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Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies.
Ophthalmology 2005; 112(5):799-805O

Abstract

OBJECTIVES

To evaluate factors related to the incidence of diabetic retinopathy (DR) in a population of African descent, after 9 years of follow-up.

DESIGN

Population-based cohort study; 81% participation after 9 years.

PARTICIPANTS

Three hundred twenty-four participants of the Barbados Eye Studies, with diabetes mellitus (DM) at baseline and at risk for developing DR during follow-up.

METHODS

Diabetes-related changes were assessed by masked gradings of baseline and follow-up photographs using a standardized system. The 9-year cumulative incidence of DR was based on participants with DM and free of retinopathy at baseline; incidence rates were estimated by the product-limit approach. Cox regression models for discrete-time data were used to evaluate risk factors associated with the 9-year incidence of DR.

RESULTS

Multivariate analyses revealed that older age at DM onset decreased the 9-year risk of DR development; for each 10 years of older age at onset, the risk of DR decreased by 30% (risk ratio [RR], 0.7; 95% confidence interval [CI], 0.56-0.96). The risk of DR doubled among persons with DM duration between 5 and 9 years (RR, 2.1; 95% CI, 1.2-3.6) versus those with shorter durations; it also doubled in those treated with oral medications or insulin at baseline versus those treated with diet only. Antihypertensive treatment halved the risk of DR versus no treatment (RR, 0.5; 95% CI, 0.3-0.9) and high systolic or diastolic blood pressure (BP) increased risk. Thus, DR risk increased by 30% for every 10 mmHg of higher systolic BP at baseline (RR, 1.3; 95% CI, 1.1-1.4) or of BP increase from baseline to the 4-year follow-up (RR, 1.3; 95% CI, 1.1-1.4). Diabetic retinopathy risk similarly increased with each 1% of higher glycosylated hemoglobin level at baseline (RR, 1.3; 95% CI, 1.2-1.5).

CONCLUSIONS

The long-term follow-up of persons with DM in this population of African origin, where disease prevalence is high, identified important potentially modifiable risk factors for DR. Findings suggest that efforts to achieve optimal glycemic and BP control may reduce the vision-threatening complications of DM.

Authors+Show Affiliations

Department of Preventive Medicine, Stony Brook University, Stony Brook, New York 11794-8036, USA. cleske@notes.cc.sunysb.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15878059

Citation

Leske, M Cristina, et al. "Hyperglycemia, Blood Pressure, and the 9-year Incidence of Diabetic Retinopathy: the Barbados Eye Studies." Ophthalmology, vol. 112, no. 5, 2005, pp. 799-805.
Leske MC, Wu SY, Hennis A, et al. Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies. Ophthalmology. 2005;112(5):799-805.
Leske, M. C., Wu, S. Y., Hennis, A., Hyman, L., Nemesure, B., Yang, L., & Schachat, A. P. (2005). Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies. Ophthalmology, 112(5), pp. 799-805.
Leske MC, et al. Hyperglycemia, Blood Pressure, and the 9-year Incidence of Diabetic Retinopathy: the Barbados Eye Studies. Ophthalmology. 2005;112(5):799-805. PubMed PMID: 15878059.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies. AU - Leske,M Cristina, AU - Wu,Suh-Yuh, AU - Hennis,Anselm, AU - Hyman,Leslie, AU - Nemesure,Barbara, AU - Yang,Ling, AU - Schachat,Andrew P, AU - ,, PY - 2004/08/10/received PY - 2004/11/24/accepted PY - 2005/5/10/pubmed PY - 2005/5/20/medline PY - 2005/5/10/entrez SP - 799 EP - 805 JF - Ophthalmology JO - Ophthalmology VL - 112 IS - 5 N2 - OBJECTIVES: To evaluate factors related to the incidence of diabetic retinopathy (DR) in a population of African descent, after 9 years of follow-up. DESIGN: Population-based cohort study; 81% participation after 9 years. PARTICIPANTS: Three hundred twenty-four participants of the Barbados Eye Studies, with diabetes mellitus (DM) at baseline and at risk for developing DR during follow-up. METHODS: Diabetes-related changes were assessed by masked gradings of baseline and follow-up photographs using a standardized system. The 9-year cumulative incidence of DR was based on participants with DM and free of retinopathy at baseline; incidence rates were estimated by the product-limit approach. Cox regression models for discrete-time data were used to evaluate risk factors associated with the 9-year incidence of DR. RESULTS: Multivariate analyses revealed that older age at DM onset decreased the 9-year risk of DR development; for each 10 years of older age at onset, the risk of DR decreased by 30% (risk ratio [RR], 0.7; 95% confidence interval [CI], 0.56-0.96). The risk of DR doubled among persons with DM duration between 5 and 9 years (RR, 2.1; 95% CI, 1.2-3.6) versus those with shorter durations; it also doubled in those treated with oral medications or insulin at baseline versus those treated with diet only. Antihypertensive treatment halved the risk of DR versus no treatment (RR, 0.5; 95% CI, 0.3-0.9) and high systolic or diastolic blood pressure (BP) increased risk. Thus, DR risk increased by 30% for every 10 mmHg of higher systolic BP at baseline (RR, 1.3; 95% CI, 1.1-1.4) or of BP increase from baseline to the 4-year follow-up (RR, 1.3; 95% CI, 1.1-1.4). Diabetic retinopathy risk similarly increased with each 1% of higher glycosylated hemoglobin level at baseline (RR, 1.3; 95% CI, 1.2-1.5). CONCLUSIONS: The long-term follow-up of persons with DM in this population of African origin, where disease prevalence is high, identified important potentially modifiable risk factors for DR. Findings suggest that efforts to achieve optimal glycemic and BP control may reduce the vision-threatening complications of DM. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/15878059/Hyperglycemia_blood_pressure_and_the_9_year_incidence_of_diabetic_retinopathy:_the_Barbados_Eye_Studies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(05)00095-3 DB - PRIME DP - Unbound Medicine ER -