Elsevier

Ophthalmology

Volume 115, Issue 11, November 2008, Pages 1859-1868
Ophthalmology

Original article
The Wisconsin Epidemiologic Study of Diabetic Retinopathy XXII: The Twenty-Five-Year Progression of Retinopathy in Persons with Type 1 Diabetes

https://doi.org/10.1016/j.ophtha.2008.08.023Get rights and content

Objective

To examine the 25-year cumulative progression and regression of diabetic retinopathy (DR) and its relation to various risk factors.

Design

Population-based study.

Participants

A total of 955 insulin-taking persons living in an 11-county area in southern Wisconsin with type 1 diabetes diagnosed before age 30 years who participated in a baseline examination (1980–1982) and at least 1 of 4 follow-up (4-, 10-, 14-, and 25-year) examinations or died before the first follow-up examination (n = 64).

Methods

Stereoscopic color fundus photographs were graded using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study retinopathy severity scheme.

Main Outcome Measures

Progression and regression of DR status.

Results

The 25-year cumulative rate of progression of DR was 83%, progression to proliferative DR (PDR) was 42%, and improvement of DR was 18%. Progression of DR was more likely with less severe DR, male sex, higher glycosylated hemoglobin, an increase in glycosylated hemoglobin level, and an increase in diastolic blood pressure level from the baseline to the 4-year follow-up. Increased risk of incidence of PDR was associated with higher glycosylated hemoglobin, higher systolic blood pressure, proteinuria greater body mass index at baseline, and an increase in the glycosylated hemoglobin between the baseline and 4-year follow-up examinations. Lower glycosylated hemoglobin and male sex, as well as decreases in glycosylated hemoglobin and diastolic blood pressure during the first 4 years of follow-up, were associated with improvement in DR. Persons diagnosed most recently with a similar duration of diabetes had a lower prevalence of PDR independently of glycosylated hemoglobin level, blood pressure level, and presence of proteinuria.

Conclusions

These data show relatively high 25-year cumulative rates of progression of DR and incidence of PDR. The lower risk of prevalent PDR in more recently diagnosed persons possibly reflects improvement in care over the period of the study.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Population

The population, who have been described in previous reports,9, 10, 11, 30, 31, 32, 33 consisted of a sample selected from 10,135 diabetic patients who received primary care in an 11-county area in southern Wisconsin from 1979 to 1980. This sample was composed of all those with “younger-onset” type 1 diabetes and a duration-stratified sample of those with “older-onset” type 1 diabetes. The analyses in this report are limited to the group with younger-onset type 1 diabetes, all of whom were

Characteristics of the Cohort

Characteristics at the baseline examination of those who participated in the 25-year follow-up, those who did not participate because they could not be located or they refused, and those who had died in the 11-year interval between the 14- and 25-year examinations are given in Table 1. With the exception of less education, there were no significant differences in characteristics of those who participated compared with those who survived but did not participate. The 120 persons with

Discussion

The data reported provide unique population-based information regarding the 25-year cumulative rates of progression and improvement of DR and their relationship to glycemia, blood pressure, and other factors in persons with type 1 diabetes mellitus over a period of profound change in the management of this condition. The overall 25-year incidence of any retinopathy (97%), rates of progression of retinopathy (83%), and progression to proliferative retinopathy (42%) were high, and the strongest

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    Manuscript no. 2008-303.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

    This research is supported by National Institutes of Health grant EY03083 and EY016379 (Ronald Klein, MD, MPH, Barbara E. K. Klein, MD, MPH) and, in part, by the Research to Prevent Blindness (R. Klein and BEK Klein, Senior Scientific Investigator Awards), New York, NY. The National Eye Institute provided funding for entire study including collection and analyses and of data; RPB provided further additional support for data analyses.

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