title: Retinopathy and microalbuminuria in type 2 diabetes: determinants and time-dependency of the association.
abstract: Background: The aim of this study was to identify the independent determinants of diabetic retinopathy (RET) and microalbuminuria (MA) and to assess the time-dependency of the association of RET with MA. Methods: In 668 out-patients with type 2 diabetes, RET was assessed by stereoscopic fundoscopy and by measuring the level of MA in untimed, triplicate urine collections on at least two and four separate visits, respectively, during a period of at least 24 months. RET was defined as RET of any type and MA as a urinary albumin-to-creatinine ratio (ACR) between 2 and 30 mg/mmol. Multiple logistic regression analysis was used to determine odds ratios (OR) and 95% confidence intervals (CI). The extent of the association (OR(assoc)) was estimated by the odds that a patient with RET has MA divided by the odds that a patient without RET has MA. Results: Common determinants of RET and MA were: systolic BP, HbA(1c), and triglycerides. Age, non-Caucasian ethnicity, and RET were associated with MA, whereas duration of diabetes and ACR were associated with RET. We estimated an overall OR(assoc) of 2.36 (95% CI, 1.72-3.24). The time-dependency of OR(assoc) showed a hyperbolically shaped curve, reaching a maximum value of 2.5 at 9.8 years after the diagnosis of type 2 diabetes. Conclusions: Our study, which supports what is currently known about independent determinants of diabetic RET and MA, suggests a drastic increase in clustering of RET and MA over the first 5 years before the diagnosis of type 2 diabetes.
authors.affiliation: Department of Clinical Chemistry and Haematology, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
authors.forename: R N.M.
authors.initials: RN
authors.lastname: Weijers
authors.forename: G G.
authors.initials: GG
authors.lastname: van Merode