Abstract
Aim. To determine the influence of age at onset of type 1 diabetes and of traditional vascular risk factors on the development of diabetic retinopathy, in a cohort of patients who have been followed up after onset. Methods. Observational, retrospective study. The cohort consists of 989 patients who were followed up after diagnosis for a mean of 10.1 (SD: 6.8) years. The influence of age at diagnosis, glycemic control, duration of diabetes, sex, blood pressure, lipids, BMI, and smoking is analyzed using Cox univariate and multivariate models with fixed and time-dependent variables. Results. 135 patients (13.7%) developed diabetic retinopathy. The cumulative incidence was 0.7, 5.9, and 21.8% at 5-, 10-, and 15-year follow-up, respectively. Compared to the group with onset at age <10 years, the risk of retinopathy increased 2.5-, 3-, 3.3-, and 3.7-fold in the groups with onset at 10–14, 15–29, 30–44, and >44 years, respectively. During follow-up we also observed an association between diabetic retinopathy and HbA1c levels, HDL-cholesterol, and diastolic blood pressure. Conclusion. The rate of diabetic retinopathy is higher in patients who were older at type 1 diabetes diagnosis. In addition, we confirmed the influence of glycemic control, HDL-cholesterol, and diastolic blood pressure on the occurrence of retinopathy.
Highlights
Diabetic retinopathy (DR) remains a common complication in people with type 1 diabetes (T1D). 39, 55, and 84% of T1D patients will develop DR after 10, 20, and 40 years of evolution, respectively [1,2,3]
The rate of DR increases with the age of diagnosis
Taking advantage of the follow-up of the patients included in the T1D Registry of Navarra, we have confirmed the influence of some controversial risk factors on the occurrence of DR
Summary
Diabetic retinopathy (DR) remains a common complication in people with type 1 diabetes (T1D). 39, 55, and 84% of T1D patients will develop DR after 10, 20, and 40 years of evolution, respectively [1,2,3]. The duration of diabetes and the glycemic control are the risk factors that are most closely related with all forms of DR. Other factors such as male gender, hypertension, high body mass index (BMI), nephropathy, dyslipidemia, smoking, and genetic factors appear to influence the onset or progression of DR, their role is controversial [1, 3,4,5]. Some studies have reported that the prepubertal stage, especially the first 5 years of life, might protect from the occurrence of DR [6,7,8]. There are authors that point out that such protection disappears as the disease progresses [2, 5], while others have never observed such an effect [9, 10]
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