RISK-FACTORS FOR DEVELOPMENT OF RETINOPATHY IN ELDERLY JAPANESE PATIENTS WITH DIABETES-MELLITUS

OBJECTIVE - To define the risk factors for the development of diabetic retinopathy in elderly patients with diabetes mellitus. RESEARCH DESI GN AND METHODS - We studied 110 diabetic outpatients >60 yr of age who were free of diabetic retinopathy at the first visit and were followe d for at least 5 yr to examine the relationships between the initial f indings and the subsequent development of retinopathy. RESULTS - A tot al of 49 of the subjects developed diabetic retinopathy during the fol low-up period; of these, 4 patients progressed to preproliferative and 3 to proliferative retinopathy. Univariate analysis showed that the i nitial fasting plasma glucose levels, the HbA, values, the 2-h postloa d plasma glucose levels, the estimated duration of diabetes, and the p resence of persistent proteinuria were all associated with the develop ment of diabetic retinopathy. However, age at the initial examination, estimated age at diabetes onset, sex, body mass index, type of therap y, and hypertension had little impact on the development of retinopath y. Stepwise multiple Cox regression analysis revealed that the initial HbA1 or fasting plasma glucose, the diabetes duration, and the presen ce of persistent proteinuria are significant independent predictors fo r the development of retinopathy. CONCLUSIONS - Initial fasting plasma glucose, diabetes duration, and protein-uria are important risk facto rs for the development of retinopathy in elderly patients with diabete s mellitus.