Prevalence and Risk Factors of Diabetic Retinopathy Among Noninsulin-dependent Diabetic Subjects

doi:10.1016/S0002-9394(14)74051-6

American Journal of Ophthalmology

Volume 114, Issue 6, December 1992, Pages 723-730

https://doi.org/10.1016/S0002-9394(14)74051-6 Get rights and content

In a population-based study in Taiwan, 11,478 subjects aged 40 years or older were screened for diabetes in one urban and five rural areas. Among the 715 subjects proven to have diabetes, 527 subjects underwent ophthalmoscopy. Diabetic retinopathy was present in 184 of the 527 subjects (35.0%), including background diabetic retinopathy in 157 subjects (30.0%), preproliferative diabetic retinopathy in 15 subjects (2.8%), and proliferative diabetic retinopathy in 12 subjects (2.2%). Diabetic retinopathy was correlated with the duration of diabetes and age at onset of diabetes, type of diabetes treatment, higher serum creatinine levels, and lower serum cholesterol levels. Several other factors, including gender, age, residential area, family income, educational level, control and family history of diabetes, body mass index, physical activity, exercise, cigarette smoking, stroke, ischemic heart disease, leg vessel disease, hypertension, and proteinuria, had no significant association with retinopathy. By multiple logistic regression analysis, duration of diabetes was the most important risk factor related to retinopathy. Diabetic subjects treated with insulin had a higher risk of developing retinopathy than those treated with dietary control (relative risk, 1.57; .05 < P < .10). The univariate analysis disclosed that proliferative diabetic retinopathy was related to older age at examination, older age at onset of diabetes, type of diabetes treatment, and presence of leg vessel disease. Insulin-treated diabetic subjects also had a higher risk of proliferative diabetic retinopathy than patients in whom diabetes was controlled by diet, with a relative risk of 2.51 (.05 < P < .10) in the multiple logistic regression analysis.

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Citation Excerpt :
This is expected, given that HbA1c approximates a roughly 3-month average of blood glucose levels32 and that hyperglycemia is a well-established cause of DR.33 Further, HbA1c has been consistently found to be a predictor for DR incidence14,26,31 and prevalence7,8,29 in studies where it was considered. In studies where HbA1c was not considered, blood glucose, a correlated measure of glycemic control, was found to be associated with DR incidence13 and prevalence,11,27,28 with the exception of the Taiwan study25 of prevalence among Chinese and the Cardiovascular Health Study (CHS)12 of prevalence among US non-Hispanic whites. Systolic blood pressure was a strong predictor in both the any DR (ORper 10 mmHg+ = 1.19) and VTDR (ORper 10 mmHg+ = 1.17) models.
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Total of 4582 Chinese Americans aged 50 or older residing in Monterey Park, California.
Participants completed an in-home questionnaire on sociodemographic status and medical history, and a comprehensive clinical eye examination, using the same protocol implemented in the Los Angeles Latino Eye Study. Fundus photographs from 7 Early Treatment Diabetic Retinopathy Study fields were graded in a masked manner using a modified Airlie House grading system to assess presence and severity of DR. Logistic regression analyses based on a conceptual model of DR risk identified factors associated with prevalent DR.
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In total, 238 participants were diagnosed with any DR; 27 of these were classified as having VTDR. Both any DR and VTDR showed statistically significant positive associations with T2DM duration (OR_{5–9 years} = 1.24; OR_{10–14 years} = 2.07; OR_15+years = 3.99), glycosylated hemoglobin (HbA_1c) (OR_6.5%–6.9% = 1.33; OR_7%–7.9% = 1.86; OR_8%+ = 3.22), systolic blood pressure (SBP) (OR_{per 10 mmHg+} = 1.19), and insulin treatment (OR_insulin+ = 2.44). For VTDR, we also found novel associations with antihypertensive drugs (OR = 0.18; 95% CI = 0.06–0.61) and statins (OR: 4.96; 95% CI: 1.60–16.41). Chinese Americans and Latinos had a nearly identical DR probability based on HbA_1c and SBP. However, Latinos had a higher DR probability at every year of duration of T2DM (≥5 years).
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This study was supported by grant DOH75-0299-25 from the Department of Health, Executive Yuan, Taiwan, Republic of China (Dr. Tai).

Reprint requests to Tong-Yuan Tai, M.D., No. 7, Chung-Shan South Road, Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China.

View full text

Prevalence and Risk Factors of Diabetic Retinopathy Among Noninsulin-dependent Diabetic Subjects

Am. J. Ophthalmol.

Am. J. Ophthalmol.

Am. J. Ophthalmol.

Ophthalmology

Metabolism

Am. J. Ophthalmol.

Ophthalmology

Lancet

Ophthalmology

Longevity of diabetic patients in recent years

Diabetes

Epidemiology of diabetes mellitus in Taiwan

Epidemiology of diabetes mellitus among adults in Taiwan, R.O.C

J. Med. Assoc. Thai.

Epidemiology of diabetes mellitus in Taiwan, R.O.C. Comparison between urban and rural areas

J. Med. Assoc. Thai.

The prevalence of diabetic retinopathy. A study of 1300 diabetics from Newcastle and the Hunter Valley

Aust. J. Ophthalmol.

Diabetic retinopathy in a natural population

Aust. J. Ophthalmol.

Diabetic retinopathy. I. The course of retinopathy in insulin-treated diabetics. A one year epidemiological cohort study of diabetes mellitus. The Island of Falster, Denmark

Acta Ophthalmol.

Diabetic retinopathy. II. The course of retinopathy in diabetics treated with oral hypoglycaemic agents and diet regime alone. A one year epidemiological cohort study of diabetes mellitus. The Island of Falster, Denmark

Acta Ophthalmol.

Prevalence of retinopathy and proteinuria in type 1 diabetics in Iceland

Acta Med. Scand.

The prevalence of retinopathy in insulin-dependent juvenile-onset diabetes mellitus. A fluorescein-angiographic study

Acta Ophthalmol.

Prevalence of retinopathy in diabetes treated with oral antihyperglycaemic agents

Acta Ophthalmol.

The Wisconsin epidemiologic study of diabetic retinopathy. A comparison of retinopathy in younger and older onset diabetic persons

The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years

Arch. Ophthalmol.

The Wisconsin epidemiologic study of diabetic retinopathy, III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years

Arch. Ophthalmol.