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Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy.
Arch Intern Med 1994; 154(19):2169-78AI

Abstract

BACKGROUND

The object was to examine the relationship of hyperglycemia, as measured by glycosylated hemoglobin level, to the incidence and progression of diabetic retinopathy over a 10-year period.

METHODS

Patients who were younger (n = 682) and older (n = 834) than 30 years at onset of diabetes participated in baseline (1980-1982) and follow-up (1984-1986 and 1990-1992) examinations of a population-based cohort study. Glycosylated hemoglobin levels were measured by microcolumn. Retinopathy was determined from stereoscopic fundus photographs.

RESULTS

Persons with glycosylated hemoglobin levels in the highest quartile at baseline were more likely to have progression of retinopathy than persons with levels in the lowest quartile (younger-onset group: relative risk [RR], 2.9; 95% confidence interval [CI], 2.3 to 3.5; older-onset group taking insulin: RR, 2.1; 95% CI, 1.6 to 2.8; and older-onset group not taking insulin: RR, 4.3; 95% CI, 3.0 to 6.2) and were more likely to develop proliferative diabetic retinopathy (younger-onset group: RR, 7.1; 95% CI, 4.6 to 11.1; older-onset group taking insulin: RR, 3.1; 95% CI, 1.5 to 6.1; and older-onset group not taking insulin: RR, 13.8; 95% CI, 4.8 to 39.5). These relations were significant (P < .005) in all groups examined, even after controlling for other risk variables.

CONCLUSIONS

These data are compatible with the hypothesis that long-term control of hyperglycemia, as measured by glycosylated hemoglobin levels, is a significant risk factor for the long-term progression of diabetic retinopathy and that lower levels of glycosylated hemoglobin, even later in the course of diabetes, may modify the risk imposed by higher levels earlier in the course of disease in people with both younger- and older-onset diabetes.

Authors+Show Affiliations

Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison.No 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

7944837

Citation

Klein, R, et al. "Relationship of Hyperglycemia to the Long-term Incidence and Progression of Diabetic Retinopathy." Archives of Internal Medicine, vol. 154, no. 19, 1994, pp. 2169-78.
Klein R, Klein BE, Moss SE, et al. Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy. Arch Intern Med. 1994;154(19):2169-78.
Klein, R., Klein, B. E., Moss, S. E., & Cruickshanks, K. J. (1994). Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy. Archives of Internal Medicine, 154(19), pp. 2169-78.
Klein R, et al. Relationship of Hyperglycemia to the Long-term Incidence and Progression of Diabetic Retinopathy. Arch Intern Med. 1994 Oct 10;154(19):2169-78. PubMed PMID: 7944837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy. AU - Klein,R, AU - Klein,B E, AU - Moss,S E, AU - Cruickshanks,K J, PY - 1994/10/10/pubmed PY - 1994/10/10/medline PY - 1994/10/10/entrez SP - 2169 EP - 78 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 154 IS - 19 N2 - BACKGROUND: The object was to examine the relationship of hyperglycemia, as measured by glycosylated hemoglobin level, to the incidence and progression of diabetic retinopathy over a 10-year period. METHODS: Patients who were younger (n = 682) and older (n = 834) than 30 years at onset of diabetes participated in baseline (1980-1982) and follow-up (1984-1986 and 1990-1992) examinations of a population-based cohort study. Glycosylated hemoglobin levels were measured by microcolumn. Retinopathy was determined from stereoscopic fundus photographs. RESULTS: Persons with glycosylated hemoglobin levels in the highest quartile at baseline were more likely to have progression of retinopathy than persons with levels in the lowest quartile (younger-onset group: relative risk [RR], 2.9; 95% confidence interval [CI], 2.3 to 3.5; older-onset group taking insulin: RR, 2.1; 95% CI, 1.6 to 2.8; and older-onset group not taking insulin: RR, 4.3; 95% CI, 3.0 to 6.2) and were more likely to develop proliferative diabetic retinopathy (younger-onset group: RR, 7.1; 95% CI, 4.6 to 11.1; older-onset group taking insulin: RR, 3.1; 95% CI, 1.5 to 6.1; and older-onset group not taking insulin: RR, 13.8; 95% CI, 4.8 to 39.5). These relations were significant (P < .005) in all groups examined, even after controlling for other risk variables. CONCLUSIONS: These data are compatible with the hypothesis that long-term control of hyperglycemia, as measured by glycosylated hemoglobin levels, is a significant risk factor for the long-term progression of diabetic retinopathy and that lower levels of glycosylated hemoglobin, even later in the course of diabetes, may modify the risk imposed by higher levels earlier in the course of disease in people with both younger- and older-onset diabetes. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/7944837/Relationship_of_hyperglycemia_to_the_long_term_incidence_and_progression_of_diabetic_retinopathy_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/154/pg/2169 DB - PRIME DP - Unbound Medicine ER -