Diabetic control and progression of retinopathy in elderly patients: five-year follow-up study.
OBJECTIVE
To assess whether control of diabetes mellitus is as important in the elderly as in young and middle-aged diabetic patients in terms of progression of retinopathy.


METHODS
A 5-year longitudinal cohort study.


METHODS
Outpatient diabetic clinic.


METHODS
One hundred fourteen non-insulin-dependent diabetic patients (30 males, 84 females) > or = 60 years of age.


METHODS
Retinopathy was checked at the beginning and end of the follow-up period. During the 5-year follow-up period, demographic variables, body mass index, HbA1c, blood pressure, and plasma lipids were monitored. Retinopathy was classified as follows: grade 0, no lesion; grade 1, non-proliferative retinopathy; grade 2, pre-proliferative retinopathy; grade 3, proliferative retinopathy. Progression of retinopathy during the 5-year follow-up was defined as an increase in its grade.


RESULTS
At the start of the study, 13% of the patients already had retinopathy, all of grade 1. The 5-year follow-up study showed that progression of retinopathy was 23.6% in all cases, 22.2% in those with grade 0 initially, and 33.3% in those with grade 1 initially. The progression rates of retinopathy as a function of the mean HbA1c during the follow-up were as follows: lower than 7%, 2%; 7-8%, 20%; 8-9%, 40%; more than 9%, 61%. Multiple logistic regression analysis showed that, of the parameters examined, only HbA1c was a significant risk factor for progression of retinopathy.


CONCLUSIONS
Control of diabetes mellitus is the most important factor associated with prevention of progression of retinopathy in elderly patients.
Morisaki
N
N
Second Department of Internal Medicine, School of Medicine, Chiba University, Japan.
Watanabe
S
S
Kobayashi
J
J
Kanzaki
T
T
Takahashi
K
K
Yokote
K
K
Tezuka
M
M
Tashiro
J
J
Inadera
H
H
Saito
Y
Y
D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000097:blood / Q000503:physiopathology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis