E. Agardh et al., A 5-YEAR FOLLOW-UP-STUDY ON THE INCIDENCE OF RETINOPATHY IN TYPE-1 DIABETES-MELLITUS IN RELATION TO MEDICAL RISK INDICATORS, Journal of internal medicine, 235(4), 1994, pp. 353-358
Objectives. The aim of the present study was to describe the 5-year in
cidence of retinopathy in type 1 diabetes mellitus and to characterize
risk indicators for the development and progression of retinopathy. D
esign. A cross-sectional study of type 1 diabetic patients taken care
of at a medical department. Setting. All type 1 diabetic patients atte
nding the Department of Internal Medicine, University Hospital, Lund,
during a 2-year period were offered ophthalmological examination. Subj
ects. A total of 396 out of 461 (85.9%) initially examined type 1 diab
etic patients formed the basis for this 5-year follow-up study. Main o
utcome measures. The degree of retinopathy was based on fundus photogr
aphy or biomicroscopy. Degree of metabolic control was assessed by HbA
(1c) levels, signs of nephropathy by albumin creatinine clearance rati
o and urinary albumin levels. Blood pressure was measured in the supin
e position. Duration of diabetes, age, and insulin dosage were registe
red. Results. The incidence of retinopathy was 47.2%, and progression
from background to severe retinopathy occurred in 41%. Risk indicators
for the development of retinopathy were duration of diabetes (P < 0.0
01), degree of metabolic control (P < 0.001), insulin dosage (P < 0.05
) and signs of nephropathy based on measurements of albumin creatinine
clearance ratio (P < 0.01) and urinary albumin concentration (P < 0.0
5). Two risk indicators could be identified for progression of retinop
athy, i.e. the degree of metabolic control (P < 0.01) and diastolic bl
ood pressure (P < 0.05). Conclusions. The results suggest that apart f
rom poor metabolic control, development of retinopathy in type 1 diabe
tes is associated with long diabetes duration and clinical signs of di
abetic nephropathy. Progression of retinopathy is associated with poor
metabolic control and elevated diastolic blood pressure levels.