COMPLICATION-FREE DURATION AND THE RISK OF DEVELOPMENT OF RETINOPATHYIN ELDERLY DIABETIC-PATIENTS

Background: Determining which diabetic patients are at risk for compli cations and targeting,these patients for intensive therapy may avoid t he unwanted consequences of hypoglycemia in low-risk patients. Since a ging is associated with a decrease in the incidence of diabetic retino pathy, we assessed whether long complication free duration can define elderly patients at lower risk for future development of diabetic reti nopathy. Methods: In a 10-year clinic-based study, we studied 833 type 2 diabetic patients who were free of diabetic retinopathy and older t han 50 years, followed up for more than 4 years. Data included demogra phic and clinical information on arrival, updated every 3 to 6 months, and yearly direct ophthalmoscopic examination after pupillary dilatio n by experienced ophthalmologists. All the data were prospectively com piled on relational databases. End points studied were presence of ret inopathy, nephropathy, peripheral neuropathy, peripheral vascular dise ase, hyperlipidemia, and hypertension. Results: Of the patients withou t retinopathy at the age of 50 years, 10% developed retinopathy during 4 years of follow-up. These patients had longer duration and younger onset of diabetes than the group without retinopathy at the if-year fo llow-up. Clustering of microvascular and macrovascular complications w as noted. Discriminant analysis showed the following factors to be sig nificant and independent predictors of the development of retinopathy in the elderly: duration of diabetes, body mass index, age, and glucos e control. Conclusions: A long complication-free period does not defin e elderly patients with type 2 diabetes who are at lower risk for futu re development of retinopathy. On the contrary, the increase in diseas e duration is significantly associated with the development of retinop athy in this age group, as described in younger patients.