Elsevier

Ophthalmology

Volume 105, Issue 10, 1 October 1998, Pages 1801-1815
Ophthalmology

The Wisconsin epidemiologic study of diabetic retinopathy: XVII: The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes1,

https://doi.org/10.1016/S0161-6420(98)91020-XGet rights and content

Abstract

Objective

To examine the 14-year incidence and progression of diabetic retinopathy and macular edema and its relation to various risk factors.

Design

Population-based incidence study.

Setting

The study was conducted in an 11-county area in southern Wisconsin.

Participants

Six hundred thirty-four insulin-taking persons with diabetes diagnosed before age 30 years participated in baseline, 4-year, 10-year, and 14-year follow-up examinations.

Main outcome measures

The 14-year progression of retinopathy, progression to proliferative retinopathy, and incidence of macular edema were detected by masked grading of stereoscopic color fundus photographs using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study retinopathy severity scheme.

Results

The 14-year rate of progression of retinopathy was 86%, regression of retinopathy was 17%, progression to proliferative retinopathy was 37%, and incidence of macular edema was 26%. Progression of retinopathy was more likely with less severe retinopathy, being male, having higher glycosylated hemoglobin or diastolic blood pressure at baseline, an increase in the glycosylated hemoglobin level, and an increase in diastolic blood pressure level from the baseline to the 4-year follow-up. Increased risk of proliferative retinopathy or incidence of macular edema was associated with more severe baseline retinopathy, higher glycosylated hemoglobin at baseline, and an increase in the glycosylated hemoglobin between the baseline and 4-year follow-up examination. The increased risk of proliferative retinopathy was associated with the presence of hypertension at baseline, whereas the increased risk of a participant having macular edema develop was associated with the presence of gross proteinuria at baseline. Lower glycosylated hemoglobin at baseline was associated with improvement in retinopathy.

Conclusions

These data suggest relatively high 14-year rates of progression of retinopathy and incidence of macular edema. These data also suggest that a reduction of hyperglycemia and hypertension may result in a beneficial decrease in the progression to proliferative retinopathy.

Section snippets

Study population

The population, which has been described in previous reports,26, 27, 28, 36, 37 consisted of a sample selected from 10,135 patients with diabetes who received primary care in an 11county area in southern Wisconsin from 1979 to 1980. This sample was composed of “younger-onset” persons and “olderonset” persons. These analyses will be limited to the group of younger-onset persons, all of whom were taking insulin and had been diagnosed before 30 years of age (n = 1210). There were 996 persons in

Results

Characteristics of those who participated in the 14-year follow-up, those who did not participate because they could not be located or they refused, and those who had died in the 4-year interval between the 10- and 14-year examinations are given in Table 1. With the exception of older age at diagnosis, older age at the baseline examination, and lower glycosylated hemoglobin at the baseline examination, there were no significant differences in characteristics of those who participated compared

Discussion

The data reported herein provide unique long-term population-based information regarding the incidence and progression of diabetic retinopathy and macular edema and its relationship to hyperglycemia, hypertension, and other factors. The cohort was composed of all known patients with type 1 diabetes diagnosed before 30 years of age who were receiving treatment in a defined geographic area during a specified period. The cohort was large, there was a broad distribution of severity of retinopathy

Acknowledgements

The authors thank the 452 Wisconsin physicians and their staffs who participated in and supported this study. The authors also thank Richard J. Chappell, PhD, Dayna S. Dalton, MPH, Matthew D. Davis, MD, Stacy M. Meuer, BA, Moneen Meuer, BA, Polly A. Newcomb, PhD, Mari Palta, PhD, and Kathy Peterson, RN, for their assistance; the local hospitals that provided supportive services for the mobile van; and the State of Wisconsin Division of Health for donating the van.

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  • Cited by (0)

    Supported by National Institutes of Health grant EY03083 (RK, BEKK) and, in part, by Research to Prevent Blindness (RK, Senior Scientific Investigator Award). Glycosylated hemoglobin determinations were performed in the Core Laboratory of the Clinical Nutrition Center with support from U.S. Public Health Service grant P30AMAG 26659 (Earl Shrago, MD).

    1

    Proprietary interest: none.

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