International Ophthalmology

, Volume 35, Issue 4, pp 503–511 | Cite as

The prognosis of diabetic retinopathy in patients with type 2 diabetes since 1996–1998: the Skaraborg Diabetes Register

  • Grete Garberg
  • Monica Lövestam-Adrian
  • Salmir Nasic
  • Kristina Bengtsson Boström
Original Paper

Abstract

Diabetes mellitus is the main reason for visual impairment among patients of working ages. The aim of this paper was to investigate the prognosis of eye complications in patients with diabetes during 10 years of follow-up and contributing risk factors. Data from ophthalmological records (occurrence of retinopathy and laser treatment and visual acuity), and clinical data (blood pressure, glycosylated hemoglobin (HbA1c), body mass index (BMI), and antihypertensive treatment) from the Skaraborg Diabetes Register were retrieved in the Skaraborg Screening Program of 1,258 patients diagnosed during 1996–1998. Kaplan Meyer survival analysis and Log Rank test were used to analyze eye complications in 773 patients with type 2 diabetes and ≤70 years at diagnosis. Visual acuity was above the limit for driving license in 96 % of 548 patients and only nineteen patients were treated by laser. At diagnosis of diabetes, mean HbA1c was 6.7 ± 1.7 % (59 ± 7.1 mmol/mol), and systolic blood pressure was 142.9 ± 0.7 mmHg; neither changed significantly during follow-up. Retinopathy appeared about 1 year, and maculopathy 2 years earlier, if HbA1c ≥ 7 % (63 mmol/mol) at diagnosis (p < 0.001 and p < 0.006). Antihypertensive treatment, higher BMI, and higher age at diagnosis were associated with less retinopathy during follow-up. Most patients with diabetes develop little retinopathy for the first 10 years after diagnosis. High HbA1c at baseline was associated with retinopathy and maculopathy during follow-up. Antihypertensive treatment, probably a proxy for regular controls and early detection of diabetes, was associated with less retinopathy.

Keywords

Diabetes mellitus type 2 Diabetic retinopathy Retinal photo screening Longitudinal study 

References

  1. 1.
    Squirrell DM, Talbot JF (2003) Screening for diabetic retinopathy. J R Soc Med 96:273–276PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Javitt JC, Aiello LP (1996) Cost-effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med 124:164–169PubMedCrossRefGoogle Scholar
  3. 3.
    Kohner EM, Aldington SJ, Stratton IM et al (1998) United Kingdom Prospective Diabetes Study, 30: diabetic retinopathy at diagnosis of non-insulin-dependent diabetes mellitus and associated risk factors. Arch Ophthalmol 116:297–303PubMedCrossRefGoogle Scholar
  4. 4.
    Early Treatment Diabetic Retinopathy Study Research Group (1991) Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Ophthalmology 98:766–785CrossRefGoogle Scholar
  5. 5.
    Klein R, Klein BEK, Moss SE et al (1995) The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XV. The long-term incidence of macular edema. Ophthalmology 102:7–16PubMedCrossRefGoogle Scholar
  6. 6.
    Brown JB, Pedula KL, Summers KH (2003) Diabetic retinopathy: contemporary prevalence in a well-controlled population. Diabetes Care 26:2637–2642PubMedCrossRefGoogle Scholar
  7. 7.
    Turner RC, Holman RR, Cull CA et al (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. UKPDS 33. Lancet 352:837–853CrossRefGoogle Scholar
  8. 8.
    Matthews DR, Stratton IM, Aldington SJ (2004) Risk of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes, UKPDS 69. Arch Ophthalmol 122:1631–1640PubMedCrossRefGoogle Scholar
  9. 9.
    Stratton IM, Kohner EM, Aldington SJ et al (2001) UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis. Diabetologia 44:156–163. doi:10.1007/s001250051594 PubMedCrossRefGoogle Scholar
  10. 10.
    White NH, Sun W, Cleary PA et al (2010) Effect of prior intensive therapy in type 1 diabetes on 10-year progression of retinopathy in the DCCT/EDIC: comparison of adults and adolescents. Diabetes 59:1244–1253. doi:10.2337/db09-1216 PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Chew EY, Ambrosius WT, Davis MD et al (2010) Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med 363:233–244PubMedCrossRefGoogle Scholar
  12. 12.
    National Board of Health and Welfare, Sweden (1999) National guidelines for treatment and care of diabetic patientsGoogle Scholar
  13. 13.
    WHO study group: Diabetes mellitus (1985) Report of a WHO Study Group World Health Organization Technical Report Series 727, GenevaGoogle Scholar
  14. 14.
    Gudbjornsdottir S, Cederholm J, Nilsson PM et al (2003) The National Diabetes Register in Sweden: an implementation of the St. Vincent Declaration for Quality Improvement in Diabetes Care. Diabetes Care 26:1270–1276PubMedCrossRefGoogle Scholar
  15. 15.
    Treatment of mild hypertension: Vol 1 (1987) National Board of Health and Welfare, Drug information Committee, SwedenGoogle Scholar
  16. 16.
    Berger B, Stenstrom G, Chang YF et al (1998) The prevalence of diabetes in a Swedish population of 280,411 inhabitants. A report from the Skaraborg Diabetes Registry. Diabetes Care 21:546–548PubMedCrossRefGoogle Scholar
  17. 17.
    Berger B, Stenstrom G, Sundkvist G (2000) Random C-peptide in the classification of diabetes. Scand J Clin Lab Invest 60:687–693PubMedCrossRefGoogle Scholar
  18. 18.
    Klein R, Klein BE, Moss SE et al (1992) The Beaver Dam Eye Study. Retinopathy in adults with newly discovered and previously diagnosed diabetes mellitus. Ophthalmology 99:58–62PubMedCrossRefGoogle Scholar
  19. 19.
    Turner R, Holdman R, Stratton I et al (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317:703–713CrossRefGoogle Scholar
  20. 20.
    Nilsson PM, Cifkova R, Kjeldsen SE (1998) Treatment of hypertension in patients with type 2 diabetes mellitus. European Society of Hypertension Scientific Newsletter, 2010 10 No 1 RGoogle Scholar
  21. 21.
    Sjolie AK, Klein R, Porta M et al (2008) Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial. Lancet 372:1385–1393PubMedCrossRefGoogle Scholar
  22. 22.
    Bog-Hansen E, Lindblad U, Ranstam J et al (2002) Antihypertensive drug treatment in a Swedish community: Skaraborg Hypertension and Diabetes Project. Pharmacoepidemiol Drug Saf 11:45–54. doi:10.1002/pds.681 PubMedCrossRefGoogle Scholar
  23. 23.
    Bloomgarden ZT (2002) Obesity, hypertension, and insulin resistance. Diabetes Care 25:2088–2097PubMedCrossRefGoogle Scholar
  24. 24.
    Bays HE, Chapman RH, Grandy S (2007) The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: comparison of data from two national surveys. Int J Clin Pract 61:737–747PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Munch IC, Kessel L, Borch-Johnsen K et al (2012) Microvascular retinopathy in subjects without diabetes: the Inter99 Eye Study. Acta Ophthalmol 90:613–619. doi:10.1111/j.1755-3768.2011.2148.x PubMedCrossRefGoogle Scholar
  26. 26.
    Tobias DK, Pan A, Jackson CL et al (2014) Body-mass index and mortality among adults with incident type 2 diabetes. N Engl J Med 370:233–244PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Klein R, Klein BEK, Moss SE et al (1984) The Wisconsin epidemiologic study of diabetic retinopathy III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 102:527–532PubMedCrossRefGoogle Scholar
  28. 28.
    Lovestam-Adrian M, Hansson-Lundblad Torffvit O (2007) Sight-threatening retinopathy is associated with lower mortality in type 2 diabetic subjects: a 10-year observation study. Diabetes Res Clin Pract 77:141–147. doi:10.1016/j.diabres.2006.10.026 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Grete Garberg
    • 1
  • Monica Lövestam-Adrian
    • 2
  • Salmir Nasic
    • 3
  • Kristina Bengtsson Boström
    • 4
  1. 1.Department of OphthalmologySkaraborg HospitalSkövdeSweden
  2. 2.Department of Ophthalmology, Lund University HospitalUniversity of LundLundSweden
  3. 3.R&D Center Skaraborg HospitalSkövdeSweden
  4. 4.R&D Center Skaraborg Primary CareSkövdeSweden

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