RELATIONS BETWEEN DIABETIC-RETINOPATHY AND CARDIOVASCULAR NEUROPATHY - A CROSS-SECTIONAL STUDY IN IDDM AND NIDDM PATIENTS

The pathogenetic process of diabetic retinopathy and the role of diffe rent systemic risk factors in IDDM and NIDDM is not completely underst ood. The aim of the present cross-sectional clinical study was (1) to compare the prevalence of systemic risk factors for diabetic retinopat hy in IDDM and NIDDM patients, (2) to determine relations between thes e risk factors and the degree of retinopathy and (3) to evaluate the r elationship between retinopathy and neuropathy. The study included 1,2 18 IDDM and 784 NIDDM patients attending our hospital during 1994. The mean diabetes duration was 15.4 and 13.2 years, respectively. IDDM pa tients with proliferative retinopathy were characterized by higher mea n age of 46.4 +/- 1.08 vs. 21.8 +/- 0.42 years and longer diabetes dur ation of 30.0 +/- 0.79 vs. 7.7 +/- 0.26 years. Among the NIDDM patient s, those ones with proliferative retinopathy had the lowest mean age o f 40.5 +/- 1.42 vs. 49.7 +/- 0.61 years (p < 0.01) at diabetes manifes tation. There was no statistical difference between mean HbA(1c) conce ntrations in relation to retinopathy stages. Albumin excretion was inc reased in both IDDM and NIDDM patients with proliferative retinopathy (p < 0.01) along with increased BMI of IDDM and increased insulin requ irement of NIDDM patients (p < 0.01). Multiple regression analysis sho wed that proliferative retinopathy with the inclusion of non-prolifera tive retinopathy of IDDM and NIDDM patients was significantly correlat ed with diabetes duration, albumin excretion, somatic and autonomic ne uropathy (p < 0.01). In NIDDM patients proliferative retinopathy with the inclusion of nonproliferative retinopathy was correlated with the age at diabetes manifestation and with cholesterol levels (p < 0.05). In IDDM and NIDDM patients proliferative retinopathy was found to be c orrelated with somatic and autonomic neuropathy, albumin excretion (p < 0.01) and hypertension (p < 0.05). The importance of the significant correlation of autonomic neuropathy both with background and prolifer ative retinopathy in IDDM and NIDDM patients needs to be prospectively investigated.