Retinal vascular lesions in patients of Caucasian and Asian origin with type 2 diabetes: baseline results from the ADVANCE Retinal Measurements (AdRem) study.
OBJECTIVE
The objective of this study was to describe prevalent vascular retinal lesions among patients with type 2 diabetes enrolled in the ADVANCE Retinal Measurements (AdRem) study, a substudy of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial.


METHODS
Seven-field stereoscopic photographs of both eyes were obtained at the baseline assessment of the ADVANCE trial. All photographs were graded in a central reading center. Gradable retinal images were received from 1,605 patients.


RESULTS
The number of patients with any retinopathy (Early Treatment of Diabetic Retinopathy Study [ETDRS] score > or = 20) was 645 (40.2% [95% CI 37.8-42.6]); of these, 35 (2.2% [1.6-3.0]) had severe diabetic retinopathy (ETDRS score > or = 50). Focal arterial narrowing, venous beading, and arteriovenous nicking were present in 3.8, 5.1, and 9.8% of participants, respectively. Among participants included in this study, Chinese and South-Asian patients had more retinopathy than Caucasians, as defined both by ETDRS score (49.4, 46.0, and 31.3%, respectively; P < 0.001, adjusted for age, sex, A1C, systolic blood pressure, and duration of diabetes) and specific vascular lesions (e.g., arteriovenous nicking 12.3, 8.5, and 7.5%, respectively; adjusted P < 0.005). A1C, duration of diabetes, and systolic blood pressure were similarly associated with increased retinal lesions in Chinese, South-Asian, and Caucasian patients.


CONCLUSIONS
Using a sensitive diagnostic procedure, more than one-third of patients with type 2 diabetes enrolled in the AdRem study had retinal lesions at baseline. Despite differences in prevalence and severity of retinopathy among Chinese, South-Asian, and Caucasian patients included in this study, the cross-sectional associations among established risk factors for retinopathy and retinal lesions were similar across ethnic groups.
Stolk
Ronald P
RP
Department of Epidemiology, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands. r.p.stolk@epi.umcg.nl
van Schooneveld
Mary J
MJ
Cruickshank
J Kennedy
JK
Hughes
Alun D
AD
Stanton
Alice
A
Lu
Juming
J
Patel
Anushka
A
Thom
Simon A McG
SA
Grobbee
Diederick E
DE
Vingerling
Johannes R
JR
D000328:Adult; D000368:Aged; D001208:Asia / Q000208:ethnology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D003930:Diabetic Retinopathy / Q000453:epidemiology*; D005006:Ethnicity; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010781:Photography; D015995:Prevalence; D012160:Retina / Q000033:anatomy & histology; D012164:Retinal Diseases / Q000453:epidemiology*; D012171:Retinal Vessels / Q000503:physiopathology; D044465:White People / Q000706:statistics & numerical data*
D006442:Glycated Hemoglobin