Risk of early-onset proliferative retinopathy in IDDM is closely related to cardiovascular autonomic neuropathy.
Determinants of proliferative diabetic retinopathy (PDR) that occur during the 2nd decade of insulin-dependent diabetes mellitus (IDDM) (early-onset PDR) were investigated in a nested case-control study. From an inception cohort of patients with juvenile-onset IDDM that now has 15-21 yr diabetes duration, the patients with PDR (cases, n = 74) were selected for study along with a random sample of the patients in the cohort without PDR (control subjects, n = 88). The risk of PDR was associated with poor glycemic control during the first 12 yr of diabetes. Relative to patients in the first quartile of the index of hyperglycemia, those in higher quartiles and nonattenders had a four- to fivefold risk of developing PDR. A striking relationship with cardiovascular autonomic neuropathy (CAN) was found. Relative to patients without CAN, patients with significant and mild CAN had odds ratios of 77.5 and 34.6, respectively. Patients with albumin excretion rates greater than 30 micrograms/min had moderately increased risk of PDR (ranging from 4-fold for microalbuminuria to 7-fold for proteinuria). In contrast, patients with impaired renal function had an extremely high risk of PDR. All 20 of these patients were cases, therefore the odds ratio was infinite. All three factors (poor glycemic control, CAN, and various stages of nephropathy) were associated with PDR in multiple logistic regression analysis. However, in models including glycemic control, the association between microalbuminuria or proteinuria and PDR was weakened. In conclusion, our findings are consistent with a hypothesis that the level of glycemia is a primary determinant of early-onset PDR.(ABSTRACT TRUNCATED AT 250 WORDS)
Krolewski
A S
AS
Epidemiology and Genetics Section, Joslin Diabetes Center, Boston, Massachusetts 02215.
Barzilay
J
J
Warram
J H
JH
Martin
B C
BC
Pfeifer
M
M
Rand
L I
LI
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D002319:Cardiovascular System / Q000294:innervation*; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003929:Diabetic Neuropathies / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D003930:Diabetic Retinopathy / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000453:epidemiology; D015994:Incidence; D008297:Male; D012044:Regression Analysis; D012307:Risk Factors