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Long-term study reports high rate of DR in patients with type 1 diabetes
Ophthalmology. 2008;115(11):1859-1868.
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Nearly all patients in a study had some form of diabetic retinopathy 25 years after a diagnosis of type 1 diabetes mellitus, and eight out of 10 patients had progression of retinopathy.
In a population of 955 insulin-dependent patients in the Wisconsin Epidemiologic Study of Diabetic Retinopathy, the 25-year cumulative incidence of diabetic retinopathy (DR) was 97%. The 25-year cumulative rate of progression of DR was 83% and progression to proliferative diabetic retinopathy (PDR) was 42%. Improvement of DR was noted in 18% in the study population.
Risk factors for DR on univariate analysis included male gender, higher glycosylated hemoglobin level and greater body mass index at baseline. Time-varying covariate analysis also showed a link between diastolic blood pressure and progression of DR. Several risk factors were associated with PDR, but associations with higher glycosylated hemoglobin were the strongest and most consistent.
While the rate of PDR was high, there was a reduction in prevalence in more recently diagnosed cohorts, which may be a signal that changes in diabetes management strategies are having a positive effect on PDR.
"Our data suggest that better glycemic control, and to a lesser extent blood pressure control at baseline and throughout the study, may be beneficial in reducing the incidence of PDR and increasing the odds of improvement in DR," the study authors said.