title: Retinopathy predicts progression of fasting plasma glucose: An Early Diabetes Intervention Program (EDIP) analysis.
abstract: BACKGROUND
  Retinopathy is increasingly recognized in prediabetic populations, and may herald increased risk of metabolic worsening. The Early Diabetes Intervention Program (EDIP) evaluated worsening of glycemia in screen-detected Type 2 diabetes, following participants for up to 5years. Here we have evaluated whether the presence of retinopathy at the time of detection of diabetes was associated with accelerated progression of glycemia.
  
  
  METHODS
  We prospectively studied 194 participants from EDIP with available baseline retinal photographs. Retinopathy was determined at baseline using 7-field fundus photography and defined as an Early Treatment of Diabetic Retinopathy Study Scale grading score of ≥20.
  
  
  RESULTS
  At baseline, 12% of participants had classical retinal lesions indicating retinopathy. In univariate Cox proportional hazard analysis, the presence of retinopathy at baseline was associated with a doubled risk of progression of fasting plasma glucose (HR 2.02; 95% CI 1.05-3.89). The retinopathy effect was robust to individual adjustment for age and glucose, the most potent determinants of progression in EDIP.
  
  
  CONCLUSIONS
  Retinopathy was associated with increased risk of progression of fasting plasma glucose among adults with screen-detected, early diabetes. Early detection of retinopathy may help individualize more aggressive therapy to prevent progressive metabolic worsening in early diabetes.
authors.affiliation: Department of medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Yash R
authors.initials: YR
authors.lastname: Patel
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA; University of North Carolina, Chapel Hill, NC.
authors.forename: M Sue
authors.initials: MS
authors.lastname: Kirkman
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Robert V
authors.initials: RV
authors.lastname: Considine
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Tamara S
authors.initials: TS
authors.lastname: Hannon
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: kmather@iu.edu.
authors.forename: Kieren J
authors.initials: KJ
authors.lastname: Mather
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D003930:Diabetic Retinopathy / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D018450:Disease Progression; D018572:Disease-Free Survival; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012160:Retina / Q000000981:diagnostic imaging*; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
keywords: Diabetes; Early diabetes; Microvascular disease; Prediction; Retinopathy