Retinopathy In African Americans Research Articles

498-P: Prevalence and Impact on Quality of Life of Diabetic Retinopathy in African Americans with End-Stage Kidney Disease on Hemodialysis

Background: The prevalence, severity, and quality of life (QoL) impact of diabetic retinopathy (DR) among African Americans (AA) with end-stage-kidney disease (ESKD) receiving dialysis are unknown. Methods: We conducted a prospective cross-sectional study in 93 AA adults with type 1 (n=9) and type 2 (n=84) diabetes with ESKD on hemodialysis. The diagnosis of DR was based on a review of medical records and/or having a positive photograph with a portable hand-held device (Optomed Aurora retinal camera) reviewed by both artificial intelligence software (AEYE Health’s retinal screening system) and a retinal specialist. Visual acuity was assessed with the Snellen Chart. Associations with QoL (ascertained using kidney disease QoL and depression questionnaires), physical disability (ascertained using visual impairment questionnaire), and social determinants of health (SDoH) including personal and household income, marital status, health insurance, education, food insecurity, or employment status assessed by standardized questionnaires. Results: The overall prevalence of DR was 75%, with 33% of patients having mild, 9.6% moderate and 57.4% severe DR. A total of 43% had normal visual acuity, 45% had moderate and 12% severe visual impairment. We found high burden of disease, multiple SDoH challenges, and low QoL among all patients, with most unemployed or disabled, living below poverty line, mainly receiving public health insurance, reporting poor general health, and substantial time spent dealing with kidney disease interfered with daily and family activities. However, the presence of DR had no significant impact on physical health and QoL compared to subjects without DR. Conclusion: DR is present in 75% of AA patients with diabetes and ESKD on hemodialysis. ESKD has a significant burden on general health and QoL; however, DR has a minor additional impact on the overall physical health and QoL in people with ESKD and diabetes. Disclosure Z.E.Zabala: None. B.Moazzami: None. M.Egeolu: None. R.L.Caleon: None. A.Y.G.Gerges: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. R.G.Mccoy: Consultant; Emmi. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter.

27-LB: Prevalence and Severity of Diabetic Retinopathy in African Americans with End-Stage Kidney Disease

Background and Methods: This cross-sectional study determined the prevalence of diabetic retinopathy (DR) in non-Hispanic African Americans (AA) with end-stage-kidney disease (ESKD) and their impact on quality of life. A total of 95 adults with type 1 (n= 10) and type 2 (n= 85) on dialysis diabetes were assessed for DR using portable hand-held (Optomed Aurora) with artificial intelligence report with AEYE Diagnostic System (AEYE-DS) , visual acuity using a Snellen chart, and social determents of health, and standardized questionnaires (Kidney Disease Quality of Life (KDQoL) , depression screening (Patient health Questionaire-9) and food insecurity. Results: Among the 95 participants (female 51%, mean age 59.5 ±12.3 years, duration of diabetes (DM) 18.2 ± 12.0 years and duration of dialysis 4.5±3.6 years) . A total of 55% of patients had a diagnosis of (DR+) , who had a longer duration of DM (18.8±9.5 vs. 15.8±12.2 years, p=0.20 and shorter duration of dialysis (3.6±2.7 vs. 5.9±5.0 years compared to DR negative (DR-) , p=0.09. Kidney Disease Quality of Life score on symptoms/problems related to ESKD and greater effect of kidney disease in daily life were lower compared to the general US, AA population with ESKD, p <.0001) . DR+ had worse physical health (p: 0.09) , greater rate of severe vision impact on quality of life (p= 0.01) , similar rates below the federal poverty level per household income (25% vs. 30%) , non-statistically significantly higher Ph-Q9 depression (6.9±5.3 vs. 4.8±4.1, p=0.16) , and food insecurity scores compared to without DR (1.07±1.51 vs. 0.83±1.56, p=0.33) . Overall, the prevalence of diabetic retinopathy was 55% based on the AEYE artificial intelligence system. Diabetic retinopathy was associated with poor quality of life and physical health, higher rates of poverty, and greater impact of vision impairment on quality of life compared to DR negative. Our preliminary finding highlights the increased disease burden of DR in AAs with ESKD, indicating an alarming gap in care. Disclosure M. Egeolu: None. G. E. Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. E. Manishimwe: None. Z. E. Zabala: None. B. Moazzami: None. R. L. Caleon: None. R. J. Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. J. E. Navarrete: None. A. Y. G. Gerges: None. L. Peng: None.

Assessment of retinal vascular oxygenation and morphology at stages of diabetic retinopathy in African Americans

BackgroundDiabetic retinopathy (DR) is a microvascular complication of diabetes and a leading cause of blindness in working-age adults. The likelihood of visual impairment associated with DR is two-fold higher in the African-American (AA) compared to non-Hispanic white. Although alterations in retinal vessel oxygenation and morphology have been reported in DR, there is limited knowledge about these vascular changes in AA subjects. The purpose of the current study was to investigate alterations in retinal vascular oxygen saturation (SO2), vessel diameter (D) and tortuosity at severity stages of DR in AA subjects.MethodsA nested case-control study of 56 AA subjects was conducted. Right eyes were grouped as non-diabetic (ND) (N = 26), no clinical DR (NDR) (N = 19), or moderate/severe non-proliferative DR (NPDR) (N = 11). Imaging was performed using a commercially available scanning laser ophthalmoscope. Images were analyzed to determine retinal arterial and venous SO2 (SO2A and SO2V), diameter (DA and DV), and vessel tortuosity index (VTI) (VTIA and VTIV).ResultsSO2V and DV were higher in NPDR compared to ND and NDR groups (P < 0.05). There were no significant differences in SO2A and DA among ND, NDR, and NPDR groups (P > 0.8). Maximum VTIA was higher in diabetics (NDR and NPDR) compared to non-diabetics (P < 0.03). There was no significant difference in maximum VTIV among the 3 groups (P = 0.5).ConclusionsThe findings advance our understanding of DR pathophysiology in the AA population and may propel identification of race-specific retinal vascular biomarkers for improved diagnosis and monitoring of DR.

Adequate vitamin D status is associated with the reduced odds of prevalent diabetic retinopathy in African Americans and Caucasians.

BackgroundVitamin D status has been hypothesized to protect against development of diabetic retinopathy via its anti-inflammatory and anti-angiogenic properties. Additionally, in vitro and in vivo studies suggest vitamin D favorably influences blood pressure and blood glucose control, strong risk factors for diabetic retinopathy. We examined the association between vitamin D status and prevalent diabetic retinopathy in participants with diabetes from a population-based cohort.MethodsAmong participants in the Atherosclerosis Risk in Communities (ARIC) study with diabetes at visit 3 (1993–1995), 1339 (906 Caucasians, 433 African Americans) had serum 25-hydroxyvitamin (25[OH]D) concentrations assessed at visit 2 (1989–1992) and nonmydriatic retinal photographs taken at visit 3. Dietary intake of vitamin D was assessed at visit 1 (1987–1989). Logistic regression was used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for diabetic retinopathy by categories of season-adjusted 25(OH)D (<30 [referent], 30–<50, 50–<75 and ≥75 nmol/L), by quartile of vitamin D intake (IU/day), and use of vitamin D or fish oil supplements (yes/no). P for trend was estimated using continuous 25(OH)D or vitamin D intake. ORs were adjusted for race, and duration of diabetes. We further adjusted for HBA1c and hypertension to examine if 25(OH)D influenced diabetic retinopathy via its effects on either glycemic control or blood pressure.ResultsORs (95 % CIs) for retinopathy, adjusted for race and duration, were 0.77 (0.45–1.32), 0.64 (0.37–1.10), and 0.39 (0.20–0.75), p for trend = 0.001, for participants with 25(OH)D of 30–<50, 50–<75, and ≥75 nmol/L, respectively. Further adjustment for hypertension minimally influenced results (data not show), but adjustment for HBA1c attenuated the OR among those with 25(OH)D ≥75 (0.47 [0.23–0.96], p for trend = 0.030). No statistically significant association was observed between vitamin D intake from foods or supplements and retinopathy.Conclusions25(OH)D concentrations ≥75 nmol/L were associated with lower odds of any retinopathy assessed 3 years later. We speculate this may be due in part to vitamin D’s influence on blood glucose control.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0434-1) contains supplementary material, which is available to authorized users.

Risk Factors for Proliferative Diabetic Retinopathy in African Americans with Type 2 Diabetes

ABSTRACTPurpose: To assess personal and demographic risk factors for proliferative diabetic retinopathy in African Americans with type 2 diabetes.Methods: In this prospective, non-interventional, cross-sectional case-control study, 380 African Americans with type 2 diabetes were enrolled. Participants were recruited prospectively and had to have either: (1) absence of diabetic retinopathy after ≥10 years of type 2 diabetes, or (2) presence of proliferative diabetic retinopathy when enrolled. Dilated, 7-field fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study scale. Covariates including hemoglobin A1C (HbA1C), blood pressure, height, weight and waist circumference were collected prospectively. Multivariate regression models adjusted for age, sex and site were constructed to assess associations between risk factors and proliferative diabetic retinopathy.Results: Proliferative diabetic retinopathy was associated with longer duration of diabetes (odds ratio, OR, 1.62, p < 0.001), higher systolic blood pressure (OR 1.65, p < 0.001) and insulin use (OR 6.65, p < 0.001) in the multivariate regression analysis. HbA1C was associated with proliferative diabetic retinopathy in the univariate analysis (OR 1.31, p = 0.002) but was no longer significant in the multivariate analysis.Conclusions: In this case-control study of African Americans with type 2 diabetes, duration of diabetes, systolic hypertension and insulin use were strong risk factors for the development of proliferative diabetic retinopathy. Interestingly, HbA1C did not confer additional risk in this cohort.

African Ancestry Analysis and Admixture Genetic Mapping for Proliferative Diabetic Retinopathy in African Americans.

To examine the relationship between proportion of African ancestry (PAA) and proliferative diabetic retinopathy (PDR) and to identify genetic loci associated with PDR using admixture mapping in African Americans with type 2 diabetes (T2D). Between 1993 and 2013, 1440 participants enrolled in four different studies had fundus photographs graded using the Early Treatment Diabetic Retinopathy Study scale. Cases (n = 305) had PDR while controls (n = 1135) had nonproliferative diabetic retinopathy (DR) or no DR. Covariates included diabetes duration, hemoglobin A1C, systolic blood pressure, income, and education. Genotyping was performed on the Affymetrix platform. The association between PAA and PDR was evaluated using logistic regression. Genome-wide admixture scanning was performed using ANCESTRYMAP software. In the univariate analysis, PDR was associated with increased PAA (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.16-1.59, P = 0.0002). In multivariate regression adjusting for traditional DR risk factors, income and education, the association between PAA and PDR was attenuated and no longer significant (OR = 1.21, 95% CI = 0.59-2.47, P = 0.61). For the admixture analyses, the maximum genome-wide score was 1.44 on chromosome 1. In this largest study of PDR in African Americans with T2D to date, an association between PAA and PDR is not present after adjustment for clinical, demographic, and socioeconomic factors. No genome-wide significant locus (defined as having a locus-genome statistic > 5) was identified with admixture analysis. Further analyses with even larger sample sizes are needed to definitively assess if any admixture signal for DR is present.

P-selectin Plasma Levels and Genetic Variant Associated With Diabetic Retinopathy in African Americans

To report the prevalence and risk factors for retinopathy in African Americans with impaired fasting glucose (IFG) and type 2 diabetes in the Jackson Heart Study and to determine if P-selectin plasma levels are independently associated with retinopathy in this population. Prospective, cross-sectional observational study. setting: Community-based epidemiologic study. Total of 629 patients with type 2 diabetes and 266 participants with impaired fasting glucose. Bilateral, 7-field fundus photographs were scored by masked readers for diabetic retinopathy (DR) level. Covariate data including P-selectin plasma levels and genotypes were collected in a standardized fashion. Association between risk factors, including P-selectin plasma levels and genotypes, and retinopathy. The prevalences of any retinopathy among participants with IFG and type 2 diabetes were 9.4% and 32.4%, respectively. Among those with type 2 diabetes, in multivariate models adjusted for age, sex, and other traditional risk factors, higher P-selectin levels were associated with any DR (odds ratio= 1.11, 95% confidence interval= 1.02-1.21, P= .02) and proliferative DR (odds ratio= 1.23, 95% confidence interval= 1.03-1.46, P= .02). To further investigate the relationship between P-selectin and DR, we examined the association between P-selectin genotype and DR. Minor allele homozygotes for the variant rs6128 were less likely to develop DR (P after Bonferroni correction= 0.03). Both serologic and genetic data show an association between P-selectin and DR in the Jackson Heart Study. If confirmed in other studies, this association may provide insight into the pathogenesis of retinopathy.

Inflammatory Biomarkers and Progression of Diabetic Retinopathy in African Americans With Type 1 Diabetes

We examined whether baseline plasma levels of markers of inflammation and endothelial dysfunction are associated with the incidence of diabetic retinopathy (DR) in African Americans with type 1 insulin-dependent diabetes mellitus (T1DM). At baseline and follow-up examinations, detailed ocular examination, structured clinical interview, venous blood specimens, and masked grading of seven standard field retinal photographs were obtained. Baseline plasma levels of 28 inflammatory biomarkers, measured using multiplex bead analysis system, were measured in the participants. After adjusting for age, glycemic control, and other potential confounders, baseline plasma levels of E-selectin were associated significantly with progression of DR, E-selectin and tumor necrosis factor-α (TNF-α) levels with incidence of proliferative DR (PDR), and soluble intercellular adhesion molecule-1 (sICAM-1) and TNF-α levels with incidence of macular edema (ME). In African Americans with T1DM, inflammation and endothelial dysfunction precede the development of DR, thus supporting the notion that inflammation may influence progression/incidence of disease.

Assessment of 193 Candidate Genes for Retinopathy in African Americans With Type 1 Diabetes

To report in African Americans with type 1 diabetes the association of single-nucleotide polymorphisms in 193 candidate genes with diabetic retinopathy (DR) and/or its progression. A custom panel of 1536 single-nucleotide polymorphisms located on 193 candidate genes for DR was genotyped in 437 African Americans with type 1 diabetes who participated in the New Jersey 725 study. Clinical evaluations at baseline and follow-up examinations included structured clinical interview, ocular examination, 7-field stereoscopic fundus photographs, and blood pressure measurements. Severity of DR was determined via masked grading of fundus photographs. Biological evaluations included blood and urine assays. Single-nucleotide polymorphisms in 13 candidate genes for DR involved in glucose metabolism, angiogenesis, inflammation, neurotransmission, hypertension, and retinal development were significantly associated with the prevalence of severe DR. Three of these genes were also significantly associated with progression of DR. Adjusting for sex, duration of diabetes, glycosylated hemoglobin, systemic hypertension, and total cholesterol did not alter the results. Our data support the role of genetic factors to account for severity and/or progression of DR in African Americans with type 1 diabetes and to identify several prime genes that likely contribute to the risk of DR.

Depression is a Risk Factor for Poor Glycemic Control and Retinopathy in African-Americans With Type 1 Diabetes

To examine longitudinal data about depression in relationship to glycemic control and as a risk factor for diabetic retinopathy (DR). Depression is a common psychiatric disorder among diabetic persons and has been shown in cross-sectional studies to be associated with the vascular complications of diabetes. A total of 483 African-American patients with Type 1 diabetes had a baseline examination and 6-year follow-up examination. Evaluations at both visits included administering the Beck Depression Inventory (BDI), a detailed ophthalmologic examination, retinal photographs, and measurement of glycosylated hemoglobin as an index of glycemic control. Six-year progression of DR between baseline and follow-up visits was evaluated from the change in retinopathy severity using the Early Treatment of Diabetic Retinopathy Study grading scale. Patients with high BDI scores at both baseline and 6-year follow-up visits had significantly higher baseline glycosylated hemoglobin values (p = .01), and were more likely to show progression of DR (odds ratio (OR) = 2.44; 95% confidence interval (CI): 1.01-5.88; p = .049) and progression to proliferative diabetic retinopathy (PDR) (OR = 3.19; 95% CI: 1.30-7.87; p = .01) than patients with low BDI scores at both visits. This was independent of baseline medical risk factors for DR. Six-year longitudinal data indicate that depression is significantly associated with both poor glycemic control and higher 6-year progression to PDR in African-Americans with Type 1 diabetes.

Racial differences in the prevalence of hypertensive retinopathy

The higher prevalence of systemic hypertension in African Americans compared with white persons in the US is well documented. Studies have shown that African Americans are more likely to develop hypertensive-related complications (such as left ventricular hypertrophy, stroke, hypertensive kidney disease) and to have higher mortality rates. However, few population-based data support the hypothesis that hypertensive retinopathy is more common in African Americans than in whites. The authors examined racial differences in the prevalence of and risk factors for hypertensive retinopathy in a population-based sample of 1860 African Americans and 7874 white persons, aged 49 to 73 years, without diabetes (participants in the ARIC study). Retinal photographs were taken of one randomly selected eye and evaluated for the presence of retinopathy (flame and blot-shaped retinal hemorrhages, microaneurysms, and soft exudates) according to standardized protocols by graders masked to participant characteristics. The prevalence of retinopathy was 2 times higher in African Americans than in whites (7.7% versus 4.1%, age- and gender-adjusted odds ratio [OR] 2.03, 95% confidence intervals [CI] 1.65, 2.49). After controlling for 6-year mean arterial blood pressure, use of antihypertensive medications and left ventricular hypertrophy by ECG criteria, the excess prevalence of retinopathy in African Americans was reduced by 40% (adjusted OR 1.61, 95% CI 1.26, 2.06). Further adjustment for other vascular risk factors, common carotid artery intima-media thickness, and serum creatinine levels reduced the excess prevalence in African Americans by another 13% (adjusted OR 1.48, 95% CI 1.08, 2.03). The authors conclude that hypertensive retinopathy is twice as frequent in African Americans compared with whites without diabetes and that the excess prevalence of retinopathy in African Americans is associated with blood pressure and severity of hypertension.—Valérie Biousse

Diabetic Retinopathy in African Americans: Vision Impairment, Prevalence, Incidence, and Risk Factors

Diabetic Retinopathy in African Americans: Vision Impairment, Prevalence, Incidence, and Risk Factors

Diabetic retinopathy in African Americans: vision impairment, prevalence, incidence, and risk factors.

Diabetic retinopathy in African Americans: vision impairment, prevalence, incidence, and risk factors.

Depressive symptoms in African-American type 1 diabetics.

This study examined depressive symptoms and their correlates in African-American patients with type 1 diabetes. Five-hundred eighty-one diabetics participated in a study on risk factors for retinopathy in African-Americans with type 1 diabetes. Evaluations included structured interview, ocular examination, blood test, and completion of the Beck Depression Inventory (BDI). Among the 581 diabetic patients, 159 (26.9%) had a BDI score > 14. Significantly more of these patients were unemployed, had less education, lower socio-economic status, and less personal and family income than those who had a BDI < or = 14. Also, significantly more patients with a BDI score > 14 had proliferative retinopathy and were receiving disability payments. In the multiple logistic regression, two factors that significantly and independently associated with the BDI score > 14 were unemployment or not working due to disability. Both socio-economic and diabetic variables are associated with depressive symptoms among African-American patients with type 1 diabetes.

Diabetic retinopathy in African Americans with type 1 diabetes: The New Jersey 725: II. Risk factors.

To determine whether diabetic retinopathy in African Americans with type 1 diabetes is associated with the following 6 putative risk factors: duration of diabetes, glycemic control, systemic hypertension, renal disease, socioeconomic status, and male sex. Patients in The New Jersey 725 study underwent detailed ocular evaluation, a structured clinical interview, blood pressure measurements, and assays of blood and urine samples. Glycemic control was poor; 89.8% of the patients had glycosylated hemoglobin values of more than 0.08. Renal disease and systemic hypertension were present in 49.8% and 34.3% of patients, respectively. Frequency and severity of retinopathy were significantly associated with longer duration of diabetes (P<.001). After adjusting for duration of diabetes and other confounding variables, on average, patients with total glycosylated hemoglobin values in the highest quartile were 3 times more likely to have any retinopathy than those in the lowest quartile; patients with renal disease, 3 times more likely to have any retinopathy and 10 times more likely to have proliferative retinopathy than patients without renal disease; and patients in the highest quartile of systolic sitting blood pressure, 3 times more likely to have proliferative retinopathy than patients in the lowest quartile. Risk factors for diabetic retinopathy in African Americans with type 1 diabetes include presence of renal disease, poor glycemic control, high systolic blood pressure, and long duration of diabetes.

Diabetic retinopathy in African Americans with type 1 diabetes: The New Jersey 725: I. Methodology, population, frequency of retinopathy, and visual impairment.

To determine the frequency and severity of diabetic retinopathy, as well as associated visual impairment, among African Americans with type 1 diabetes. A total of 725 African Americans with type 1 diabetes were enrolled in the study (The New Jersey 725). Clinical evaluations included structured clinical interview, ocular examination, stereoscopic fundus photography, and blood pressure measurements. Severity of retinopathy was determined via masked grading of fundus photographs. Biological evaluations included blood and urine assays. Of the 725 patients, 463 (63.9%) presented with any diabetic retinopathy and 137 (18.9%) with proliferative diabetic retinopathy. The frequency and severity of retinopathy were both significantly associated with older age at examination. Visual impairment (visual acuity in the better eye < or =20/40) was present in 79 (11.0%) and legal blindness in 22 (3.1%) of the patients. Diabetic retinopathy was responsible for 90.9% of the blindness. Frequency of visual impairment was significantly associated with older age and female sex, and only weakly with lower education. Diabetic retinopathy in African Americans with type 1 diabetes is common, being found in almost two thirds of the patients studied. Its frequency and severity increase with age. Visual impairment is common, increasing with age and duration of diabetes and is more frequent in women than in men.

Development of proliferative diabetic retinopathy in African-Americans and whites with type 1 diabetes.

To investigate the comparable risk of developing proliferative diabetic retinopathy (PDR) in African-Americans and whites with type 1 diabetes. Using a cohort design with the sample drawn from medical records, the sample consisted of 312 people with type 1 diabetes (97 African-Americans, 215 whites) having at least two visits to a Model Demonstration Unit with gradeable fundus photographs (stereo, color, 7 standard fields). Excluded were subjects with preexisting or treated PDR or hemoglobinopathy. Masked grading of the fundus photographs was conducted at the Wisconsin Reading Center. At baseline, African-Americans had poorer glycemic control (mean HbA1 of 11.3 vs. 10.0%, P < 0.0001), higher systolic blood pressure (mean of 117 vs. 110 mmHg, P < 0.001), and were older (mean of 26.8 vs. 19.3 years, P < 0.0001) than the white subjects. African-Americans also tended to have slightly longer duration of diabetes and length of follow-up. In the African-Americans, 17.5% developed PDR, compared with 10.2% in the 215 whites, for an odds ratio (OR) of 1.86 (95% CI 0.93-3.70). When adjusted for baseline glycemic control, retinopathy grade, and length of follow-up, race was not a significant risk factor (OR = 0.73, 95% CI 0.30-1.78). African-Americans with type 1 diabetes may have a higher rate of developing PDR. The observed racial difference, however, is attributable to the presence of a worse risk factor profile, especially to poorer glycemic control. Efforts should be expanded to improve the care for all individuals with poor glycemic control.

Retinopathy in African Americans and Whites With Insulin-Dependent Diabetes Mellitus

The development and progression of diabetic retinopathy in African Americans with insulin-dependent diabetes mellitus is not known. Two hundred subjects with insulin-dependent diabetes mellitus with duration of diabetes 16 years or less at first visit were studied; 58 were African Americans and 142 were whites. All had gradable stereoscopic color fundus photographs (seven standard fields) from at least two visits (mean time between first and second visit was 4.1 years). Subjects with hemoglobinopathy or proliferative retinopathy or subjects who had evidence of treatment for proliferative retinopathy at first visit were excluded. Masked grading of photographs was conducted using the modified Airlie House classification scheme. African Americans were older, heavier, had higher systolic blood pressure (all P < .05), and marginally higher hemoglobin A1 (HbA1) values (P = .06) than the whites at first visit. African Americans had a lower rate of two steps or more progression from preexistent retinopathy (19%) than whites (43%). Progression to proliferative retinopathy or treatment was similar by race. Multivariate analysis predicting development oe progression of retinopathy, while controlling for length of follow-up, found higher HbA1 (odds ratio [OR] = 2.15), longer duration of insulin-dependent diabetes mellitus (OR = 1.69), higher serum creatinine concentration (OR = 1.59), and white race (OR = 2.62) to be independent risk factors. These data suggest a previously unsuspected reduction in the adjusted risk for development and progression of retinopathy in African Americans. The reason for this apparently reduced risk are not known.

Retinopathy in African Americans and whites with insulin-dependent diabetes mellitus

Retinopathy in African Americans and whites with insulin-dependent diabetes mellitus