. CONCLUSIONS: Our data indicate a slight but significant increase in retinal blood flow with blood pressure. Whether this is of clinical relevance in eye diseases with altered retinal perfusion, such as diabetic retinopathy, remains to be established.     

The prevalence of retinopathy in subjects with and without type 2 diabetes mellitus

Purpose:  To evaluate the prevalence of and risk factors for, retinopathy in a geographically defined population with type 2 diabetes mellitus compared with a control group of subjects without diabetes, matched by age, sex and residence in order to find the retinopathy attributable to type 2 diabetes. Methods:  The study populations are, on one hand, a prevalence cohort of subjects with type 2 diabetes resident in the community of Laxå, Sweden, and on the other a control group, matched by age, gender and residence with those with a diagnosis of type 2 diabetes mellitus. Retinopathy was graded from fundus photographs using a modification of the Early Treatment Retinopathy Study (ETDRS) adaptation of the modified Airlie House classification of diabetic retinopathy (DR). Results:  Any retinopathy was found in 34.6% in the type 2 diabetes cohort and in 8.8% in the control group without diabetes. Among the diabetic patients, any retinopathy was significantly associated with duration of diabetes (p = 0.0001), HbA1c (p = 0.0056), systolic blood pressure (p = 0.0091) and lower serum cholesterol (p = 0.0197) in multivariate logistic regression analyses. Having retinopathy in the control group was associated only with systolic blood pressure (p = 0.0014) in logistic regression analysis. Conclusions:  The prevalence of retinopathy among patients with type 2 diabetes in Laxå, Sweden, was similar or somewhat lower compared with other studies in the Nordic countries. The prevalence of retinopathy in a control group without diabetes equalled numbers from population studies worldwide. Our study indicates that the retinopathy that can be attributed to hyperglycaemia in the diabetic state is less common than is usually accounted for. A considerable fraction of retinopathy in subjects with diabetes may instead be due to other factors such as hypertension and should thus be treated correspondingly.     

Four years incidence of diabetic retinopathy and effective factors on its progression in type II diabetes

PURPOSE: To study the 4 years incidence of diabetic retinopathy in patients with type II diabetes and effective factors on its progression. METHODS: Among diabetic patients referred to Yazd Diabetes Research Center, 120 patients with type II diabetes without diabetic retinopathy were selected. After complete ophthalmic examination, fasting blood sugar (FBS), postprandial blood sugar, triglyceride, and cholesterol were measured and height, weight, and blood pressure (BP) were recorded. Then patients were followed with eye examination yearly for 4 years. RESULTS: Four-year cumulative incidence of diabetic retinopathy was 47.5% (95% CI: 38.6-56.4). The retinopathy was mild nonproliferative diabetic retinopathy (NPDR) in 43 (35.8%) whereas 10 (8.3%) patients had moderate NPDR, 3 (2.5%) patients had severe NPDR, and only one patient had proliferative diabetic retinopathy. The incidence of diabetic retinopathy was 5.8% in first year, 20.3% in the second year, 24.4% in the third year, and 7.4% in the fourth year. Duration of diabetes, FBS, and systolic BP had statistically significant relation with grades of diabetic retinopathy. However, there was no significant association between age, sex, body mass index, triglyceride, cholesterol, method of treatment, smoking, and diastolic BP with grades of diabetic retinopathy. CONCLUSIONS: These data provide 4-year cumulative incidence of diabetic retinopathy in defined type 2 diabetic patients. The present study shows that duration of diabetes, hyperglycemia, and systolic BP appear to be the major factors associated with the development of any level of retinopathy in type 2 diabetic patients.     

动态血压和偶测血压与糖尿病视网膜病变的关系

目的 研究血压升高和昼夜节律与糖尿病视网膜病变的关系。方法 以５０例健康人列血压正常的非胰岛素依赖型糖尿病患者进行偶测血压、２４ｈ动态血压监测。结果 非胰岛素依赖型糖尿病患者的２４ｈ、白天、夜间平均舒张压均比对照组明显升高,夜间收缩、舒张压下降百分率均降低,昼夜节律消失,与眼底改变呈明显正相关（Ｐ〈０．０１）,偶测血压与眼底改变无相关性（Ｐ〉０．０５）。结论 随着血压昼夜节律消失及舒张压持续升高,     

copeptin和MK在糖尿病视网膜病变患者中的表达及其意义

目的：探讨和肽素(copeptin)和中期因子(midkine,MK)在糖尿病视网膜病变患者中的表达水平及其临床意义。

方法：选择2016-06/2017-10我院收治的180例2型糖尿病(T2DM)患者,根据糖尿病视网膜病变分期标准,将患者分为三组,其中无视网膜病变组68例,非增殖性视网膜病变组72例,增殖性视网膜病变组40例,另选同期体检健康者90例作为对照组,采用双抗体免疫夹心法检测copeptin水平,采用ELISA法检测MK水平,采用TOSOH全自动糖化血红蛋白分析仪检测糖化血红蛋白(HbA1c),采用血常规仪器检测全血超敏C反应蛋白(hs-CRP),采用全自动生化分析仪检测空腹血糖(FPG)、三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)水平,并记录各组收缩压(SBP)和舒张压(DBP),并分析copeptin 和MK水平与血脂、血压、生化相关指标及糖尿病病程的关系。

结果：糖尿病视网膜病变患者copeptin 和MK水平明显高于对照组,且随着疾病进展,copeptin 和MK水平逐渐升高(P<0.05)。copeptin和MK水平均与HbA1c、hs-CRP、糖尿病病程呈正相关性(均P<0.05),但与血脂、血压、FPG水平均无明显相关性(均P>0.05)。

结论：copeptin和MK水平与糖尿病视网膜病变的病程和病情严重程度密切相关,二者可能参与了糖尿病视网膜病变的发生发展。     

Retinal capillary blood flow in diabetic and nondiabetic women during pregnancy and postpartum period

PURPOSE: To evaluate the response of retinal capillary circulation to pregnancy in women with diabetes and to correlate microcirculatory changes with progression of retinopathy during pregnancy. METHODS: A prospective follow-up study of 32 pregnant women with insulin-dependent diabetes and 11 nondiabetic pregnant women. Perimacular capillary blood flow measured noninvasively by retinal flowmetry in the inferior perimacular retina. Eleven nonpregnant diabetic women served as diabetic control subjects. RESULTS: In diabetic women, blood flows, measured by small-box analysis, were 233 +/- 69 (mean +/- SD) arbitrary units (AU) during the first trimester, 248 +/- 55 AU during the third trimester, and 238 +/- 46 AU 3 months postpartum, compared with 204 +/- 32, 195 +/- 22, and 196 +/- 34 AU in nondiabetic pregnant women (P = 0.007 between groups). A difference of the same magnitude was evident between the two groups when the mean of the 50th (P = 0.032), 75th (P = 0.004), and 90th (P = 0.007) percentiles of the individual pixel flow values were used in point-wise analysis. In nonpregnant diabetic women, the small-box mean value was 201 +/- 36, and the mean of the 75th percentile value in point-wise analysis was 316 +/- 49. Blood flow was lower in nonpregnant than in pregnant diabetic women during the third trimester (P = 0.023 and P = 0.012, respectively). CONCLUSIONS: Compared with nondiabetic pregnant women, retinal capillary blood flow was higher in diabetic women during pregnancy and after delivery. Together with the hormonal and metabolic changes occurring during pregnancy, hyperdynamic retinal capillary circulation may contribute to the progression of retinopathy in pregnant diabetic women.     

The risk of blindness in diabetic retinopathy

A good control of blood sugar <110 mg/dl, HbA1c <7%, diastolic BP <80 mmHg and systolic BP <140 mmHg, cholesterol <200 mg/dl, triglycerides <150 mg/dl are the best way to set a limit to the progression of diabetic retinopathy. Progression of DR leads finally to blindness! Blindness is visual acuity less than 3/60 with the best possible correction. Low-vision is a visual acuity less than 6/18, but equal to or better than 3/60, best possible correction in the better eye.     

高血压对糖尿病视网膜病变患者血浆TXB2浓度的影响

用放射免疫法测定204例糖尿病患者的血浆TXB₂和6-Keto-PGFla浓度。结果显示：糖尿病视网膜病变（DR）各组的TXB₂水平随DR加重而升高，6-keto-PGFla无明显弯。DR各组中血压正常者仅增殖性糖尿病视网膜病变（PDR）组TXB₂升高（P＜0.05），而合并高血压各组TXB₂均显著升高（P＜0.01），高血压组TXB₂水平均高于血压正常组（P＜0.05）.提示TXB₂在DR微血栓形成中起重要作用，合并高血压时对DR的发生、发展有明显的促进作用。 （中华眼底病杂志，1995，11：235-236）     

Choroidal blood flow in diabetic retinopathy

The ocular hemodynamics in diabetic patients with increasingly severe retinopathy have been evaluated using a non-invasive computerized methodology. In a group of 19 healthy volunteers the mean ophthalmic arterial pressure and the ocular pulsatile blood flow were 83 +/- 2.4 mmHg and 648 +/- 42 microliters min-1 respectively. Nine diabetics with no apparent retinopathy had ophthalmic pressures and pulsatile blood flows similar to those in the control subjects. In 11 diabetic patients with background retinopathy the mean pulsatile blood flow was 471 +/- 70 microliters min-1. Thirteen diabetics with proliferative retinopathy had a pulsatile blood flow of 210 +/- 37 microliters min-1 and abnormally low ophthalmic arterial pressures. The results provide evidence that the choroidal blood flow decreases with the severity of the retinopathy in diabetes due to increased vascular resistance and a decreased ocular perfusion pressure.     

Diabetic retinopathy in Oman: a hospital based study

The magnitude of diabetic retinopathy, its determinants, and coverage of laser treatment for diabetic retinopathy among registered people with diabetes in Oman are presented. 2249 randomly selected subjects representing 5564 registered diabetics were examined. WHO recommended definitions of diabetes, retinopathy, and other related conditions were used. Physicians reported the profile of the diabetes while ophthalmologists reported ocular profile and the eye care provided to them. The prevalence of diabetic retinopathy was 14.39% (95% CI 13.46 to 15.31). Men had significantly higher rate of retinopathy than women. The retinopathy rate was higher in age groups 50-59 years and 60-69 years. The rates of background retinopathy, proliferative retinopathy, and diabetic maculopathy were 8.65%, 2.66%, and 5.12%, respectively. The rate was higher among subjects with longer duration of diabetes than those with a shorter duration. Those with an HbA(1c) level more than 9% had significantly higher rates of diabetic retinopathy than those with an HbA(1c) level less than 9%. The retinopathy rate was higher in cases with hypertension, nephropathy, and neuropathy. Of those with diabetic retinopathy who were advised to have treatment at the time of registration, only 20% were treated with laser therapy.     

The burgeoning public health impact of diabetes: the role of the ophthalmologist

With the recent increases and future projected increases in the incidence of type 2 diabetes mellitus and with the incidence increasing in teenagers and young adults, the already substantial public health effect of diabetes and diabetic retinopathy will become greater in years to come. Despite the strength of the evidence that optimizing control of glucose, blood pressure, and lipid levels will reduce the incidence and progression of diabetic retinopathy, metabolic control remains suboptimal for many patients with diabetes. In addition, many patients do not follow recommended guidelines for regular eye examinations, which is unfortunate because there is good evidence that with regular follow-up and intervention with photocoagulation as indicated, severe vision loss from diabetic retinopathy is uncommon. Yet, diabetic retinopathy is a leading cause of severe vision loss in adults. The current health care system too often fails to adequately manage diabetes and is lacking in providing proper education and motivation for patients to optimize their metabolic control. In addition to treating retinopathy, ophthalmologists can play an important role in educating and motivating patients to achieve better metabolic control, which, if successful, potentially could do more to reduce the progression of retinopathy than any of the ocular treatments currently in the armamentarium of the ophthalmologist.     

Microvascular retinopathy in subjects without diabetes: the Inter99 Eye Study

Purpose: Retinal vascular lesions such as microaneurysms and haemorrhages, while typical of diabetic retinopathy, are also seen in subjects without diabetes where they are associated with elevated cardiovascular mortality. In theory, these lesions could be a consequence of past hyperglycaemia. We examined the prevalence and risk factors for retinopathy, including lens fluorescence, a biomarker of cumulative life‐time glycaemia in adults without diabetes. Methods: Cross‐sectional population‐based study of 711 subjects without diabetes ( WHO 1999 criteria) aged 30–60 years, including oral glucose tolerance testing, clinical and laboratory examinations, non‐invasive ocular lens fluorometry and seven‐field fundus photography. Results: Retinopathy was present in 8.3% (CI₉₅ 6.3–10.3%) of subjects. Higher systolic blood pressure (SBP) (p = 0.032), increasing body mass index (BMI) (p = 0.014) and wider waist circumference (p = 0.014) were significantly associated with retinopathy after adjusting for age and sex. Retinopathy was not significantly related to long‐term, short‐term or current glycaemia (lens fluorescence, HbA_1c, fasting plasma glucose). In the multivariate analysis, the odds ratio (OR) for retinopathy in subjects with SBP ≥160 mmHg compared to subjects with SBP <130 mmHg was 2.68 (CI₉₅ 1.07–6.70, p = 0.036) and in subjects with BMI ≥30 compared to subjects with BMI < 25 the OR for retinopathy was 2.14 (CI₉₅ 1.01–4.57, p = 0.049) when adjusting for both variables, age, sex, the presence of impaired glucose tolerance and impaired fasting glucose. Conclusion: Retinopathy in subjects without diabetes was associated with hypertension and obesity. The study found no evidence that microvascular retinopathy in non‐diabetic subjects was a consequence of past hyperglycaemia.     

Prevalence and risk factors for diabetic retinopathy among Omani diabetics

AIMS—To study the prevalence of diabetic retinopathy in a population of patients attending a diabetic clinic and to evaluate the medical risk factors underlying its development.
METHODS—500 randomly selected diabetic patients attending the diabetes clinic in Al Buraimi hospital were referred to the ophthalmology department where they were fully evaluated for the absence or presence of retinopathy. Any retinopathy present was graded as mild non-proliferative retinopathy (NPR), moderate-severe NPR, and proliferative retinopathy. Several risk factors were then evaluated in order to delineate those related to occurrence of retinopathy in general as well as to the different grades of retinopathy in particular.
RESULTS—Diabetic retinopathy was detected in 212 patients (42.4%), with mild NPR present in 128 patient (25.6% of the total population), moderate-severe NPR in 20 patients (4%), and proliferative diabetic retinopathy present in 64 patients (12.8%). Factors significantly related to occurrence of retinopathy were age of the patient, duration of diabetes, presence of ischaemic heart disease, presence of hypertension, a high fasting capillary glucose level as well as elevated serum levels of urea, creatinine, cholesterol, and triglycerides. After adjustment for covariates, it was found that duration of diabetes was the only risk factor associated with mild NPR, while high diastolic blood pressure and high levels of serum creatinine, cholesterol, and triglycerides were significantly associated with the occurrence of proliferative retinopathy.
CONCLUSIONS—In addition to glycaemic control, lowering of blood lipids as well as diastolic blood pressure (in hypertensive patients) may be effective in lowering the incidence of retinopathy in compromised patients.

Keywords: diabetic retinopathy; Oman; diabetics     

Retinal circulatory changes related to retinopathy progression in insulin-dependent diabetes mellitus

To quantify the vascular deterioration of the diabetic retina, retinal circulatory changes in 45 insulin-dependent diabetic patients, and in 17 normal controls, were measured and divided into four groups according to severity of retinopathy. The noninvasive laser Doppler technique was used to measure the systolic/diastolic variation of red blood cell velocity (V) at sites along temporal retinal arteries. Flow pulsatility [V (systole)/V (diastole)] was 18% lower (P less than 0.00001) in the mild-retinopathy group than in normal controls, but 35% higher (P less than 0.001) in the severe-retinopathy group than in the mild-retinopathy group. Repeated measurements in three eyes during the progression from mild or moderate to severe retinopathy showed progressive increases in both flow pulsatility and mean retinal blood flow. Altered flow pulsatility appears to be a sensitive indicator of vascular alterations during the progression of diabetic retinopathy.     

社区2型糖尿病视网膜病变的相关危险因素分析

目的:分析2型糖尿病患者糖尿病视网膜病变(diabetic retinopthy,DR)相关危险因素。方法:2型糖尿病患者300例,根据有无DR及病变程度分为3组:正常视网膜(NDR)组、非增殖型视网膜病变(NPDR)组和增殖型视网膜病变(PDR)组进行临床分析。结果:和NDR组比较,NPDR、PDR组病程、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、2h血糖(2hPG)、糖化血红蛋白(HbA1c)、24h尿蛋白排泄量显著升高,差异有统计学意义(P<0.05)。Logistic回归分析表明:病程和SBP是DR发生的独立危险因素。结论:病程、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、2h血糖(2hPG)、糖化血红蛋白(HbA1c)、24h尿蛋白排泄量等因素与DR的发生有关,其中糖尿病病程及SBP是DR的独立危险因素。     

Macular circulation in patients with diabetes mellitus with and without arterial hypertension

BACKGROUND: Previous fluorescein angiographic studies have shown alterations in the macular microcirculation in patients with diabetes mellitus and arterial hypertension. In both diseases capillary blood velocity was reduced and capillary density decreased. These changes were more pronounced in diabetic patients. We have examined the influence of arterial hypertension in combination with diabetes mellitus. METHODS: 62 patients with diabetes mellitus and arterial hypertension (group 1) were matched with patients with diabetes mellitus but without arterial hypertension (group 2, match criteria: ETDRS stage of retinopathy). In all subjects fluorescein angiograms were performed with a scanning laser ophthalmoscope. Macular capillary blood velocity (CBV), perifoveal intercapillary area (PIA), the coefficient of variation of both parameters, the area of the foveal avascular zone (FAZ), and the arteriovenous passage time (AVP) were assessed by digital image analysis. RESULTS: Systolic and diastolic blood pressures were significantly increased in the patients with arterial hypertension (systolic p=0.0008; diastolic p=0.03). Neither dynamic measures (AVP: 1.64 (0.49) seconds (group 1), 1.72 (0.58) seconds (group 2); CBV: 1.98 (0.39) mm/s (group 1), 2.09 (0.43) mm/s (group 2)) nor morphological measures (PIA: 7985 (3137) microm(2) (group 1), 8338 (3376) microm(2) (group 2); FAZ: 0.319 (0.206) mm(2) (group 1), 0.363 (0.237) mm(2) (group 2)) were significantly different between the two groups of diabetic patients. CONCLUSION: Arterial hypertension did not result in more severe macular capillary dropout than diabetes without hypertension. This might be explained by the fact that most of the patients were being treated with antihypertensive drugs.