Retinopathy During the First 5 Years of Type 1 Diabetes and Subsequent Risk of Advanced Retinopathy

Authors

John I. Malone, University of South Florida, Tampa, FL.
Xiaoyu Gao, Biostatistics Center, The George Washington University, Rockville, MD.
Gayle M. Lorenzi, Department of Medicine, University of California, San Diego, La Jolla, CA.
Philip Raskin, University of Texas Southwestern Medical Center, Dallas, TX.
Neil H. White, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
Dean P. Hainsworth, Mason Eye Institute, University of Missouri, Columbia, MO.
Arup Das, University of New Mexico, Albuquerque, NM.
William Tamborlane, Yale School of Medicine, New Haven, CT.
Amisha Wallia, Department of Medicine, Northwestern University, Chicago, IL.
Lloyd P. Aiello, Department of Ophthalmology, Joslin Diabetes Center, Boston, MA.
Ionut Bebu, Biostatistics Center, The George Washington University, Rockville, MD.

Document Type

Journal Article

Publication Date

12-13-2022

Journal

Diabetes care

DOI

10.2337/dc22-1711

Abstract

OBJECTIVE: To determine whether individuals with type 1 diabetes (T1D) who develop any retinopathy at any time prior to 5 years of diabetes duration have an increased subsequent risk for further progression of retinopathy or onset of proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME), diabetes-related retinal photocoagulation, or anti-vascular endothelial growth factor injections. Additionally, to determine the influence of HbA1c and other risk factors in these individuals. RESEARCH DESIGN AND METHODS: Diabetic retinopathy (DR) was assessed longitudinally using standardized stereoscopic seven-field fundus photography at time intervals of 6 months to 4 years. Early-onset DR (EDR) was defined as onset prior to 5 years of T1D duration. Cox models assessed the associations of EDR with subsequent risk of outcomes. RESULTS: In unadjusted models, individuals with EDR (n = 484) had an increased subsequent risk of PDR (hazard ratio [HR] 1.51 [95% CI 1.12, 2.02], P = 0.006), CSME (HR 1.44 [1.10, 1.88], P = 0.008), and diabetes-related retinal photocoagulation (HR 1.48 [1.12, 1.96], P = 0.006) compared with individuals without EDR (n = 369). These associations remained significant when adjusted for HbA1c, but only the association with PDR remained significant after adjustment for age, duration of T1D, HbA1c, sex, systolic/diastolic blood pressure, pulse, use of ACE inhibitors, albumin excretion rate, and estimated glomerular filtration rate (HR 1.47 [95% CI 1.04, 2.06], P = 0.028). CONCLUSIONS: These data suggest that individuals with any sign of retinopathy within the first 5 years of T1D onset may be at higher risk of long-term development of advanced DR, especially PDR. Identification of early-onset DR may influence prognosis and help guide therapeutic management to reduce the risk of future visual loss in these individuals.

APA Citation

Malone, John I.; Gao, Xiaoyu; Lorenzi, Gayle M.; Raskin, Philip; White, Neil H.; Hainsworth, Dean P.; Das, Arup; Tamborlane, William; Wallia, Amisha; Aiello, Lloyd P.; and Bebu, Ionut, "Retinopathy During the First 5 Years of Type 1 Diabetes and Subsequent Risk of Advanced Retinopathy" (2022). GW Authored Works. Paper 2110.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2110

Department

Biostatistics and Bioinformatics