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Blindness in a 25-year follow-up of a population-based cohort of Danish type 1 diabetic patients.
Ophthalmology. 2009 Nov; 116(11):2170-4.O

Abstract

PURPOSE

To assess the long-term incidence of blindness and to evaluate risk factors for blindness in a population-based cohort of type 1 diabetic patients.

DESIGN

Retrospective cohort study.

PARTICIPANTS

A population-based cohort of 573 type 1 diabetic patients, all of whom participated in a clinical ophthalmologic examination in 1981 and 1982 and were followed up for 25 years.

METHODS

At the baseline examination in 1981 and 1982, visual acuity, level of retinopathy, maculopathy, hemoglobin A(1) (HbA(1)), proteinuria, smoking habits, and blood pressure were evaluated and related to the subsequent development of blindness. Blindness was defined as present in patients who were registered as members of the Danish Association of the Blind between baseline and January 2007. The Danish Association of the Blind is a voluntary organization open for all patients with a best-corrected visual acuity in the best eye of <or=6/60 (20/200) or with complications (i.e., visual fields <10 degrees) subjectively leading to a best-corrected visual acuity in the best eye of <or=6/60 (20/200).

MAIN OUTCOME MEASURES

Evaluation of 25-year incidence of blindness, predictors for blindness, and gender-specific incidence rates for blindness.

RESULTS

The 25-year cumulative crude incidence of blindness was 7.5% (men, 8.0%; women, 6.8%; P = 0.61), corresponding to a mortality-adjusted cumulative incidence of blindness of 9.5% (95% confidence interval [CI], 7.1%-12.0%) and an overall incidence rate of blindness of 4.11 per 1000 person-years (95% CI, 3.03-5.59 per 1000 person-years). Blindness was predicted by HbA(1) and maculopathy at baseline. The odds ratio of blindness during follow-up was 1.69 (95% CI, 1.01-2.84) for a 1% increase in baseline HbA(1) and was 6.18 (95% CI, 1.18-32.47) and 8.61 (95% CI, 2.54-29.23) for patients with maculopathy in combination with nonproliferative retinopathy and proliferative retinopathy, respectively. Age and duration at baseline, gender, proteinuria, smoking, systolic and diastolic blood pressure, and visual acuity at baseline were not associated with the development of blindness. Mortality was higher in patients who had become blind (61.0% vs. 42.1%; P = 0.02).

CONCLUSIONS

Blindness is still a common complication in type 1 diabetes. Glycemic regulation and the presence of maculopathy are important risk factors for the development of blindness.

Authors+Show Affiliations

Department of Ophthalmology, Odense University Hospital, Odense, Denmark. jakob.grauslund@ouh.regionsyddanmark.dkNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19744716

Citation

Grauslund, Jakob, et al. "Blindness in a 25-year Follow-up of a Population-based Cohort of Danish Type 1 Diabetic Patients." Ophthalmology, vol. 116, no. 11, 2009, pp. 2170-4.
Grauslund J, Green A, Sjølie AK. Blindness in a 25-year follow-up of a population-based cohort of Danish type 1 diabetic patients. Ophthalmology. 2009;116(11):2170-4.
Grauslund, J., Green, A., & Sjølie, A. K. (2009). Blindness in a 25-year follow-up of a population-based cohort of Danish type 1 diabetic patients. Ophthalmology, 116(11), 2170-4. https://doi.org/10.1016/j.ophtha.2009.04.043
Grauslund J, Green A, Sjølie AK. Blindness in a 25-year Follow-up of a Population-based Cohort of Danish Type 1 Diabetic Patients. Ophthalmology. 2009;116(11):2170-4. PubMed PMID: 19744716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blindness in a 25-year follow-up of a population-based cohort of Danish type 1 diabetic patients. AU - Grauslund,Jakob, AU - Green,Anders, AU - Sjølie,Anne Katrin, Y1 - 2009/09/10/ PY - 2008/11/07/received PY - 2009/03/23/revised PY - 2009/04/23/accepted PY - 2009/9/12/entrez PY - 2009/9/12/pubmed PY - 2009/11/13/medline SP - 2170 EP - 4 JF - Ophthalmology JO - Ophthalmology VL - 116 IS - 11 N2 - PURPOSE: To assess the long-term incidence of blindness and to evaluate risk factors for blindness in a population-based cohort of type 1 diabetic patients. DESIGN: Retrospective cohort study. PARTICIPANTS: A population-based cohort of 573 type 1 diabetic patients, all of whom participated in a clinical ophthalmologic examination in 1981 and 1982 and were followed up for 25 years. METHODS: At the baseline examination in 1981 and 1982, visual acuity, level of retinopathy, maculopathy, hemoglobin A(1) (HbA(1)), proteinuria, smoking habits, and blood pressure were evaluated and related to the subsequent development of blindness. Blindness was defined as present in patients who were registered as members of the Danish Association of the Blind between baseline and January 2007. The Danish Association of the Blind is a voluntary organization open for all patients with a best-corrected visual acuity in the best eye of <or=6/60 (20/200) or with complications (i.e., visual fields <10 degrees) subjectively leading to a best-corrected visual acuity in the best eye of <or=6/60 (20/200). MAIN OUTCOME MEASURES: Evaluation of 25-year incidence of blindness, predictors for blindness, and gender-specific incidence rates for blindness. RESULTS: The 25-year cumulative crude incidence of blindness was 7.5% (men, 8.0%; women, 6.8%; P = 0.61), corresponding to a mortality-adjusted cumulative incidence of blindness of 9.5% (95% confidence interval [CI], 7.1%-12.0%) and an overall incidence rate of blindness of 4.11 per 1000 person-years (95% CI, 3.03-5.59 per 1000 person-years). Blindness was predicted by HbA(1) and maculopathy at baseline. The odds ratio of blindness during follow-up was 1.69 (95% CI, 1.01-2.84) for a 1% increase in baseline HbA(1) and was 6.18 (95% CI, 1.18-32.47) and 8.61 (95% CI, 2.54-29.23) for patients with maculopathy in combination with nonproliferative retinopathy and proliferative retinopathy, respectively. Age and duration at baseline, gender, proteinuria, smoking, systolic and diastolic blood pressure, and visual acuity at baseline were not associated with the development of blindness. Mortality was higher in patients who had become blind (61.0% vs. 42.1%; P = 0.02). CONCLUSIONS: Blindness is still a common complication in type 1 diabetes. Glycemic regulation and the presence of maculopathy are important risk factors for the development of blindness. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/19744716/Blindness_in_a_25_year_follow_up_of_a_population_based_cohort_of_Danish_type_1_diabetic_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(09)00471-0 DB - PRIME DP - Unbound Medicine ER -