DOMINANT RISK-FACTORS FOR RETINOPATHY AT CLINICAL-DIAGNOSIS IN PATIENTS WITH TYPE-II DIABETES-MELLITUS

A study of 270 newly presenting, previously untreated, type II diabeti c patents revealed that 38 patients (14%) had already developed diabet ic retinopathy (DR). Among this group, 26 patients had lesions of back ground diabetic retinopathy and 12 patients already had maculopathy or preproliferative changes. The aim of this study was to determine the risk factors influencing susceptibility to retinopathy, and to provide an accurate predictive value for diabetic retinopathy from a detailed multiple regression analysis that involved 27 demographic variables a nd the metabolic and hormonal responses during a meal tolerance test ( MTT) at presentation. Compared to the nonretinopaths, the retinopaths had higher fasting plasma glucose levels (FPG) (mean +/- SD) (13.9 +/- 3.1 versus 11.6 +/- 3.2 mmol/L, p < 0.001), lower body-mass index val ues (BMI) (26.1 +/- 3.8 versus 29.3 +/- 5.0 kg/m(2), p < 0.001) and hi gher plasma urea concentrations (6.0 +/- 1.9 versus 5.3 +/- 1.2 mmol/L , p 0.05). In contrast, gender and levels of blood pressure and other lipid level did not influence the prevalence of diabetic retinopathy. A multiple regression formula for the prediction of diabetic retinopat hy was derived and then used to categorize patients into high-risk and low-risk groups. The retinopaths also had higher HbA(1c) (p < 0.001), higher plasma glucose area under curve (0-2 h, p < 0.001), lower plas ma insulin area under curve (0-22 h, p < 0.001), lower C-peptide area under curve (0-2 h, p < 0.01). They were also leaner (p < 0.001) and o lder (p < 0.05). However, these variables did not feature significantl y in the multiple regression formula. The retinopaths were found to ha ve higher risk probability values (25.1 +/- 11.5 versus 13.1 +/- 10.4% , p < 0.001). In the high risk group, 81.6% of retinopaths were identi fied. In the low-risk group, 63.8% of nonretinopaths were found. The i ncidence of diabetic retinopathy in type II diabetic patients at clini cal diagnosis was found to be highly related to the degree of hypergly cemia, body-mass index, and to a lesser extent, renal impairment.