RETINOPATHY AND VISION LOSS IN INSULIN-DEPENDENT DIABETES IN EUROPE -THE EURODIAB IDDM COMPLICATIONS STUDY

Purpose: To assess the frequency of retinopathy and vision loss in pat ients with insulin-dependent diabetes mellitus and their relations to potentially modifiable risk factors. Methods: The authors conducted a multicenter cross-sectional study of diabetic complications and their risk factors using standardized methods of assessment. The sample was comprised of 3250 insulin-dependent diabetic patients (1668 men, 1582 women) aged 15 to 60 years with mean (standard deviation) duration of diabetes of 14.7 (9.3) years from 31 European diabetes centers; 2991 o f the patients were eligible for retinal photography. Visual acuity wa s measured using the Snellen chart. Retinopathy was evaluated by retin al photographs (two fields per eye) graded at a central facility. Glyc ated hemoglobin (HbA(1c)), cholesterol, triglyceride, fibrinogen, von Willebrand factor, and urinary albumin excretion rate were assessed at a single location. Results: Corrected visual acuity was greater than or equal to 1.0 in both eyes in 69.7% of patients and less than or equ al to 0.1 in the best eye in 2.3%. Factors significantly related to vi sion loss were age, duration of diabetes, glycated hemoglobin (HbA(1c) ), and level of retinopathy. Mild nonproliferative retinopathy was fou nd in 25.8% of the patients, moderate-severe nonproliferative retinopa thy in 9.8% of the patients, and proliferative retinopathy in 10.6% of the patients. After adjustment for age, duration of diabetes, HbA(1c) , and albumin excretion rate, significant risk factors for moderate-se vere nonproliferative retinopathy were blood pressure and triglyceride , and risk factors for proliferative retinopathy were triglyceride and fibrinogen. Conclusion: Vision loss is a common complication of patie nts with insulin-dependent diabetes, with diabetic retinopathy an impo rtant cause. Apart from poor glycemic control, several other potential ly modifiable risk factors for retinopathy may be important, including elevated blood pressure, plasma triglyceride, and fibrinogen. In view of the possible barriers to the full implementation of strict glycemi c control in this type of diabetes, additional strategies for the prev ention and slowing of progression of retinopathy should be investigate d, such as blood pressure and lipid lowering therapies.