Maculopathy in patients with diabetes mellitus type 1 and type 2: associations with risk factors

Aim-To examine possible relation between diabetic maculopathy and various r isk factors for diabetic complications in patients with diabetes mellitus t ype I and type 2. Methods-Cross sectional study of two cohorts of diabetic patients, comprisi ng 1796 patients with type 1 diabetes (mean age 47 years, mean duration of diabetes 24 years) and 1563 patients with type 2 diabetes (mean age 62 year s, mean duration of diabetes 16 years). Retinopathy levels (RO-RV) and macu lopathy were assessed by fluorescence angiography and fundus photography an d binocular biomicroscopy. Diabetic neuropathy was assessed by means of com puter assisted electrocardiography and by thermal and vibratory sensory exa mination. Patients were classified as normoalbuminuric (<20 mu g/min) or mi croalbuminuric (20-200 mu g/min) according to their albumin excretion rates measured in urine collected overnight. Using univariate analyses, the effe cts of selected patient characteristics on the presence of maculopathy were evaluated. Multiple logistic regression analyses were performed to determi ne independent effects of risk variables on diabetic maculopathy. Results-Background retinopathy (RII) was found to be present in 28% of type 1 diabetic patients and in 38% of type 2 diabetic patients. The prevalence of maculopathy in these patients was remarkably high (42% in type 1 and 53 % in type 2 diabetic patients). Patients with maculopathy had significantly impaired visual acuity. Multiple logistic correlation analysis revealed th at in both types of diabetes maculopathy exhibited independent associations with duration of diabetes and with neuropathy (p <0.01); in type 1 diabeti c patients there were significant associations with age at diabetes onset, serum triglyceride and total cholesterol levels (p <0.05); in type 2 diabet es with serum creatinine levels and with hypertension (p <0.05). Conclusions-Irrespective of the type of diabetes, diabetic patients with lo ng standing diabetes have a high risk far the development of diabetic macul opathy. Diabetic maculopathy is closely associated with diabetic nephropath y and neuropathy and with several atherosclerotic risk factors which sugges ts that these factors might have an important role in the pathogenesis of m aculopathy. However, prospective trials are necessary to evaluate the predi ctive value of such factors. The findings of the present cross sectional st udy reinforce the arguments of previous studies by others for tight control of hypertension and hyperglycaemia.