DIABETIC CONTROL AND PROGRESSION OF RETINOPATHY IN ELDERLY PATIENTS -5-YEAR FOLLOW-UP-STUDY

Objective: To assess whether control of diabetes mellitus is as import ant in the elderly as in young and middle-aged diabetic patients in te rms of progression of retinopathy. Design: A 5-year longitudinal cohor t study. Setting: Outpatient diabetic clinic. Patients: One hundred fo urteen non-insulin-dependent diabetic patients (30 males, 84 females) greater than or equal to 60 years of age. Measurements: Retinopathy wa s checked at the beginning and end of the follow-up period. During the 5-year followup period, demographic variables, body mass index, HbA1c , blood pressure, and plasma lipids were monitored. Retinopathy was cl assified as follows: grade 0, no lesion; grade 1, non-proliferative re tinopathy; grade 2, pre-proliferative retinopathy; grade 3, proliferat ive retinopathy. Progression of retinopathy during the 5-year follow-u p was defined as an increase in its grade. Results: At the start of th e study, 13% of the patients already had retinopathy, all of grade 1. The 5-year follow-up study showed that progression of retinopathy was 23.6% in all cases, 22.2% in those with grade 0 initially, and 33.3% i n those with grade 1 initially. The progression rates of retinopathy a s a function of the mean HbA1c during the follow-up were as follows: l ower than 7%, 2%; 7-8%, 20%; 8-9%, 40%; more than 9%, 61%. Multiple lo gistic regression analysis showed that, of the parameters examined, on ly HbA1c was a significant risk factor for progression of retinopathy. Conclusions: Control of diabetes mellitus is the most important facto r associated with prevention of progression of retinopathy in elderly patients.