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- Title
Risk Factors Predictive of Retinopathy Severity, Retinal Thickness, and Visual Acuity in Patients with 50 Years or More of Type 1 Diabetes Mellitus.
- Authors
Sun, Jennifer K.; Keenan, Hillary A.; Aiello, Lloyd P.; Cavallerano, Jerry D.; Eisenbarth, George S.; Doria, Alessandro; King, George L.
- Abstract
We examined relationships between historical, biochemical, and genetic risk factors and diabetic retinopathy (DR) severity levels, retinal thickness, and visual acuity (VA) in 178 patients who have lived 50 or more years with type 1 diabetes mellitus (DM). Each patient underwent Early Treatment of Diabetic Retinopathy Study-protocol VA testing and fundus photos; ocular coherence tomography (OCT); measurement of weight, height, hemoglobin A1c (HbA1c), lipids, islet cell antibodies, and C-peptide; and HLA DQB1, DQA1, and DRB1 genotyping. Fundus photo grading was performed by two primary readers and a third adjudicator, and revealed that in the eye with more severe DR, 6.7% of patients had no discernible DR, 1.7% had questionable DR, 32.6% had mild nonproliferative DR (NPDR), 9.6% had moderate NPDR, 0.6% had severe NPDR, and 46.6% had proliferative DR (PDR). Mean thickness on OCT of the central retinal subfield was 235 ± 94 µ (median thickness = 212 µ). Only 8.7% of patients had clinically significant macular edema in either eye on fundus photos, but central subfield thickness was greater than 250 µ (average nondiabetic thickness ± 2SD) in 29.1%. VA was 20/20 or better in 56%, 20/40 or better in 96.2%, and 20/200 or worse in 1.6% of patients. Multivariate analysis revealed that less severe DR correlated with the presence of risk alleles of the HLA loci above (p = 0.022), the presence of IA2 antibodies (p = 0.046), and the absence of microalbuminuria (p = 0.003), but was not related to HbA1c. VA of 20/20 or better was correlated with less severe DR (p<0.0001) and lower HbA1c (p=0.039). Neither DR severity nor VA were related to age, duration of DM, hypertensive status, C-peptide, or lipid levels. Linear regression analysis demonstrated that increasing retinal thickness was not significantly correlated with DR severity, gender, age, duration of DM, hypertensive status, HbA1c, total cholesterol, microalbuminuria, or the presence of HLA risk alleles or IA2 antibodies. These findings from a large cohort of patients with extreme long duration of DM reveal that a large proportion (41%) have no or mild NPDR and that over 50% retain excellent VA. The correlation of less severe DR with HLA risk alleles and IA2 antibodies, and its lack of relationship with HbA1c suggest that the presence of certain genetic and biochemical factors can protect against the development of diabetic microvascular complications even after 50 years of DM.
- Subjects
DISEASE risk factors; RETINAL diseases; VISUAL acuity; PEOPLE with diabetes; DIABETIC retinopathy
- Publication
Diabetes, 2007, Vol 56, pA25
- ISSN
0012-1797
- Publication type
Article