Abstract
This study aimed to assess the impact of diabetic retinopathy (DR) severity on the incidence of major adverse cardiac events (MACE) and end-stage renal disease (ESRD) in T1D patients. Patients diagnosed with T1D between 1999 and 2013 were identified from patient-level data of Taiwan’s National Health Insurance Research database. A total of 1135 patients were included and classified into mild DR (n = 454), severe DR (n = 227), or non-DR (n = 454) by using propensity score matching. Multi-state model analyses, an extension of competing risk models with adjustment for transition-specific covariates for prediction of subsequent MACE and ESRD, were performed. MACE and ESRD risks were significantly higher in the severe DR patients; a 2.97-fold (1.73, 5.07) and 12.29-fold (6.50, 23.23) increase in the MACE risk among the severe DR patients compared to the mild DR and DR-free patients, respectively; and, a 5.91-fold (3.50, 9.99) and 82.31-fold (29.07, 233.04) greater ESRD risk of severe DR patients than that of the mild DR and DR-free groups, respectively (p < 0.001). Severity of DR was significantly associated with the late diabetes-related vascular events (i.e., MACE, ESRD) among T1D patients.
Highlights
This study aimed to assess the impact of diabetic retinopathy (DR) severity on the incidence of major adverse cardiac events (MACE) and end-stage renal disease (ESRD) in Type 1 diabetes (T1D) patients
There were no significant differences in comorbidities, Charlson’s comorbidity index (CCI), and diabetes duration between the severe DR, mild DR, and DR-free groups after the matching
This study is the first to examine the effect of DR severity on MACE and ESRD in a T1D patient population with applying advanced multi-state model analyses to gain more biological insights in the disease process of a patient
Summary
This study aimed to assess the impact of diabetic retinopathy (DR) severity on the incidence of major adverse cardiac events (MACE) and end-stage renal disease (ESRD) in T1D patients. Severity of DR was significantly associated with the late diabetes-related vascular events (i.e., MACE, ESRD) among T1D patients. Using a large populationbased T1D cohort in Taiwan, we have previously reported the long-term risk of ESRD and associated mortality among T1D patients across all a ges[3,16] and details of the cumulative incidences of various vascular complications in this p opulation[17]. We further applied advanced multi-state model analyses to explore the impact of DR severity on long-term risks of ESRD and major adverse cardiovascular events (MACE) among patients with T1D by utilizing a nation-wide population-based T1D patient cohort
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