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The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes.
Ophthalmology 2008; 115(11):1859-68O

Abstract

OBJECTIVE

To examine the 25-year cumulative progression and regression of diabetic retinopathy (DR) and its relation to various risk factors.

DESIGN

Population-based study.

PARTICIPANTS

A total of 955 insulin-taking persons living in an 11-county area in southern Wisconsin with type 1 diabetes diagnosed before age 30 years who participated in a baseline examination (1980-1982) and at least 1 of 4 follow-up (4-, 10-, 14-, and 25-year) examinations or died before the first follow-up examination (n = 64).

METHODS

Stereoscopic color fundus photographs were graded using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study retinopathy severity scheme.

MAIN OUTCOME MEASURES

Progression and regression of DR status.

RESULTS

The 25-year cumulative rate of progression of DR was 83%, progression to proliferative DR (PDR) was 42%, and improvement of DR was 18%. Progression of DR was more likely with less severe DR, male sex, higher glycosylated hemoglobin, an increase in glycosylated hemoglobin level, and an increase in diastolic blood pressure level from the baseline to the 4-year follow-up. Increased risk of incidence of PDR was associated with higher glycosylated hemoglobin, higher systolic blood pressure, proteinuria greater body mass index at baseline, and an increase in the glycosylated hemoglobin between the baseline and 4-year follow-up examinations. Lower glycosylated hemoglobin and male sex, as well as decreases in glycosylated hemoglobin and diastolic blood pressure during the first 4 years of follow-up, were associated with improvement in DR. Persons diagnosed most recently with a similar duration of diabetes had a lower prevalence of PDR independently of glycosylated hemoglobin level, blood pressure level, and presence of proteinuria.

CONCLUSIONS

These data show relatively high 25-year cumulative rates of progression of DR and incidence of PDR. The lower risk of prevalent PDR in more recently diagnosed persons possibly reflects improvement in care over the period of the study.

Authors+Show Affiliations

Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19068374

Citation

Klein, Ronald, et al. "The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the Twenty-five-year Progression of Retinopathy in Persons With Type 1 Diabetes." Ophthalmology, vol. 115, no. 11, 2008, pp. 1859-68.
Klein R, Knudtson MD, Lee KE, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes. Ophthalmology. 2008;115(11):1859-68.
Klein, R., Knudtson, M. D., Lee, K. E., Gangnon, R., & Klein, B. E. (2008). The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes. Ophthalmology, 115(11), pp. 1859-68. doi:10.1016/j.ophtha.2008.08.023.
Klein R, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the Twenty-five-year Progression of Retinopathy in Persons With Type 1 Diabetes. Ophthalmology. 2008;115(11):1859-68. PubMed PMID: 19068374.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes. AU - Klein,Ronald, AU - Knudtson,Michael D, AU - Lee,Kristine E, AU - Gangnon,Ronald, AU - Klein,Barbara E K, PY - 2008/03/07/received PY - 2008/08/06/revised PY - 2008/08/08/accepted PY - 2008/12/11/pubmed PY - 2008/12/31/medline PY - 2008/12/11/entrez SP - 1859 EP - 68 JF - Ophthalmology JO - Ophthalmology VL - 115 IS - 11 N2 - OBJECTIVE: To examine the 25-year cumulative progression and regression of diabetic retinopathy (DR) and its relation to various risk factors. DESIGN: Population-based study. PARTICIPANTS: A total of 955 insulin-taking persons living in an 11-county area in southern Wisconsin with type 1 diabetes diagnosed before age 30 years who participated in a baseline examination (1980-1982) and at least 1 of 4 follow-up (4-, 10-, 14-, and 25-year) examinations or died before the first follow-up examination (n = 64). METHODS: Stereoscopic color fundus photographs were graded using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study retinopathy severity scheme. MAIN OUTCOME MEASURES: Progression and regression of DR status. RESULTS: The 25-year cumulative rate of progression of DR was 83%, progression to proliferative DR (PDR) was 42%, and improvement of DR was 18%. Progression of DR was more likely with less severe DR, male sex, higher glycosylated hemoglobin, an increase in glycosylated hemoglobin level, and an increase in diastolic blood pressure level from the baseline to the 4-year follow-up. Increased risk of incidence of PDR was associated with higher glycosylated hemoglobin, higher systolic blood pressure, proteinuria greater body mass index at baseline, and an increase in the glycosylated hemoglobin between the baseline and 4-year follow-up examinations. Lower glycosylated hemoglobin and male sex, as well as decreases in glycosylated hemoglobin and diastolic blood pressure during the first 4 years of follow-up, were associated with improvement in DR. Persons diagnosed most recently with a similar duration of diabetes had a lower prevalence of PDR independently of glycosylated hemoglobin level, blood pressure level, and presence of proteinuria. CONCLUSIONS: These data show relatively high 25-year cumulative rates of progression of DR and incidence of PDR. The lower risk of prevalent PDR in more recently diagnosed persons possibly reflects improvement in care over the period of the study. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/19068374/The_Wisconsin_Epidemiologic_Study_of_Diabetic_Retinopathy:_XXII_the_twenty_five_year_progression_of_retinopathy_in_persons_with_type_1_diabetes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(08)00817-8 DB - PRIME DP - Unbound Medicine ER -