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Interval Between Onset of Mild Nonproliferative and Proliferative Retinopathy in Type I Diabetes

Interval Between Onset of Mild Nonproliferative and Proliferative Retinopathy in Type I Diabetes Abstract Objective: To describe the interval between first appearance of mild nonproliferative diabetic retinopathy (NPDR) and first appearance of neovascularization (NV) in type I diabetes. Setting: A longitudinal study of 269 patients followed up annually. Participants: Participants had insulin-dependent diabetes and were free of proliferative diabetic retinopathy in both eyes at the baseline visit. Main Outcome Measure: Stereoscopic color fundus photographs of each eye at each study visit, graded for features of retinopathy. Results: Among the 305 eyes for which the duration of diabetes at the first appearance of mild NPDR could be determined, NV developed in 28 by the end of the study. Survival analysis showed that the later the onset of mild NPDR was, the shorter the time from onset of mild NPDR to onset of NV (relative hazard for each additional year to onset of mild NPDR, 1.22; 95% confidence interval, 1.10-1.35). Adjustment for systolic and diastolic blood pressure, proteinuria, and glycosylated hemoglobin (Hgb A1c) levels did not change the relative hazard estimate for onset of mild NPDR. Higher levels of Hgb A1c were associated with a shorter time from onset of mild NPDR to onset of NV (relative hazard, 1.26; 95% confidence interval, 1.05-1.51 [after adjusting for time at onset of mild NPDR]), as were higher levels of diastolic blood pressure, although not significantly (relative hazard for 10-mm Hg increase in diastolic blood pressure, 1.52; 95% confidence interval, 0.82-2.83 [adjusting for onset of mild NPDR, Hgb A1c level, systolic blood pressure, and proteinuria]). Neither proteinuria nor systolic blood pressure had an effect on time from onset of mild NPDR to onset of NV, after adjustment for time at onset of mild NPDR, Hgb A1c level, and diastolic blood pressure. Conclusion: Later onset of mild NPDR is not necessarily associated with delayed development of NV in patients with type I diabetes. Caution must therefore be used in assessing the value of interventions that delay the onset of mild NPDR without evidence of delayed onset of NV. References 1. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, II: prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years . Arch Ophthalmol . 1984;102:520-526.Crossref 2. Palmberg P, Smith M, Waltman S, et al. The natural history of retinopathy in insulin-dependent juvenile-onset diabetes . Ophthalmology . 1981;88:613-618.Crossref 3. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, IX: four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years . Arch Ophthalmol . 1989;107:237-243.Crossref 4. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy . JAMA . 1988;260:2864-2871.Crossref 5. Krolewski AS, Warram JH, Rand LI, Christlieb AR, Busick EJ, Kahn CR. Risk of proliferative diabetic retinopathy in juvenile-onset type I diabetes: a 40-year follow-up study . Diabetes Care . 1986;9:443-452.Crossref 6. Rand LI, Krolewski AS, Aiello LM, Warram JH, Baker RS, Maki T. Multiple factors in the prediction of risk of proliferative diabetic retinopathy . N Engl J Med . 1985;313:1433-1438.Crossref 7. Janka HU, Warram JH, Rand LI, Krolewski AJ. Risk factors for progression of background retinopathy in long-standing IDDM . Diabetes . 1989;38:460-464.Crossref 8. Marshall G, Garg SK, Jackson WE, Holmes DL, Chase HP. Factors influencing the onset and progression of diabetic retinopathy in subjects with insulin-dependent diabetes mellitus . Ophthalmology . 1993;100:1133-1139.Crossref 9. Goldstein DE, Blinder KJ, Ide CH, et al. Glycemic control and development of retinopathy in youth-onset insulin-dependent diabetes mellitus: results of a 12-year longitudinal study . Ophthalmology . 1993;100:1125-1132.Crossref 10. Sorbinil Retinopathy Trial Research Group. A randomized trial of sorbinil, an aldose reductase inhibitor, in diabetic retinopathy . Arch Ophthalmol . 1990;108:1234-1244.Crossref 11. The TIMAD Study Group. Ticlopidine treatment reduces the progression of non-proliferative diabetic retinopathy . Arch Ophthalmol . 1990;108:1577-1583.Crossref 12. Arauz-Pacheco C, Ramirez LC, Pruneda L, Sanborn GE, Rosenstock J, Raskin P. The effect of the aldose reductase inhibitor, ponalrestat, on the progression of diabetic retinopathy . J Diabetes Complications . 1992;6:131-137.Crossref 13. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus . N Engl J Med . 1993;329:977-986.Crossref 14. Kohner EM. Diabetic retinopathy . Br Med Bull . 1989;45:148-173. 15. Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981:217-225. 16. Cox DR. Regression models and life-tables (with discussion) . J R Stat Soc B . 1972;34:187-220. 17. Therneau T. A Package for Survival Analysis in S. Rochester, Minn: Section of Biostatistics, Mayo Clinic; 1994. Technical Report 53. 18. Murphy RP, Nanda M, Plotnick L, Enger C, Vitale S, Patz A. The relationship of puberty to diabetic retinopathy . Arch Ophthalmol . 1990;108:215-218.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Interval Between Onset of Mild Nonproliferative and Proliferative Retinopathy in Type I Diabetes

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100150196009
Publisher site
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Abstract

Abstract Objective: To describe the interval between first appearance of mild nonproliferative diabetic retinopathy (NPDR) and first appearance of neovascularization (NV) in type I diabetes. Setting: A longitudinal study of 269 patients followed up annually. Participants: Participants had insulin-dependent diabetes and were free of proliferative diabetic retinopathy in both eyes at the baseline visit. Main Outcome Measure: Stereoscopic color fundus photographs of each eye at each study visit, graded for features of retinopathy. Results: Among the 305 eyes for which the duration of diabetes at the first appearance of mild NPDR could be determined, NV developed in 28 by the end of the study. Survival analysis showed that the later the onset of mild NPDR was, the shorter the time from onset of mild NPDR to onset of NV (relative hazard for each additional year to onset of mild NPDR, 1.22; 95% confidence interval, 1.10-1.35). Adjustment for systolic and diastolic blood pressure, proteinuria, and glycosylated hemoglobin (Hgb A1c) levels did not change the relative hazard estimate for onset of mild NPDR. Higher levels of Hgb A1c were associated with a shorter time from onset of mild NPDR to onset of NV (relative hazard, 1.26; 95% confidence interval, 1.05-1.51 [after adjusting for time at onset of mild NPDR]), as were higher levels of diastolic blood pressure, although not significantly (relative hazard for 10-mm Hg increase in diastolic blood pressure, 1.52; 95% confidence interval, 0.82-2.83 [adjusting for onset of mild NPDR, Hgb A1c level, systolic blood pressure, and proteinuria]). Neither proteinuria nor systolic blood pressure had an effect on time from onset of mild NPDR to onset of NV, after adjustment for time at onset of mild NPDR, Hgb A1c level, and diastolic blood pressure. Conclusion: Later onset of mild NPDR is not necessarily associated with delayed development of NV in patients with type I diabetes. Caution must therefore be used in assessing the value of interventions that delay the onset of mild NPDR without evidence of delayed onset of NV. References 1. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, II: prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years . Arch Ophthalmol . 1984;102:520-526.Crossref 2. Palmberg P, Smith M, Waltman S, et al. The natural history of retinopathy in insulin-dependent juvenile-onset diabetes . Ophthalmology . 1981;88:613-618.Crossref 3. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, IX: four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years . Arch Ophthalmol . 1989;107:237-243.Crossref 4. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy . JAMA . 1988;260:2864-2871.Crossref 5. Krolewski AS, Warram JH, Rand LI, Christlieb AR, Busick EJ, Kahn CR. Risk of proliferative diabetic retinopathy in juvenile-onset type I diabetes: a 40-year follow-up study . Diabetes Care . 1986;9:443-452.Crossref 6. Rand LI, Krolewski AS, Aiello LM, Warram JH, Baker RS, Maki T. Multiple factors in the prediction of risk of proliferative diabetic retinopathy . N Engl J Med . 1985;313:1433-1438.Crossref 7. Janka HU, Warram JH, Rand LI, Krolewski AJ. Risk factors for progression of background retinopathy in long-standing IDDM . Diabetes . 1989;38:460-464.Crossref 8. Marshall G, Garg SK, Jackson WE, Holmes DL, Chase HP. Factors influencing the onset and progression of diabetic retinopathy in subjects with insulin-dependent diabetes mellitus . Ophthalmology . 1993;100:1133-1139.Crossref 9. Goldstein DE, Blinder KJ, Ide CH, et al. Glycemic control and development of retinopathy in youth-onset insulin-dependent diabetes mellitus: results of a 12-year longitudinal study . Ophthalmology . 1993;100:1125-1132.Crossref 10. Sorbinil Retinopathy Trial Research Group. A randomized trial of sorbinil, an aldose reductase inhibitor, in diabetic retinopathy . Arch Ophthalmol . 1990;108:1234-1244.Crossref 11. The TIMAD Study Group. Ticlopidine treatment reduces the progression of non-proliferative diabetic retinopathy . Arch Ophthalmol . 1990;108:1577-1583.Crossref 12. Arauz-Pacheco C, Ramirez LC, Pruneda L, Sanborn GE, Rosenstock J, Raskin P. The effect of the aldose reductase inhibitor, ponalrestat, on the progression of diabetic retinopathy . J Diabetes Complications . 1992;6:131-137.Crossref 13. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus . N Engl J Med . 1993;329:977-986.Crossref 14. Kohner EM. Diabetic retinopathy . Br Med Bull . 1989;45:148-173. 15. Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981:217-225. 16. Cox DR. Regression models and life-tables (with discussion) . J R Stat Soc B . 1972;34:187-220. 17. Therneau T. A Package for Survival Analysis in S. Rochester, Minn: Section of Biostatistics, Mayo Clinic; 1994. Technical Report 53. 18. Murphy RP, Nanda M, Plotnick L, Enger C, Vitale S, Patz A. The relationship of puberty to diabetic retinopathy . Arch Ophthalmol . 1990;108:215-218.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Feb 1, 1997

References