Lloyd, C. E.; Klein, R.; Maser, R. E.; Kuller, L. H.; Becker, D. J. and Orchard, T. J.
The progression of retinopathy over 2 years: The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study.
Journal of Diabetes and its Complications, 9(3),
This study examined potential risk factors for the incidence and progression of retinopathy in a large representative cohort of childhood onset insulin-dependent diabetic patients. Participants in the Epidemiology of Diabetes Complications (EDC) Study underwent a full clinical examination at baseline and again at a 2-year follow-up. Retinopathy status was ascertained using stereo fundus photographs graded according to the modified Airlie House System. The study population is based on a large cohort of childhood-onset insulin-dependent diabetic patients, seen within 1 year of diagnosis at the Children's Hospital of Pittsburgh between January 1950 and May 1980. A total of 657 subjects participated at baseline (1986-1988), with 80% of eligible survivors taking part in the follow-up examination. This report concerns risk factors associated with the progression of diabetic retinopathy over a 2-year period, and the interaction of these factors with the presence of nephropathy. Analyses showed that baseline diastolic blood pressure was significantly associated with the incidence of any retinopathy, while glycosylated hemoglobin, baseline severity of retinopathy, serum triglycerides, and, to a lesser extent, higher levels of low-density lipoprotein (LDL) cholesterol and fibrinogen were associated with the progression of retinopathy. Progression to proliferative retinopathy was related to higher LDL cholesterol, fibrinogen, serum triglycerides, albumin excretion rate, and glycosylated hemoglobin (GHb). Risk factors varied with the presence of nephropathy. In the absence of nephropathy, GHb was a significant predictor of progression, whilst this was not the case in the presence of nephropathy. Multivariate analyses demonstrated that the incidence of new cases of retinopathy was associated only with baseline diastolic blood pressure, while both the progression of retinopathy and progression to proliferative retinopathy were significantly associated with baseline glycosylated hemoglobin and baseline severity of retinopathy. These results suggest that the risk factors for the development of retinopathy may differ at various stages of the disease and according to the presence of nephropathy. While blood pressure, even within the normal range, may be important in the early stages of retinopathy, glycemic control remains the most important factor in the long-term development of this complication.
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