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Quantification of risk factors for diabetic retinopathy progression

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Abstract

Aims

To determine the importance of blood sugar control, blood pressure, and other key systemic factors on the risk of progression from no retinopathy to various stages of diabetic retinopathy.

Methods

Restrospective cohort analysis of patients (N = 99, 280) in the Kaiser Permanente Northern California healthcare system with a baseline retina photographic screening showing no evidence of retinopathy and a minimum follow-up surveillance period of 3 years from 2008 to 2019. We gathered longitudinal data on diabetic retinopathy progression provided by subsequent screening fundus photographs and data captured in the electronic medical record over a mean surveillance of 7.3 ± 2.2 (mean ± SD) years. Progression from an initial state of no diabetic retinopathy to any of four outcomes was determined: (1) any incident retinopathy, (2) referable (moderate or worse) retinopathy, (3) diabetic macular edema, and (4) proliferative diabetic retinopathy. Multiple predictors, including age, race, gender, glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), cholesterol, chronic renal disease, and type of diabetes were investigated.

Results

Among modifiable risk factors, the average HbA1c had the strongest impact on the progression of diabetic retinopathy, followed by average SBP control and total cholesterol. Patients with an average HbA1c of 10.0% or greater (≥ 97 mmol/mol) had a risk ratio of 5.72 (95% CI 5.44–6.02) for progression to any retinopathy, 18.84 (95% CI 17.25–20.57) for referable retinopathy, 22.85 (95% CI 18.87–27.68) for diabetic macular edema, and 25.96 (95% CI 18.75–36.93) for proliferative diabetic retinopathy compared to those with an average HbA1c of 7.0% (53 mmol/mol) or less. Non-white patients generally had a higher risk of progression to all forms of diabetic retinopathy, while Asian patients were less likely to develop diabetic macular edema (HR 0.76, 95% CI 0.66–0.87).

Conclusions

We confirm the critical importance of glucose control as measured by HbA1c on the risk of development of diabetic retinopathy.

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Funding

This work was funded by Kaiser Permanente Community Health Grant.

Author information

Authors and Affiliations

  1. The Permanente Medical Group, Department of Ophthalmology, Oakland, CA, USA

    Dariusz Tarasewicz & Ronald B. Melles

  2. Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA

    Carol Conell

  3. The Permanente Medical Group, Department of Endocrinology, Oakland, CA, USA

    Lisa K. Gilliam

Authors
  1. Dariusz Tarasewicz
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  2. Carol Conell
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  3. Lisa K. Gilliam
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  4. Ronald B. Melles
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Corresponding author

Correspondence to Ronald B. Melles.

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No conflicting relationship exists for any author.

Ethics Approval

This study was performed under Kaiser Permanente Institutional Review Board approval and adhered to the tenets of the Declaration of Helsinki.

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This article belongs to the topical collection Eye Complications of Diabetes, managed by Giuseppe Querques.

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Tarasewicz, D., Conell, C., Gilliam, L.K. et al. Quantification of risk factors for diabetic retinopathy progression. Acta Diabetol 60, 363–369 (2023). https://doi.org/10.1007/s00592-022-02007-6

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  • DOI: https://doi.org/10.1007/s00592-022-02007-6

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