Development Of Retinopathy In Type Research Articles

Are soluble E-selectin, ICAM-1, and VCAM-1 potential predictors for the development of diabetic retinopathy in young adults, 15-34 years of age? A Swedish prospective cohort study.

The aim of this study was to determine plasma levels of three adhesion molecules that may contribute to the development of diabetic retinopathy; soluble endothelial selectin (sE-selectin), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1), in young adults, aged 15-34 years at diagnosis of diabetes, to find potential predictors for development of retinopathy, and to evaluate their relation to diabetes associated autoantibodies. Participants with type 1 (n = 169) and type 2 diabetes (n = 83) were selected from the complications trial of the Diabetes Incidence Study in Sweden and classified in two subgroups according to presence (n = 80) or absence (n = 172) of retinopathy as determined by retinal photography at follow-up 8-10 years after diagnosis of diabetes. Blood samples were collected at diagnosis in 1987-88. The levels of sE-selectin, sICAM-1, and sVCAM-1 were analysed by enzyme-linked immunosorbent assay and islet cell antibodies by a prolonged two-colour immunofluorescent assay. Mean HbA1c (p<0.001) and clinical characteristics: mean body mass index (p = 0.019), systolic blood pressure (p = 0.002), diastolic blood pressure (p = 0.003), male gender (p = 0.026), and young age at diagnosis of diabetes (p = 0.015) remained associated with development of retinopathy in type 1 diabetes. However, in a multivariate analysis only HbA1c remained as a risk factor. sE-selectin was significantly higher in the group with type 2 diabetes and retinopathy, compared to the group with type 2 diabetes without retinopathy (p = 0.04). Regarding sE-selectin, sICAM-1, and sVCAM-1 in participants with type 1 diabetes, no differences were observed between the groups with or without retinopathy. This trial confirmed the role of HbA1c and clinical characteristics as predictors for development of retinopathy in type 1 diabetes. sE-selectin stands out as a potential predictor for development of retinopathy in type 2 diabetes, whereas a predictive role for sICAM-1 and sVCAM-1 could not be identified neither for type 1 nor type 2 diabetes.

Construction of a nomogram model to predict the development of retinopathy in type 2 diabetes mellitus based on systemic inflammatory indicators

Construction of a nomogram model to predict the development of retinopathy in type 2 diabetes mellitus based on systemic inflammatory indicators

327-OR: Smaller HDL Particles and ABCA1 Cholesterol Efflux Capacity Predict Incident Proliferative Retinopathy Only among Men with Type 1 Diabetes

Clinical studies have provided evidence for a potential role of dyslipidemia in the development of retinopathy in type 1 diabetes. Existing evidence, however, is generally based on conventional lipid analysis and/or cross-sectional study designs. We therefore assessed the prospective association of HDL particle concentration (HDL-P) and cholesterol efflux capacity (CEC) with incident proliferative diabetic retinopathy (PDR) in a cohort of childhood-onset type 1 diabetes. HDL-P (calibrated differential ion mobility analysis) and total and ABCA1-specific CEC (validated cell-based assays) were quantified in 186 men and 185 women with type 1 diabetes free of PDR (stereo fundus photography) at baseline (mean age 25.6 years; diabetes duration, 17.1 years). Women had higher large HDL-P than men; the concentrations of extra-small, small and medium HDL-P as well as both total and ABCA1 CEC were similar by sex. During a median follow-up of 28 years, 108 men and 100 women developed PDR. In multivariable Cox models stratified by sex, HDL-C did not predict PDR incidence in either sex. However, in addition to increased HbA1c, non-HDL-C, white blood cell count and albumin excretion rate, increased extra-small (HR=0.25, 95% CI=0.09-0.67) and small (HR=0.72, 95% CI=0.55-0.94) HDL-P concentrations and ABCA1 CEC (HR=0.80, 95% CI=0.64-0.998) negatively predicted PDR in men but not women, among whom HbA1c, hypertension and white blood cell count were the only consistent significant predictors of PDR. In conclusion, while extra-small and small HDL-P concentrations and ABCA1 CEC did not differ by sex in type 1 diabetes, they only predicted incident PDR in men, a finding similar to our previously reported results for coronary artery disease. Further research is warranted to better understand the role of HDL in the pathophysiology of PDR and why this appears to differ by sex in type 1 diabetes. Disclosure T.Costacou: None. R.G.Miller: None. T.J.Orchard: None. Funding National Institutes of Health (R01HL130153, R01DK034818)

Correlation of blood sugar and HbA1C levels in different stage of diabetes retinopathy

Objectives: This present study was to evaluate the different parameters and correlation of blood sugar and HbA1C levels for the development of retinopathy in type 2 diabetes mellitus patients. Methods: A complete assessment, general physical examination and routine haematological investigations were performed to all patients. A complete fundus examination was done with the help of direct and indirect Ophthalmoscope. Biochemical investigations (Blood Sugar- Fasting and Post Prandial, HbA1C level) were performed. Patients were called for follow up after 1 month, 3 months and 6 months. Results: A total of 100 patients of diabetes retinopathy were enrolled in this study. Most of the cases 67(67%) were males with age group of 51-60 years. out of 191 eyes, most of the cases 72(37.7%) had PDR. Rest cases had 58(30.36%) severe NPDR, 46(24.08%) moderate NPDR, 9(4.71%) others and 6(3.14%) mild NPDR. HbA1c levels of the most of the cases 94(49.21%) had 6.5-8.5. Most of the patients 170(89.53%) of DR had blood glucose level &gt; 140 mg% on PP.

Evaluation of the prognostic significance of leptin, adiponectin and resistin in the development of diabetic retinopathy in type 2 diabetes mellitus patients

Background. There is evidence of the participation of adipose tissue hormones leptin, adiponectin and resistin in the formation of metabolic disorders in the retina, retinal neovascularization, and diabetic microangiopathy. The development of methods for the mathematical evaluation of the prognosis of diabetic retinopathy (DR) formation with the participation of adipokines is a relevant problem in modern diabetology. Aim. Elaboration of a mathematical model for assessing the prognostic significance of serum leptin, adiponectin and resistin to study the likelihood of developing and progressing DR in patients with type 2 diabetes mellitus (DM). Materials and methods. An open observational single-center one-stage selective study was conducted among patients with type 2 DM and DR. The blood serum concentration of leptin, adiponectin and resistin, HbA1с, lipid metabolism findings were determined, the results of an instrumental examination of the fundus were analyzed. The diagnostic predictive value of serum leptin, adiponectin and resistin was assessed using discriminant analysis. Statistical analyses were conducted using Statistica 9.0 (StatSoft, Tulsa, OK, USA) software. The differences were considered statistically significant at p &lt; 0.05. A model with linear combinations of the serum leptin, adiponectin and resistin, triglyceride (TG), HbA1с, type of antihyperglycemic therapy (oral anti-hyperglycemic medication or insulin therapy) were developed, and, subsequently, formulas for classification-relevant discriminant functions were derived. Results. Fifty-nine patients (107 eyes) with type 2 DM and DR (men and women; mean age, 58.20±0.18 years; mean diabetes duration, 9.19±0.46 years; mean HbA1с 9.10±0.17%) were assigned to the basic group and underwent the study. They were divided into three DR groups based on the stage of DR. When performing the ranking of patients for discriminant analysis, the stage 2 DR group was aggregated with the stage 3 DR group for convenience to form the stage 2 + 3 DR group based on the pathognomonic sign (portents of proliferation or actual proliferation). Anti-diabetic therapy (ADT) included metformin, either alone (type 1 ADT) or in combination with oral anti-hyperglycemic medication (metformin + OAHGM, type 2 ADT) or insulin therapy (metformin + IT, type 3 ADT). Inclusion criteria were informed consent, age above 18 years, presence of T2DM and DR. Exclusion criteria were endocrine or body system disorders leading to obesity (Cushing’s syndrome, hypothyroidism, hypogonadism, polycystic ovarian syndrome, or other endocrine disorders, including hereditary disorders, and hypothalamic obesity), type 1 DM, acute infectious disorders, history of or current cancer, decompensation of comorbidities, mental disorders, treatment with neuroleptics or antidepressants, proteinuria, clinically significant maculopathy, glaucoma or cataract. The study followed the ethical standards stated in the Declaration of Helsinki and was approved by the Local Ethics Committee. The formulas for classification-relevant discriminant functions were derived based on the results of physical examination, imaging and laboratory tests, and subsequent assessment of clinical signs of DM (HbA1с), DR stage and serum leptin, adiponectin, resistin, TG concentrations and taking into account the type of antihyperglycemic therapy. The classification functions (CF) computed based on the variables found from the above developed models provided the basis for predicting the development of DR. The formulas for CF from model are as follows: CF1=0.29•TG + 1.55•HbA1С + 1.81•ADT_Type + 0.04•Leptin + 0,34•Adiponectin + 0,91•Resistin– 13,82. CF2= 0.05•TG + 1.36•HbA1С + 3.01•ADT_Type + 0.08•Leptin + 0,35•Adiponectin + 1,01•Resistin – 15.95. Astep-by-step approach to a diagnostic decision should be used. First, blood samples are tested for serum leptin, adiponectin and resistin, TG, blood HbA1c, and the patient is assigned a code for ADT Type (metformin only, 1; metformin + OAHGM, 2; or metformin + IT, 3). Second, CF1 and CF2 values are calculated based on clinical and laboratory data. Finally, the two values are compared to determine which is greater. The predictive decision is made by selecting the classification function with the greater value. Thus, if CF1 &gt; CF2, the process can be stabilized at this stage given adequate glycemic control (through compensation of carbohydrate metabolism) and body mass control as well as patient compliance. If CF1 &lt; CF2, the pathological process may progress to the next stage or even within stage 3, and there is an urgent need to reduce BMI, and to correct the ADT and the blood lipid profile. Conclusions. The informative value and statistical significance of the model were 71.4% and p=0.040, respectively. Using the formulas, one can determine the probability of progression of DR.

Electroretinogram and Visual Evoked Potentials in Patients with Type ll Diabetes Mellitus

Background: Retinopathy is a severe and common complication of diabetes. The pathology seems to be characterized not only by the involvement of retinal micro vessels but also by a real neuropathy. Before the onset of micro vascular lesions, the retina of the eye undergoes subtle functional changes that are not detectable by fundus photography. Electrophysiological investigations allow a more detailed study of the visual function. These techniques are safe, repeatable, quick, and objective. Objective: To study pattern electroretinogram (PERG) and pattern reversal visual evoked potentials (PRVEP) in type 2 diabetic patients without diabetic retinopathy (DR) or with mild non-proliferative DR (mNPDR) to detect changes by comparing with those of healthy control. And to assess the correlation of the parameters with diabetes duration and the level of Glycosylated Haemoglobin A1c (HbA1c). Materials and Methods: It was a cross-sectional study, included two groups (diabetic patients and the healthy). Age range was preset at 40-65 years. For all the participants, a detailed clinical history was collected, a comprehensive ophthalmic examination and thorough blood investigations were performed, then {PRVEP (60', 15'), PERG} were recorded and (waveform, peak time, amplitude) of tests components were analyzed. Results: Mean (P100, N135) peak times of PRVEP were statistically significantly delayed in (50) eyes of type 2 diabetics without DR when compared to (36) eyes of control (p-value<0.01), abnormalities in waveforms like (double peaks, broad peak) were also observed in diabetics. There were alterations in other parameters (amplitudes of PRVEP, peak times and amplitudes of PERG) but the changes were not statistically significant. No statistically significant changes were found in (6) eyes of diabetic patients with mNPDR. No statistically significant correlation was obtained between diabetes duration or the level of HbA1c and delay of peak times or reduce amplitudes in patients. Conclusions: Electrophysiological tests are sensitive and useful investigations for the early identification of visual dysfunctions before the development of overt retinopathy in type 2 diabetics. PRVEP is more sensitive than PERG to monitor alterations and it may be sufficient to screen the patients in this stage.

Evaluation of kidney function and risk factors of retinopathy in Type 2 diabetes mellitus people in South Africa.

Diabetic retinopathy (DR) is a disease of the retina and an important microvascular complication of diabetes, frequently causing blindness in adults. The study aims to evaluate kidney function and risk factors for the development of retinopathy in Type 2 diabetes mellitus (DM) patients. A total of 140 participants (54 Type 2DM without retinopathy, 44 with DR and 42 normal, healthy controls) consented to participate in the study. Fasting plasma glucose (FPG), glycosylated haemoglobin (HbA1c), lipid profile and renal function tests were measured using routine laboratory methods. A significant increase in FPG, HbA1c, serum triglycerides (TG), serum urea, urine albumin, the urine albumin/creatinine ratio (UACR) and, a significant decrease in high-density lipoprotein cholesterol (HDL-C) was observed in DR patients, compared to controls. In multivariate logistic analysis, FPG, insulin treatment and UACR were the risk factors found to be significantly associated with the presence of retinopathy. According to the Receiver Operating Characteristic (ROC) curve analysis, the diagnostic performance of UACR≥1.45mg/mmol-1l-1 was the optimal cut-off point. A mild alteration in renal function was observed in DR patients and UACR is found to be an important risk factor and can be a valuable marker for predicting DR.

Imbalance of Oxidant/Antioxidant Status and Risk Factors for Saudi Type 2 Diabetic Patients with Retinopathy

Aims: To estimate the oxidant/antioxidant status in type 2 diabetic patients with retinopathy; and to correlate a number of independent variables (age, gender, education, body mass index, duration of diabetes, glycosylated haemoglobin, hypertension) to development of retinopathy. Study design: Case-control study. Place and Duration of Study: Research laboratories, Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University from April 2010 to April 2011. Methodology: One-hundred diabetic patients with retinopathy recruited from King Fahad Specialist HospitalBuraidah were included in the study. The control groups were: control group 1 consisted of sixty type 2 diabetic patients without retinopathy recruited from Diabetes and Endocrinology Center, KFSH, Buraidah, KSA; and control group 2 consisted of sixty healthy non diabetic recruited from public places, i.e. Estarahes (party lounges). Plasma, serum, and erythrocyte lysate were prepared from blood of each subject. Human serum 8-OHdG, plasma MDA, and erythrocyte Research Article British Journal of Medicine & Medical Research, 1(4): 371-384, 2011 372 lysate Cu-Zn SOD were estimated by using commercial kits supplied by Northwest, U.S.A. Data was analyzed using SPSS software and Win Episcope software. Pvalues < 0.05 were considered significant. Results: Age, education, duration of diabetes, poor glycaemic control, and hypertension were consistently associated with development of retinopathy (OR 5.891, 4.44, 10.420, 1.699, 1.820 respectively). Moreover, increased plasma MDA, increased serum 8-OHdG levels, decreased Cu-Zn SOD activity were observed in diabetic patients with retinopathy compared to subjects in control groups. In addition, negative correlations were found between plasma MDA and Cu-Zn SOD activity, HbA1c & Cu-Zn SOD activity as well in all subjects. Conclusion: This report emphasizes the important role of oxidative stress in the development of retinopathy in type 2 diabetes suggesting that blocking of oxidative stress is a crucial step for delayed progression of diabetic retinopathy and hence the need for antioxidant supplements to postpone the severity of diabetic retinopathy.

Soluble adhesion molecules are not involved in the development of retinopathy in type 2 diabetic patients

Raised serum levels of adhesion molecules are believed to reflect endothelial activation and may contribute to the development of diabetic vascular complications. The aim of this study was to clarify the association between soluble adhesion molecules levels and retinopathy in type 2 diabetic patients. Levels of soluble E-selectin, ICAM-1 and VCAM-1 were measured by enzyme-linked immunosorbent assay (ELISA) in 47 type 2 diabetic patients classified in two subgroups according to the presence (n=34) or absence (n=13) of retinopathy as determined by fundus ophthalmoscopy; 22 control subjects were also studied. Soluble E-selectin levels were significantly elevated in both diabetic subgroups compared to control subjects (p<0.01), while no significant difference was found in sICAM-1 and sVCAM-1 levels. However, sE-selectin, sICAM-1 and sVCAM-1 levels were comparable in diabetic subgroups. The progression of retinopathy was not associated with an increase in soluble adhesion molecules levels. Stepwise multiple regression analysis revealed that only diabetes duration and microalbuminuria were independent determinants of retinopathy (p<0.01). Our results confirm the contribution of endothelial activation in the development of diabetic complications as indicated by increased levels of soluble adhesion molecules. However, a direct implication of adhesion molecules in the pathogenesis or progression of type 2 diabetic retinopathy cannot be supported.

The relationship between soluble L-selectin and the development of diabetic retinopathy

Diabetic retinopathy is a leading cause of adult vision loss and blindness. Earlier studies have shown that polymorphonuclear neutrophils play an important role in the pathogenesis of diabetic vascular complications. Stimulation of these cells is associated with the desquamation of L-selectin. The aim of the study was to evaluate the relationship between the serum concentration of L-selectin and the development of retinopathy in Type 2 diabetic patients. The study comprised 51 Type 2 diabetic patients, aged 65.2 ± 7.5 years, with a diabetes duration of 10.1 ± 8.9 years and HbA 1c of 8.2 ± 1.4. The study subjects were divided into two groups: Group A diabetic patients with retinopathy (n = 28) and Group B diabetic patients without retinopathy (n = 23). Twenty age- and sex-matched nondiabetic healthy subjects were enrolled as the control group. Patients with any inflammatory disease were excluded. Retinopathy was assessed by centrally graded retinal photographs. The serum concentration of sL-selectin was estimated using an ELISA test. We observed significantly higher serum concentrations of sL-selectin in Type 2 diabetic patients with retinopathy than in healthy subjects (36.5 ± 18.1 vs. 11.4 ± 7.5 ng/ml, p < 0.001). There was also a significant difference between Group A and Group B (36.5 ± 18.1 vs. 24.2 ± 13.5 ng/ml, p < 0.05) as well as between Group B and the controls (24.2 ± 13.5 vs. 11.4 ± 7.5 ng/ml, p < 0.01) with regard to sL-selectin levels. sL-selectin was significantly correlated with HbA 1c (r = 0.93, p < 0.001) and with diabetes duration (r = 0.44, p < 0.001). These results suggest that there was a strong relationship between sL-selectin and diabetic retinopathy. The strong correlation between sL-selectin and HbA 1c levels supports the concept that the sL-selectin level is increased with poor glycemic control, which may affect endothelial cell activity and cause subsequent microvascular complications.

Diabetic retinopathy, visual acuity, and medical risk indicators. A continuous 10-year follow-up study in Type 1 diabetic patients under routine care

The objective of this study was to describe incidence and progression of diabetic retinopathy in relation to medical risk indicators as well as visual acuity outcome after a continuous follow-up period of 10 years in a Type 1 diabetic population treated under routine care. The incidence and progression of retinopathy and their association to HbA 1c, blood pressure, urinary albumin, serum creatinine levels, and insulin dosage were studied prospectively in 452 Type 1 diabetic patients. The degree of retinopathy was classified as no retinopathy, background, or sight-threatening retinopathy, i.e. clinically significant macular edema, severe nonproliferative, or proliferative retinopathy. Impaired visual acuity was defined as a visual acuity <0.5 and blindness as a visual acuity ≤0.1 in the best eye. In patients still alive at follow-up ( n=344), 61% (69/114) developed any retinopathy, 45% (51/114) background retinopathy, and 16% (18/114) sight-threatening retinopathy. Progression from background to sight-threatening retinopathy occurred in 56% (73/131). In 2% (6/335), visual acuity dropped to <0.5 and in less than 1% (3/340) to ≤0.1. Patients who developed any retinopathy and patients who progressed to sight-threatening retinopathy had higher mean HbA 1c levels over time compared to those who remained stable ( P<.001 in both cases). Patients who developed any retinopathy had higher levels of mean diastolic blood pressure ( P=.036), whereas no differences were seen in systolic blood pressure levels between the groups. Cox regression analysis, including all patients, showed mean HbA 1c to be an independent risk indicator for both development and progression of retinopathy, whereas mean diastolic blood pressure was only a risk indicator for the incidence of retinopathy. Metabolic control is an important risk indicator for both development and progression of retinopathy, whereas diastolic blood pressure is important for the development of retinopathy in Type 1 diabetes. The number of patients who became blind during 10 years of follow-up was low.

Risk factors for cataract in Chinese patients with type 2 diabetes: evidence for the influence of the aldose reductase gene.

There is evidence that the development of retinopathy in type 2 diabetes is associated with a microsatellite polymorphism at 5' of the aldose reductase gene. The study examined whether cataract was associated with clinical/metabolic factors and/or the microsatellite polymorphism using a cohort of consecutively recruited Hong Kong Chinese patients with type 2 diabetes (n=567). Amongst these patients, 157 (28%) had cataract. The patients with cataract were older in age and age at diagnosis and had longer diabetes duration than those without cataract (all at p<0.01). They also had higher systolic blood pressure (p<0.01), HbA1c (p<0.05) and fasting plasma glucose levels (p<0.01; all with adjustment for the significance). Moreover, we found that the patients with cataract over-presented the microsatellite allele Z (23 vs. 30%, p<0.01) and its genotypes (Z,Z+Z,non-Z; 38 vs. 50%, p<0.01), but under-presented the allele Z-4 (8.3 vs 4.8%, p<0.05) and its genotypes (Z-4, Z-4+Z-4,non-Z-4; 16 vs. 10%, p<0.05). Using multiple logistic regression analysis (R2=0.25, p<0.01), we found that the presence of cataract was correlated positively with age, but inversely with the presence of allele Z-4. In conclusion, our data indicate that the occurrence of cataract is common in the Chinese type 2 diabetes population, with age and the aldose reductase gene as important determinants.

Glycaemic control and development of retinopathy in type 2 diabetes mellitus: a longitudinal study.

Relationships between glycaemic control, hypertension, and development of microangiopathy have been well documented in Type 1 (insulin-dependent) but not in Type 2 (non-insulin-dependent) diabetes mellitus. Therefore, we have investigated these relationships in a cohort of 64 Type 2 patients free of retinopathy (by angiofluorography), who were regularly followed until development of retinopathy or for at least 7 years as outpatients. Glycaemic control was assessed by 1 to 4 HbA1 determinations per year. Retinal status was monitored by annual angiofluorography. Nonproliferative retinopathy developed in 14 patients (cumulative incidence at 13 years: 29.8%) after a mean diabetes duration of 14.3+/-8.9 years (range 2-27). In multivariate analysis (Cox model), mean HbA1 during follow-up (p < 0.001), and hypertension at first examination (p = 0.09) were associated with the development of retinopathy, but age, sex, BMI, diabetes duration, smoking, and fasting blood glucose were not. The relative risk for developing retinopathy (RR) was 7.2 (IC 95%: 1.61-32.4) in patients with a mean HbA1 during follow-up above the median value of the cohort (8.3%) compared with patients with HbA1 during follow-up below this value. RR was 2.5 (IC 0.8-8) in patients with HbA1 at first examination above compared to below the median value (8.4%). RR was 3.0 (IC 0.9-10) in patients treated for hypertension at baseline compared to those without treatment. A sixfold increase in retinopathy prevalence was observed between patients with mean HbA1 in the highest or lowest quartile of mean HbA1 distribution during follow-up. This longitudinal study indicates a strong association between long-term glycaemic control and the development of diabetic retinopathy in Type 2 diabetes.

Glycaemic control and development of retinopathy in Type 2 diabetes mellitus: a longitudinal study

Relationships between glycaemic control, hypertension, and development of microangiopathy have been well documented in Type 1 (insulin-dependent) but not in Type 2 (non-insulin-dependent) diabetes mellitus. Therefore, we have investigated these relationships in a cohort of 64 Type 2 patients free of retinopathy (by angiofluorography), who were regularly followed until development of retinopathy or for at least 7 years as outpatients. Glycaemic control was assessed by 1 to 4 HbA1 determinations per year. Retinal status was monitored by annual angiofluorography. Nonproliferative retinopathy developed in 14 patients (cumulative incidence at 13 years: 29.8 %) after a mean diabetes duration of 14.3 ± 8.9 years (range 2–27). In multivariate analysis (Cox model), mean HbA1 during follow-up (p < 0.001), and hypertension at first examination (p = 0.09) were associated with the development of retinopathy, but age, sex, BMI, diabetes duration, smoking, and fasting blood glucose were not. The relative risk for developing retinopathy (RR) was 7.2 (IC 95 %: 1.61–32.4) in patients with a mean HbA1 during follow-up above the median value of the cohort (8.3 %) compared with patients with HbA1 during follow-up below this value. RR was 2.5 (IC 0.8–8) in patients with HbA1 at first examination above compared to below the median value (8.4 %). RR was 3.0 (IC 0.9–10) in patients treated for hypertension at baseline compared to those without treatment. A sixfold increase in retinopathy prevalence was observed between patients with mean HbA1 in the highest or lowest quartile of mean HbA1 distribution during follow-up. This longitudinal study indicates a strong association between long-term glycaemic control and the development of diabetic retinopathy in Type 2 diabetes. © 1998 John Wiley & Sons, Ltd.

The Association of Lifetime Psychiatric Illness and Increased Retinopathy in Patients With Type I Diabetes Mellitus

Forty-nine patients with Type I diabetes mellitus were assessed to examine the relationship between lifetime prevalence of psychiatric illness and retinopathy severity. The subjects with a history of psychiatric illness had significantly worse retinopathy than the subjects without psychiatric illness. Eighty-nine percent of the subjects with severe nonproliferative retinopathy or proliferative retinopathy had a history of psychiatric illness, predominantly affective illness. In addition, the subjects with a history of psychiatric illness had significantly higher current glycohemoglobin levels than those with no psychiatric history. This study's findings suggest that psychiatric illness may be a risk factor for development of retinopathy in Type I diabetic patients.

A 5‐year follow‐up study on the incidence of retinopathy in type 1 diabetes mellitus in relation to medical risk indicators

The aim of the present study was to describe the 5-year incidence of retinopathy in type 1 diabetes mellitus and to characterize risk indicators for the development and progression of retinopathy. A cross-sectional study of type 1 diabetic patients taken care of at a medical department. All type 1 diabetic patients attending the Department of Internal Medicine, University Hospital, Lund, during a 2-year period were offered ophthalmological examination. A total of 396 out of 461 (85.9%) initially examined type 1 diabetic patients formed the basis for this 5-year follow-up study. The degree of retinopathy was based on fundus photography or biomicroscopy. Degree of metabolic control was assessed by HbA1c levels, signs of nephropathy by albumin creatinine clearance ratio and urinary albumin levels. Blood pressure was measured in the supine position. Duration of diabetes, age, and insulin dosage were registered. The incidence of retinopathy was 47.2% and progression from background to severe retinopathy occurred in 41%. Risk indicators for the development of retinopathy were duration of diabetes (P < 0.001), degree of metabolic control (P < 0.001), insulin dosage (P < 0.05) and signs of nephropathy based on measurements of albumin creatinine clearance ratio (P < 0.01) and urinary albumin concentration (P < 0.05). Two risk indicators could be identified for progression of retinopathy, i.e. the degree of metabolic control (P < 0.01) and diastolic blood pressure (P < 0.05). The results suggest that apart from poor metabolic control, development of retinopathy in type 1 diabetes is associated with long diabetes duration and clinical signs of diabetic nephropathy. Progression of retinopathy is associated with poor metabolic control and elevated diastolic blood pressure levels.

Increased Testosterone in Type I Diabetic Subjects with Severe Retinopathy

Diabetic retinopathy rarely occurs before puberty, suggesting that changes in sex hormones may influence the development of this condition. The authors measured serum testosterone, estradiol, DHEA-S, and sex hormone binding globulin levels in 26 men and 22 women with type I diabetes from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR), a populationbased study of diabetic complications. The mean age was 23 years and the mean duration of diabetes was 14 years. Subjects with proliferative or preproliferative retinopathy (≥ retinopathy level 51-80) were matched by duration of diabetes (±2 years) and sex to subjects with minimal or no retinopathy (≥ retinopathy level 21). Seven stereoscopic retinal photographs of each eye were obtained and photographs were read by the University of Wisconsin Reading Center. Serum testosterone concentrations were significantly higher in male diabetic subjects with proliferative retinopathy (648 ± 36 ng/dl) than in male diabetic subjects with minimal or no retinopathy (512 ± 43 ng/dl) (P = 0.017). No other statistically significant differences in sex hormones between subjects with and without proliferative retinopathy were observed. Although these results should be regarded as preliminary because of the small number of subjects, they support the hypothesis that testosterone concentrations may be associated with the development of retinopathy in type I diabetic patients.

HLA antigens and other risk factors in the development of retinopathy in type 1 diabetes.

Factors possibly influencing the development of diabetic retinopathy were studied in 112 randomly selected type 1 diabetics having no or minimal retinopathy (group A) and in 82 type 1 diabetics with known severe diabetic retinopathy. The latter comprised those with severe background retinopathy (group B, n = 17) and those having proliferative retinopathy without (group C, n = 38) and with group D, n = 27) diabetic nephropathy. Nonretinopaths (group A) were of similar sex ratio, body weight, and age at diagnosis of diabetes but had been diabetic longer (p less than 0.001) and were thus older (p less than 0.001) than retinopaths (groups B-D). The distribution of HLA antigens of the A, B, and C loci was similar in nonretinopaths and retinopaths with the exception that HLA B7 showed a reduced (p less than 0.05) prevalence in the retinopaths (6% versus 17%) and was singularly underrepresented in group D, where no patients had this antigen. Mean postprandial plasma glucose and HbA1 concentrations were higher (p less than 0.01 and p less than 0.001) and cigarette smoking was more prevalent (p less than 0.01) in the retinopathy groups B-D than in group A. Systolic and diastolic blood pressures were similar in groups A-C, with higher (p less than 0.001) values only in group D. There was no association between insulin antibody binding in the serum or measurable plasma C-peptide immunoreactivity and retinopathy status. The risk of development of diabetic retinopathy in type 1 diabetes may be related to HLA-associated genetic factors and to cigarette smoking.