Abstract
BackgroundTo explore the associations of glycemic and blood pressure (BP) control with diabetic retinopathy (DR), with special focus on whether different combinations of categories of these two interventions are additive.MethodsA community-based survey including 913 patients with known type-2 diabetes mellitus (T2DM) was conducted in Suzhou, China. Retinal photographs were graded for the presence of DR using the Airlie House classification system. BP and blood hemoglobin A1c (HbA1C) levels were measured by standardized protocols. Binary logistic regression models were established to examine the associations of risk factors with DR.ResultsThe overall prevalence of any DR was 18.0% [95% confidence interval (95% CI) 15.5–20.6%] in this population. Stratified by conventional control thresholds, lower levels of either systolic blood pressure (SBP, < 140 mmHg) or HbA1C (< 7.0%) were not significantly associated with decreased susceptibility to DR, while patients simultaneously with lower HbA1C and SBP levels demonstrated 43% reduced likelihood of developing DR [adjusted odds ratio (OR) = 0.57, 95% CI 0.33–0.99, P = 0.045)], comparing with those with both higher levels of HbA1C (≥ 7.0%) and SBP (≥ 140 mmHg). Meanwhile, the group achieved intensive HbA1C (< 6.5%) and SBP (< 120 mmHg) control goals were found to have the smallest OR, but failed in yielding statistical significance (P = 0.10).ConclusionsIn this community-based DR screening study of Chinese adults with T2DM, combination but not individual of lower SBP (< 140 mmHg) and HbA1C (< 7.0%) levels, were suggested to be associated with a significantly reduced likelihood of having DR.
Highlights
To explore the associations of glycemic and blood pressure (BP) control with diabetic retinopathy (DR), with special focus on whether different combinations of categories of these two interventions are additive
Completed data of BP, hemoglobin A1c (HbA1C) and other covariates were obtained from 719 participants, who included in the data analyses
DR diabetic retinopathy, systolic BP (SBP) systolic blood pressure, OR odds ratio, 95% confidence interval (CI) 95% confident interval * Multivariate logistic regression models, adjusted by covariates such as gender, age, Body Mass Index (BMI), diabetes duration, and presence of hyperlipidemia
Summary
To explore the associations of glycemic and blood pressure (BP) control with diabetic retinopathy (DR), with special focus on whether different combinations of categories of these two interventions are additive. Pan et al Diabetol Metab Syndr (2018) 10:73 lowering glycemia and BP in individuals with T2DM is an area of current controversy, with particular debates surrounding who should be offered therapy and what the glucose/BP targets should be achieved When it comes to DR, the United Kingdom Prospective Diabetes Study revealed that an intensive compared with a conventional glycemia control policy could reduce the risk of DR [20], while other studies revealed inconsistent results that there was a non-significant trend toward a beneficial effect in the intensive-therapy group with respect to DRin the standard-therapy group [21,22,23,24,25]. With regard to the above mentioned conflict findings, it remains unknown as to whether there is a specific threshold at which glycemic and BP control would complement each other multiplicatively in the clinical management of T2DM and DR, or if extremes of each risk factor might mitigate or enhance the benefits of controlling the other
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