title: Risk factors for progression of diabetic retinopathy in Alberta First Nations communities.
abstract: OBJECTIVE
  The Screening for Limb, I-Eye, Cardiovascular, and Kidney Complications (SLICK) Program was implemented in 1999 to improve diabetic care for Alberta First Nations individuals living on reserve. The purpose of this review is to determine the rate and predictors of progression of diabetic retinopathy (DR) over a 10-year period.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Nine hundred and eighty First Nations patients with diabetes that underwent at least 2 teleophthalmology examinations during the study period.
  
  
  METHODS
  Patients underwent serial laboratory testing, and stereoscopic, mydriatic, retinal photography. Modified Early Treatment Diabetic Retinopathy Study grading of retinal images was performed via teleophthalmology. Progression was defined as an increase of 2 or more steps on the Diabetes Control and Complications Trial classification.
  
  
  RESULTS
  At baseline, most patients had no diabetic retinopathy (n = 777, 79.3%) whereas 203 people (20.7%) had either nonproliferative DR (n = 179, 18.3%) or proliferative DR (n = 24, 2.5%). Two-step progression occurred in 163 patients (16.6%), with only a minority of these individuals progressing to proliferative DR (n = 23). The median time to progression was 7.6 years. Multivariate Cox regression demonstrated that elevated hemoglobin A1C (hazard ratio [HR] = 1.42; p < 0.0001) and systolic blood pressure (HR = 1.24 per 10 mm Hg; p = 0.009) were independent predictors of progression of DR.
  
  
  CONCLUSIONS
  This population-based study has shown that the rate and predictors of progression of DR among First Nations individuals parallels non-First Nations populations, with HbA1C and systolic blood pressure being the strongest predictors. These findings suggest that targeted, individualized care to reduce blood pressure and control blood sugars could reduce progression of diabetic retinopathy, and possibly blindness in First Nations individuals living on reserve.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Dentistry, University of Alberta, Edmonton, Alta. crudnisk@ualberta.ca
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Rudnisky
authors.forename: Beatrice K
authors.initials: BK
authors.lastname: Wong
authors.forename: Hakique
authors.initials: H
authors.lastname: Virani
authors.forename: Matthew T S
authors.initials: MT
authors.lastname: Tennant
mesh_terms: D000416:Alberta / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015331:Cohort Studies; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007198:Indians, North American / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017216:Telemedicine
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human