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Gender differences in the incidence and progression of diabetic retinopathy among Japanese patients with type 2 diabetes mellitus: A clinic-based retrospective longitudinal study

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Abstract

A clinic-based retrospective longitudinal study conducted for 5.8 ± 2.5 years, including 383 (M/F 245/138) Japanese patients with type 2 diabetes mellitus showed that females exhibit a significantly higher prevalence of proliferative diabetic retinopathy (DR) at baseline and that female gender is an independent risk factor for the development of DR.

Introduction

The proportion of patients with type 2 diabetes mellitus (T2DM) who progress from no baseline retinopathy to referable retinopathy after one year has been reported to be very low, at approximately 0.2% in the UK [1], [2]. However, diabetic retinopathy (DR) remains a leading cause of preventable visual impairment [3]. Therefore, there is a need to discriminate between high-risk and low-risk patients [1], [4].

An analysis of 120,000 patients with T2DM in Germany/Austria showed that older or obese females are significantly more often affected by DR [5]. A population study conducted in the UK reported a significantly higher prevalence of visual loss in white females than in white males with DM [6], and several [7], [8], [9], [10], [11] but not all [12], [13], [14], [15] studies, including one longitudinal study of Type 1 DM [11], suggested that females are at higher risk of DR and visual impairment due to DR. Furthermore, the baseline presence of proliferative DR (PDR) in both genders and nonproliferative DR (NPDR) in females predicted all-cause and cardiovascular disease death [16].

The aim of this pilot study was to determine gender differences in DR together with risk associations which can be identified in daily practice in Japan.

Section snippets

Patients and methods

A clinic-based retrospective longitudinal study was conducted which included 383 Japanese patients with T2DM (M/F 245/138) who were treated for more than a half year at the Jinnouchi Clinic, Diabetes Care Center in Kumamoto, Japan, between February 2002 and January 2011. The study protocol was approved by the institutional ethics committees and written informed consent was obtained from each subject. The study was performed in accordance with the Declaration of Helsinki.

DR was diagnosed by a

Results

The mean follow-up duration was 5.8 ± 2.5 years. At baseline, 89 (23.2%) patients had NPDR and 59 (15.4%) had PDR (Table 1). The mean age, diabetes duration and HbA1c level of all subjects were 59.4 ± 11.0 years, 11.0 ± 8.3 years and 8.6 ± 2.0%, respectively. Patients with DR had longer diabetes duration and higher systolic blood pressure (SBP) values than those without. Females exhibited a significantly higher prevalence of PDR than males (21.0% vs. 12.2%, P = 0.03). Females were diagnosed with DM at an

Discussion

This clinic-based retrospective longitudinal study showed that females with T2DM exhibited a significantly higher prevalence of PDR than males at baseline and that female gender was an independent risk factor for incident DR and progression to PDR. Recently, an eight-year follow-up study of the Japan Diabetic Complications Study (JDCS) reported the incidence of DR to be 38.3/1000 person-years [17], which was lower than the finding of 90.1/1000 person-years in the UK [2] and the 58.5/1000

Conflict of interest

There is no conflict of interest.

Acknowledgment

This work was supported by KAKENHI (No. 23510348) and by a grant from the Smoking Research Foundation.

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