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- Title
Increased Fluctuations in Blood Glucose and Systolic Blood Pressure Are Risk Factors of the Diabetic Retinopathy.
- Authors
Kishimoto, Akane; Sasaski, Hideyuki; Ibata, Junko; Nakano, Yoshio; Wakasaki, Hisao; Furuta, Hiroto; Nishi, Masahiro; Sanke, Tokio; Nanjo, Kishio
- Abstract
In order to elucidate the clinical risk factors of diabetic retinopathy (DR) and nephropathy (DN), we investigated the relationships between the clinical data of long term observed diabetic patients and the onset and progression of DR and DN. 145 diabetic patients, who had been continuously followed up in our hospital over 20 years and had not prepro- or proliferative retinopathy (PDR) or persistent proteinuria (PPU) at baseline, were recruited to the study. Average age at baseline, observation period and duration of diabetes at the end of observation were 50, 23 and 30 years, respectively. DR were graded into normal, simple retinopathy (SDR) and PDR. DN were classified into normal, intermittent proteinuria (IPU) and PPU. Physical and laboratory data were collected from medical records and averaged in every 5 years intervals and the mean value of all intervals were calculated and used for analyses. Fluctuation in blood glucose (BG) and systolic blood pressure (SBP) was evaluated by the coefficients of variation in HbA1c (CV-Hb) and SBP (CV-BP) calculated from all intervals (at least 4 periods). All patients were classified into two groups, low CV-Hb (less than median) and high CV-Hb groups. Similarly, low CV-BP group and high CV-BP group were defined. Prevalence of SDR, PDR, IPU and PPU were 30%, 38%, 25% and 29%, respectively. Multiple logistic regression analysis revealed that the significant risk factors of PDR were high HbA1c, high CV-Hb, long duration of diabetes and high CV-BP, and that the significant risk factors of PPU were high HbA1c, low HDL and high SBP. Although the average HbA1c in the high CV-Hb group (8.5%) was same as the low CV-Hb group (8.4%), the percentage of the patients with SDR/PDR in the former group (75%) was significantly higher than that in the latter group (60%, p=0.044). Percentage of the patients with SDR/PDR in high CV-BP group (77%) was significantly higher than that in low CV-BP group (58%, p=0.015), however, average SBP in the former group (135 mmHg) was same as the latter group (138 mmHg). As well as the previous reports, the major risk factors of DR were high BG and long duration, and those of DN were high BG, dyslipidemia and high SBP. Additionally, this study demonstrated increased CV-Hb and CV-BP were significantly related to the progression of DR independently from HbA1c and SBP levels. Therefore, the fluctuation of blood glucose and blood pressure might be new risk factors of diabetic retinopathy.
- Subjects
DISEASE risk factors; DIABETIC retinopathy; DIABETIC nephropathies; BLOOD sugar; BLOOD pressure; DIABETES complications
- Publication
Diabetes, 2007, Vol 56, pA218
- ISSN
0012-1797
- Publication type
Article