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Retinal vascular changes and 20-year incidence of lower extremity amputations in a cohort with diabetes.
Arch Intern Med. 2003 Nov 10; 163(20):2505-10.AI

Abstract

OBJECTIVE

To examine the association of retinal vascular changes with the incidence of lower extremity amputations (LEAs) in a cohort with diabetes mellitus.

METHODS

Baseline examinations were performed in a cohort of 996 persons with diabetes diagnosed before the age of 30 years and using insulin. History of LEA was obtained at baseline and at 4, 10, 14, and 20 years. The cumulative 20-year incidence of first LEA was calculated by the product-limit method in 906 persons with follow-up information. Retinal arterioles and venules were measured on digitized fundus photographs obtained at baseline by a standard protocol. Generalized arteriolar narrowing was defined as the lowest 25% of the arteriole-venule ratio. Measurements were obtained in at least one eye for 820 persons. Focal arteriolar narrowing and arteriovenous nicking were also determined from fundus photographs by a standard protocol.

RESULTS

The 20-year cumulative incidence of LEAs was 9.9%. The unadjusted risk of undergoing a LEA was higher in persons with generalized arteriolar narrowing than in those without it (15.7% vs 5.7%; odds ratio [OR], 3.08; 95% confidence interval [CI], 1.60-4.68), and in persons with focal narrowing (33.1% vs 6.8%; OR, 5.59; 95% CI, 3.27-9.54). The results for arteriovenous nicking were not significant. With control for age, sex, levels of glycosylated hemoglobin, diastolic blood pressure, and history of ulcers of the feet, the relationships were attenuated but still statistically significant for both generalized narrowing (OR, 1.89; 95% CI, 1.06-3.35) and focal narrowing (OR, 3.56; 95% CI, 1.87-6.78).

CONCLUSION

In persons with diabetes, generalized as well as focal retinal arteriolar narrowing may reflect damage to the microvasculature, which manifests itself elsewhere in the body as a need for LEAs.

Authors+Show Affiliations

Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, WI 53726, USA. moss@epi.opth.wisc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

14609788

Citation

Moss, Scot E., et al. "Retinal Vascular Changes and 20-year Incidence of Lower Extremity Amputations in a Cohort With Diabetes." Archives of Internal Medicine, vol. 163, no. 20, 2003, pp. 2505-10.
Moss SE, Klein R, Klein BE, et al. Retinal vascular changes and 20-year incidence of lower extremity amputations in a cohort with diabetes. Arch Intern Med. 2003;163(20):2505-10.
Moss, S. E., Klein, R., Klein, B. E., & Wong, T. Y. (2003). Retinal vascular changes and 20-year incidence of lower extremity amputations in a cohort with diabetes. Archives of Internal Medicine, 163(20), 2505-10.
Moss SE, et al. Retinal Vascular Changes and 20-year Incidence of Lower Extremity Amputations in a Cohort With Diabetes. Arch Intern Med. 2003 Nov 10;163(20):2505-10. PubMed PMID: 14609788.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retinal vascular changes and 20-year incidence of lower extremity amputations in a cohort with diabetes. AU - Moss,Scot E, AU - Klein,Ronald, AU - Klein,Barbara E K, AU - Wong,Tien Y, PY - 2003/11/12/pubmed PY - 2003/12/12/medline PY - 2003/11/12/entrez SP - 2505 EP - 10 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 163 IS - 20 N2 - OBJECTIVE: To examine the association of retinal vascular changes with the incidence of lower extremity amputations (LEAs) in a cohort with diabetes mellitus. METHODS: Baseline examinations were performed in a cohort of 996 persons with diabetes diagnosed before the age of 30 years and using insulin. History of LEA was obtained at baseline and at 4, 10, 14, and 20 years. The cumulative 20-year incidence of first LEA was calculated by the product-limit method in 906 persons with follow-up information. Retinal arterioles and venules were measured on digitized fundus photographs obtained at baseline by a standard protocol. Generalized arteriolar narrowing was defined as the lowest 25% of the arteriole-venule ratio. Measurements were obtained in at least one eye for 820 persons. Focal arteriolar narrowing and arteriovenous nicking were also determined from fundus photographs by a standard protocol. RESULTS: The 20-year cumulative incidence of LEAs was 9.9%. The unadjusted risk of undergoing a LEA was higher in persons with generalized arteriolar narrowing than in those without it (15.7% vs 5.7%; odds ratio [OR], 3.08; 95% confidence interval [CI], 1.60-4.68), and in persons with focal narrowing (33.1% vs 6.8%; OR, 5.59; 95% CI, 3.27-9.54). The results for arteriovenous nicking were not significant. With control for age, sex, levels of glycosylated hemoglobin, diastolic blood pressure, and history of ulcers of the feet, the relationships were attenuated but still statistically significant for both generalized narrowing (OR, 1.89; 95% CI, 1.06-3.35) and focal narrowing (OR, 3.56; 95% CI, 1.87-6.78). CONCLUSION: In persons with diabetes, generalized as well as focal retinal arteriolar narrowing may reflect damage to the microvasculature, which manifests itself elsewhere in the body as a need for LEAs. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/14609788/Retinal_vascular_changes_and_20_year_incidence_of_lower_extremity_amputations_in_a_cohort_with_diabetes_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/163/pg/2505 DB - PRIME DP - Unbound Medicine ER -