The incidence of retinopathy 10 years after diagnosis in young adult people with diabetes: results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS).
OBJECTIVE
To estimate the prevalence and severity of diabetic retinopathy (DR) 10 years after diagnosis in a nationwide population-based cohort study of young adult diabetic patients in Sweden.


METHODS
The Diabetes Incidence Study in Sweden (DISS) aims to register all incident cases of diabetes aged 15-34 years in Sweden. In 1987-1988, 806 cases were reported, and 627 (78%) of them were followed up with regard to retinopathy 8-10 years later. The assessment was based on retinal photographs in most cases (86%).


RESULTS
Ten years after diagnosis, retinopathy was found in 247 patients (39%). The retinopathy was mild in 206 (33%), whereas 30 (4.8%) patients had moderate nonproliferative DR (NPDR) and 11 (1.8%) had proliferative DR (PDR). Patients with retinopathy had worse glycemic control during the years than patients without (HbA(1c) 8.1 +/- 1.5% and 6.8 +/- 1.2%, respectively; P < 0.001). In a Cox regression analysis, time to retinopathy was related to high HbA(1c) (P < 0.001) and high BMI (P = 0.001). Patients with type 2 diabetes had an increased prevalence of severe retinopathy (NPDR or PDR) compared with those with type 1 diabetes (14 of 93 [15%] versus no or mild 24 of 471 [5%], respectively; P < 0.001).


CONCLUSIONS
Despite modern diabetes management, 39% of young adult diabetic patients developed retinopathy within the first 10 years of the disease. Nevertheless, compared with the prevalence of retinopathy (63%), after a similar duration of diabetes before the Diabetes Control and Complications Trial, this prevalence was clearly lower. Current treatment aimed to achieve strict glycemic control has reduced the risk for developing retinopathy.
Henricsson
Marianne
M
Department of Ophthalmology, Helsingborg Hospital, Sweden. m.henricsson@telia.com
Nyström
Lennarth
L
Blohmé
Göran
G
Ostman
Jan
J
Kullberg
Carin
C
Svensson
Maria
M
Schölin
Anna
A
Arnqvist
Hans J
HJ
Björk
Elisabeth
E
Bolinder
Jan
J
Eriksson
Jan W
JW
Sundkvist
Göran
G
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015994:Incidence; D015995:Prevalence; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
D006442:Glycated Hemoglobin