Ten-year incidence of diabetic retinopathy and macular edema. Risk factors in a sample of people with type 1 diabetes

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Abstract

Aims

To determine the 10-year incidence of diabetic retinopathy (DR) and macular edema (DME), and its relationship with its risk factors in a sample of type 1 diabetes mellitus.

Methods

A total of 334 patients without diabetic retinopathy at baseline underwent a 10-year prospective study, the risk factors included: age, gender, diabetes duration, HbA1c, LDL-C, HDl-C, TC/HDL-C ratio, ApoA1, ApoB, ApoB/ApoA1 ratio, and triglycerides were recorded. Risk factors for diabetic macular edema (DME) were also recorded.

Results

The 10-year incidence of any DR was 35.90%, and 11.07% developed DME. The risk factors for DR and DME were: diabetes duration, high glycosylated level, and arterial hypertension, and overt nephropathy was well correlated with DME. The lipid study demonstrated that ApoB/ApoA1 ratio was significant for any DR [HRR: 0.594 (0.416–0.848), p = 0.01], and DME [HRR: 0.601 (0.433–0.894), p = 0.009]. The TC/HDL ratio was only significant for DME [HRR: 0.624 (0.440–0.886), p = 0.008]; other lipids values were not significant for any groups studied.

Conclusions

In the present study, the ApoB/ApoA1 ratio was significant to the 10-year incidence of diabetic retinopathy and to macular edema; and the TC/HDL ratio was significant to a 10-year incidence of macular edema.

Introduction

Diabetes mellitus (DM) is defined as a group of metabolic diseases whose common feature is an elevated blood glucose level (hyperglycaemia). Diabetes mellitus is a major health problem worldwide. In 2010 more than 200 million patients had diabetes. The world's population is predicted to increase by 62% between the years 1995 and 2025, and the prevalence of DM by over 120% [1].

In 2000, the World Health Organization Expert Committee on Diabetes [2] defined diabetes as >7.0 mmol/L (126 mg/dl) and as >11.1 mmol/L (200 mg/dl) 2 h after a 75 g glucose load.

Diabetic retinopathy (DR) is the most important cause of blindness in type 1 DM (DM1) patients [3]. Several factors appear to influence susceptibility to DR; the most powerful risk factors for DR are the duration of diabetes, high glycemic levels and arterial hypertension [4].

The importance of lipids in the development of DR has been studied but with differing results, many studies not finding any association, and others observing some relationship between lipids and different diabetic retinopathy complications such as diabetic macular edema (DME) or the number of lipid exudates in the eye fundus [5].

The aim of the present study is to determine the ten-year incidence of diabetic retinopathy in a population-based study of registered DM1 patients in our Health Care Area (HCA) and its risk factors, with lipids as independent risk factors being the focus of interest.

Section snippets

Setting

Hospital St Joan is the only public ophthalmology centre in Reus (Catalonia, Spain), and has a dependent population of 322,740. All type DM1 patients referred by general practitioners and endocrinologists since 1990 (1059) have been registered at the Ophthalmology Service. Since 1987, there has been a steady increase of 11.4 new cases per 100,000 inhabitants (13.2 men and 9.6 women).

Design

The present study is a population-based prospective ten-year study of a sample of all DM1 patients referred in

Demographic variables of the patients (Table 1)

Baseline patients’ characteristics can be seen in Table 1, thus: gender: 53.00% were men and 47.00% women; current age: between 19 and 59 years with a mean of 26.17 ± 11.74 years; diabetes duration: 7.88 ± 5.47 years (1–35 years); Microalbuminuria present in 3.59% of patients, and arterial hypertension in 30.50%; mean HbA1c, 7.72 ± 1.42%.

Incidence of diabetic retinopathy and macular edema (Table 2)

The ten-year incidence of any diabetic retinopathy was 120 patients (35.90%), and diabetic macular edema was observed in 37 patients (11.07%) of these 120 patients.

Discussion

The present study includes 334 from a total of 1059 DM1 patients surveyed in our area (of 322,740 inhabitants). Since all DM1 patients have been counted in our hospital since 1990, we believe that the results are highly representative and may be extended to other DM1 patients in our area.

The incidence of DR and DME in the present study at the ten-year follow up of a DM1 patient sample is similar to other studies carried out with patients submitted to conventional insulin treatments like the

Contributors

P.R-A. has contributed to the study design, researched data analysis, discussion, manuscript writing and supervision of the manuscript. M.B-B. has contributed to the ophthalmologic data collection, discussion, review and edition of the manuscript. N.P-G. has contributed to the study design, systemic disease diagnosis and laboratory analysis interpretation, researched data analysis and discussion. I.M-M. has contributed to the ophthalmologic data collection and research. J.F-B. has contributed

Conflict of interest

The authors state that they have no conflict of interest relevant to this article to disclose.

Acknowledgments

Medical School, University Rovira I Virgili of Tarragona, (Spain) for the technical assistance. Institut de Investigacio Sanitaria Pere Virgili (IISPV): for its analysis data support and providing funds.

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