title: Hemoglobin A1c and fasting plasma glucose levels as predictors of retinopathy at 10 years: the French DESIR study.
abstract: OBJECTIVE
  To evaluate the predictive values of hemoglobin A(1c) (HbA(1c)) and fasting plasma glucose (FPG) for retinopathy 10 years after the baseline examination.
  
  
  METHODS
  Seven hundred men and women from the DESIR (Data From an Epidemiological Study on the Insulin Resistance Syndrome) Study underwent evaluation for retinopathy using a nonmydriatic digital camera. During the preceding 9 years, 235 had diabetes mellitus (treated or FPG level of ≥126 mg/dL at least once), 227 had an impaired FPG level (110-125 mg/dL) at least once, and 238 always had glucose levels within reference limits (<110 mg/dL).
  
  
  RESULTS
  Compared with those without retinopathy, the 44 participants with retinopathy at 10 years had higher baseline mean (SD) levels of FPG (130 [49] vs 106 [22] mg/dL) and HbA(1c) (6.4% [1.6%] vs 5.7% [0.7%]) (both, P < .001). The frequency of retinopathy at 10 years, standardized according to the distribution of glycemia across the entire DESIR population, was 3.6%. In our population, FPG levels of 108 and 116 mg/dL had positive predictive values of 8.4% and 14.0%, respectively, for retinopathy at 10 years; HbA(1c) levels of 6.0% and 6.5% had positive predictive values of 6.0% and 14.8%, respectively. After 10 years of follow-up, retinopathy was equally frequent in participants with impaired FPG levels and in those who became diabetic during the study (8.6% and 6.7%, respectively), lower than in those with diabetes at baseline (13.9%).
  
  
  CONCLUSIONS
  Because the positive predictive values for retinopathy increase sharply from 108 mg/dL for FPG and from 6.0% for HbA(1c) levels, these thresholds are proposed to identify those at risk of retinopathy 10 years later.
authors.affiliation: Ophthalmology Department, Assistance Publique Hôpitaux de Paris, Hôpital Lariboisière, Paris, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Massin
authors.forename: Céline
authors.initials: C
authors.lastname: Lange
authors.forename: Jean
authors.initials: J
authors.lastname: Tichet
authors.forename: Sylviane
authors.initials: S
authors.lastname: Vol
authors.forename: Ali
authors.initials: A
authors.lastname: Erginay
authors.forename: Martine
authors.initials: M
authors.lastname: Cailleau
authors.forename: Eveline
authors.initials: E
authors.lastname: Eschwège
authors.forename: Beverley
authors.initials: B
authors.lastname: Balkau
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D003930:Diabetic Retinopathy / Q000097:blood* / Q000175:diagnosis*; D005189:False Positive Reactions; D005215:Fasting / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000175:diagnosis; D011237:Predictive Value of Tests; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human