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Low education level, beta-cell function increase risk for diabetic retinopathy
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Data from a registry study demonstrate the prevalence of diabetic retinopathy at diagnosis in patients with newly diagnosed diabetes in Sweden was 12%. Risk factors for the condition included an education of 9 or fewer years and low beta-cell function.
“There are various known risk factors for the development and progression of diabetic retinopathy, where the duration of diabetes, insufficient metabolic control and untreated hypertension are the most important,” Mats Martinell, PhD student, department of public health and caring sciences at Uppsala University, and colleagues wrote. “To tailor efficient screening intervals and individual treatment regimes, a better knowledge of individual risk factors is necessary.”
The researchers analyzed data from 2,174 patients from the All New Diabetics in Scania (ANDIS) eye complications study who enrolled via primary health care centers throughout the Scania region of Sweden; 93% had type 2 diabetes, and 7% had latent autoimmune diabetes. Martinell and colleagues assessed cardiovascular risk using the National Patient Register and Swedish Prescribed Drug Register, and measured beta-cell function and insulin sensitivity using the homeostasis model assessment (HOMA) calculator.
Diabetic retinopathy was present in 12% of patients — 7% mild and 5% moderate disease — and 11% had diabetic macular edema. Prevalence did not vary significantly between the type 2 diabetes and autoimmune diabetes groups. Patients with type 2 diabetes who had no more than 9 years of education had a 44% increased risk for diabetic retinopathy at diagnosis, Martinell and colleagues reported (OR = 1.44; 95% CI, 1.07-1.93). Patients with beta-cell function below 50%, adjusted for HbA1c and insulin sensitivity at time of diagnosis, had a 77% increased risk for diabetic retinopathy (OR = 1.77; 95% CI, 1.28-2.44). The risk decreased by 3% for every unit increase of BMI (OR = 0.97; 95% CI, 0.95-0.99).
The relationship between education and diabetic retinopathy was “related to increased incidence of diabetes and diabetic complications secondary to a higher prevalence of unhealthy lifestyle in this population,” the researchers wrote.
“We conclude that by estimating beta-cell function by inputting [fasting] C-Peptide and [fasting] P-Glucose values into the widely accessible HOMA2 calculator, the risk of diabetic retinopathy at diagnosis in patients recently diagnosed with diabetes can be more accurately estimated,” Martinell and colleagues wrote. “We believe that this can be used to develop more effective, individualized diabetic retinopathy screening programs.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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