title: Diabetic retinopathy in Oklahoma Indians with NIDDM. Incidence and risk factors.
abstract: OBJECTIVE
  To determine the incidence rates and risk factors for development of diabetic retinopathy in Oklahoma Indians.
  
  
  METHODS
  Cohort follow-up study with baseline examination between 1972 and 1980 and follow-up examination between 1987 and 1991. Mean +/- SD follow-up time was 12.8 +/- 1.7 yr. Eleven Indian Health Service facilities (clinics and hospitals) in Oklahoma participated in the study. Study participants were a quasirandom sample of 1012 American Indians (379 men, 633 women) in Oklahoma with NIDDM, 927 of whom received a detailed eye examination at baseline. The mean age of participants was 52 yr with a duration of diabetes of 6.9 yr at baseline. The average quantum of Indian blood was 92% (77% full blood). At follow-up, 515 (55.6%) were alive, 408 (44.0%) were deceased, and 4 (0.4%) could not be traced. Of the living participants, 380 (73.8%) underwent an ophthalmoscopic examination.
  
  
  RESULTS
  The incidence of retinopathy among the participants who were free of disease at baseline and who survived the follow-up interval was 72.3%. By multivariate analysis, significant independent predictors of retinopathy recorded at baseline were FPG level, therapeutic regimen, systolic blood pressure, and duration of diabetes. FPG levels > or = 11.1 mM (200 mg/dl) increased the risk of retinopathy 1.7 times that for levels < 7.8 mM (140 mg/dl). Insulin use was associated with a 20% greater incidence. Hypertension was a particularly significant risk factor for those with lower FPG levels.
  
  
  CONCLUSIONS
  Given that NIDDM is reaching epidemic proportions in Oklahoma Indians and that most may be afflicted with retinopathy, frequent ophthalmological examinations are clearly indicated for this high-risk population. The role of intervention, namely glycemic and hypertensive control, deserves further study.
authors: Center for Epidemiologic Research, University of Oklahoma Health Sciences Center, Oklahoma City 73190.
authors: E T
authors: ET
authors: Lee
authors: V S
authors: VS
authors: Lee
authors: R M
authors: RM
authors: Kingsley
authors: M
authors: M
authors: Lu
authors: D
authors: D
authors: Russell
authors: N R
authors: NR
authors: Asal
authors: C P
authors: CP
authors: Wilkinson
authors: R H
authors: RH
authors: Bradford
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D009825:Oklahoma / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D014280:Triglycerides; D002784:Cholesterol