title: Progression and regression: distinct developmental patterns of diabetic retinopathy in patients with type 2 diabetes treated in the diabetes care system west-friesland, the Netherlands.
abstract: OBJECTIVE
  To identify distinct developmental patterns of diabetic retinopathy (DR) and assess the risk factor levels of patients in these clusters.
  
  
  METHODS
  A cohort of 3,343 patients with type 2 diabetes mellitus (T2DM) monitored and treated in the Diabetes Care System West-Friesland, the Netherlands, was followed from 2 to 6 years. Risk factors were measured, and two-field fundus photographs were taken annually and graded according to the EURODIAB study group. Latent class growth modeling was used to identify distinct developmental patterns of DR over time.
  
  
  RESULTS
  Five clusters of patients with distinct developmental patterns of DR were identified: A, patients without any signs of DR (88.9%); B, patients with a slow regression from minimal background to no DR (4.9%); C, patients with a slow progression from minimal background to moderate nonproliferative DR (4.0%); D, patients with a fast progression from minimal or moderate nonproliferative to (pre)proliferative or treated DR (1.4%); and E, patients with persistent proliferative DR (0.8%). Patients in clusters A and B were characterized by lower risk factor levels, such as diabetes duration, HbA(1c), and systolic blood pressure compared with patients in progressive clusters (C-E).
  
  
  CONCLUSIONS
  Clusters of patients with T2DM with markedly different patterns of DR development were identified, including a cluster with regression of DR. These clusters enable a more detailed examination of the influence of various risk factors on DR.
authors: Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands. h.zavrelova@vumc.nl
authors: Hata
authors: H
authors: Zavrelova
authors: Trynke
authors: T
authors: Hoekstra
authors: Marjan
authors: M
authors: Alssema
authors: Laura M C
authors: LM
authors: Welschen
authors: Giel
authors: G
authors: Nijpels
authors: Annette C
authors: AC
authors: Moll
authors: Henrica C W
authors: HC
authors: de Vet
authors: Bettine C P
authors: BC
authors: Polak
authors: Jacqueline M
authors: JM
authors: Dekker
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin