MORTALITY IN DIABETIC-PATIENTS PARTICIPATING IN AN OPHTHALMOLOGICAL CONTROL AND SCREENING-PROGRAM

The aim of this follow-up study has been to assess retinopathy and cha nge of treatment to insulin therapy as risk factors for mortality in d iabetic patients participating in a control and screening programme fa r retinopathy. A total of 3220 diabetic patients, 483 with an age at d iagnosis <30 years, and 2737 with an age at diagnosis greater than or equal to 30 years, were included. Retinopathy was graded on fundus pho tographs using the Wisconsin Scale, and the visual acuity was assessed . The average HbA(1c) value was calculated for each patient for the pr evious 8 years to estimate long-term glycaemic control, Mortality data were obtained from death certificates, Two hundred and sixty-three di abetic patients (8.2 %) died during the mean follow-up time of 3.4 yea rs, 13 (2.7 %) of those with younger-onset (<30 years) and 250 (9.1 %) of those with older-onset (greater than or equal to 30 years) diabete s. Of them, 148 (56.3 %) died from cardiovascular and 23 (8.7 %) from cerebrovascular disorders. After adjusting far differences in age and sex, more severe retinopathy and the use of antihypertensive drugs wer e associated with a decreased overall survival rate as well as an incr eased mortality from cardiovascular and cerebrovascular diseases, A st atistically significant association between HbA(1c) values in the high est quartile, i.e. greater than or equal to 8.4 %, and cardiovascular and all cause mortality did not remain when retinopathy was entered in to the multivariate analyses, Duration of diabetes, but not change of treatment to insulin therapy, was associated with higher cardiovascula r mortality in patients whose diabetes was diagnosed after the age of 30 years, We conclude that severe retinopathy, use of antihypertensive drugs, and poor glycaemic control predicted death from cardiovascular disease in diabetic patients participating in an ophthalmological scr eening programme. (C) 1997 by John Wiley & Sons, Ltd.