PROLIFERATIVE DIABETIC-RETINOPATHY IS RELATED TO CARDIOVASCULAR AUTONOMIC NEUROPATHY IN NON-INSULIN-DEPENDENT DIABETES-MELLITUS

The aim of the study was to define the relationship between the presen ce of proliferative diabetic retinopathy and nephropathy with objectiv ely defined autonomic neuropathy in non-insulin-dependent diabetes mel litus (NIDDM) patients. The research design used was a cross-sectional , case control study. A cohort of NIDDM patients was classified, accor ding to five cardiovascular autonomic tests described by Ewing, as: (1 ) no involvement - no abnormal tests (n = 17); (2) cardiovascular auto nomic neuropathy - two out of five abnormal tests (n = 18). Age, age a t diagnosis, plasma creatinine, fasting plasma glucose, glycated haemo globin and blood pressure measurements were not statistically differen t among the two groups, According to indirect ophthalmoscopy and the p resence of macroproteinuria and microalbuminuria, respectively, patien ts were also classified as having proliferative, non-proliferative or no retinopathy and with or without nephropathy, The results showed a s triking relationship between cardiovascular autonomic neuropathy and p roliferative diabetic retinopathy. Relative odds for nephropathy, non- proliferative diabetic retinopathy and proliferative retinopathy were, respectively, 16.0, 10.1 and 34.7. When odds ratios were adjusted for the presence of nephropathy, hypertension, non-proliferative and prol iferative retinopathy, only proliferative retinopathy was significantl y associated (odds ratio, 7.1). It was concluded that in NIDDM the pre sence of cardiovascular autonomic neuropathy is strongly associated wi th proliferative retinopathy. Long-term prospective studies on large c ohorts of patients must be done to evaluate if having autonomic dysfun ction would be a risk factor or a risk indicator of an etiologic proce ss underlying the development of proliferative retinopathy.