DEVELOPMENT OF PROLIFERATIVE DIABETIC-RETINOPATHY IN AFRICAN-AMERICANS AND WHITES WITH TYPE-1 DIABETES

OBJECTIVE -To investigate the comparable risk of developing proliferat ive diabetic retinopathy (PDR) in African-Americans and whites with ty pe 1 diabetes. RESEARCH DESIGN AND METHODS -Using a cohort design with the sample drawn from medical records, the sample consisted of 312 pe ople with type 1 diabetes (97 African-Americans, 215 whites) having at least two visits to a Model Demonstration Unit with gradeable fundus photographs (stereo, color, 7 standard fields). Excluded were subjects with preexisting or treated PDR or hemoglobinopathy. Masked grading o f the fundus photographs was conducted at the Wisconsin Reading Center . RESULTS -At baseline, African-Americans had poorer glycemic control (mean HbA(1) of 11.3 vs. 10.0%, P < 0.0001), higher systolic blood pre ssure (mean of 117 vs. 110 mmHg, P < 0.001), and were older (mean of 2 6.8 vs. 19.3 years, P < 0.0001) than the white subjects. African-Ameri cans also tended to have slightly longer duration of diabetes and leng th of follow-up. In the African-Americans, 17.5% developed PDR, compar ed with 10.2% in the 215 whites, for an odds ratio (OR) of 1.86 (95% C I 0.93-3.70). When adjusted for baseline glycemic control, retinopathy grade, and length of follow-up, race was not a significant risk facto r (OR= 0.73. 95% CI 0.30-1.78). CONCLUSIONS -African-Americans with ty pe 1 diabetes may have a higher rate of developing PDR. The observed r acial difference, however, is attributable to the presence of a worse risk factor profile, especially to poorer glycemic control. Efforts sh ould be expanded to improve the care for all individuals with poor gly cemic control.