Development of proliferative diabetic retinopathy in African-Americans and whites with type 1 diabetes.
OBJECTIVE
To investigate the comparable risk of developing proliferative diabetic retinopathy (PDR) in African-Americans and whites with type 1 diabetes.


METHODS
Using a cohort design with the sample drawn from medical records, the sample consisted of 312 people with type 1 diabetes (97 African-Americans, 215 whites) having at least two visits to a Model Demonstration Unit with gradeable fundus photographs (stereo, color, 7 standard fields). Excluded were subjects with preexisting or treated PDR or hemoglobinopathy. Masked grading of the fundus photographs was conducted at the Wisconsin Reading Center.


RESULTS
At baseline, African-Americans had poorer glycemic control (mean HbA1 of 11.3 vs. 10.0%, P < 0.0001), higher systolic blood pressure (mean of 117 vs. 110 mmHg, P < 0.001), and were older (mean of 26.8 vs. 19.3 years, P < 0.0001) than the white subjects. African-Americans also tended to have slightly longer duration of diabetes and length of follow-up. In the African-Americans, 17.5% developed PDR, compared with 10.2% in the 215 whites, for an odds ratio (OR) of 1.86 (95% CI 0.93-3.70). When adjusted for baseline glycemic control, retinopathy grade, and length of follow-up, race was not a significant risk factor (OR = 0.73, 95% CI 0.30-1.78).


CONCLUSIONS
African-Americans with type 1 diabetes may have a higher rate of developing PDR. The observed racial difference, however, is attributable to the presence of a worse risk factor profile, especially to poorer glycemic control. Efforts should be expanded to improve the care for all individuals with poor glycemic control.
Arfken
C L
CL
Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA. carfken@med.wayne.edu
Reno
P L
PL
Santiago
J V
JV
Klein
R
R
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044383:Black People; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000208:ethnology*; D003930:Diabetic Retinopathy / Q000208:ethnology* / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D013599:Systole; D044465:White People; D001741:Black or African American
D001786:Blood Glucose; D003404:Creatinine