Diabetic Retinopathy –Incidence And Risk Factors In A Community Setting- A Longitudinal Study

Doron Komaneshter,Michal Shani,Shlomo Vinker,Tali Eviatar

doi:10.1080/02813432.2018.1487524

Abstract

Aim: To evaluate the natural history of diabetic retinopathy (DR) in diabetic patients and to assess long term risk for other chronic diseases associated with DR.Methods: Retrospective, community-based study. Diabetics who underwent their first fundoscopic examination during 2000–2002, and had at least one follow- up examination by the end of 2007 were included. The primary outcome was the development of DR (proliferative diabetic retinopathy (PDR), non PDR (NPDR) or macular edema.Patients were followed for another 9 years for documentation of new diagnosis of related diseases.Results: 516 patients' (1,032 eyes) records were included and were followed first for an average of 4.15 ± 1.27 years. During follow-up, 28 (2.7%) of the total 1,032 eyes examined were diagnosed with PDR. An additional 194 (18.8%) eyes were diagnosed with new NPDR. The cumulative incidence of NPDR was 310/1,032 (30.0%). All the patients who developed PDR had prior NDPR. By the end of the 9 years extended follow up, patients with NPDR had a greater risk for developing chronic renal failure HR = 1.71 (1.14–2.56), ischemic heart disease HR = 1.57 (1.17–2.09), and had an increased mortality rate HR = 1.26 (1.02–1.57)Conclusion: DR is associated with a higher rate of diabetes complications. Patients with DR should be followed more closely.Key pointsDuring a mean follow-up of 4.5 years, the cumulative incidence of diabetic retinopathy in a community cohort was 18.8%.NDPR (non-proliferative diabetic retinopathy) is a predictor of PDR (proliferative diabetic retinopathy).In a real life setting NPDR is a marker of a poorer prognosis.Patients with NDPR should be monitored more closely.

Highlights

Diabetes retinopathy is the leading cause of incident blindness among adults between the ages of 20–74 in the United States [1] and a leading cause for blindness in Israel [2]
Findings of the Early Treatment Diabetic Retinopathy Study (ETDRS) [6], UK Prospective Diabetes Study (UKPDS) [7], and Action to Control Cardiovascular Risk in Diabetes Study (ACCORD) [8], demonstrated a similar association in individuals with T2DM., The ten-year post-trial follow-up of the UKPDS showed that the benefit of reduced glycemia persisted over time
Data attained from patient charts was comprised of demographic variables: age when entered the study, gender, socio-economic level, as well as diabetes treatment at the beginning of follow-up, diagnoses of hyperlipidemia, hypertension, and obesity: smoking history, and chronic diseases at baseline, glycemic control according to HbA1c, mean levels during follow up of low density lipoprotein (LDL) cholesterol and of blood pressure

Summary

Introduction

Diabetes retinopathy is the leading cause of incident blindness among adults between the ages of 20–74 in the United States [1] and a leading cause for blindness in Israel [2]. Findings of the Early Treatment Diabetic Retinopathy Study (ETDRS) [6], UK Prospective Diabetes Study (UKPDS) [7], and Action to Control Cardiovascular Risk in Diabetes Study (ACCORD) [8], demonstrated a similar association in individuals with T2DM., The ten-year post-trial follow-up of the UKPDS showed that the benefit of reduced glycemia persisted over time. These studies failed to demonstrate an association between retinopathy and ischemic heart disease and cerebrovascular accident in diabetic patients.

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