TOPLINE:
A longer duration of diabetes, systemic disease, and use of drugs to reduce blood pressure appear to increase the risk for incident diabetic retinopathy (DR) and its progression to proliferative DR in patients with type 1 diabetes.
METHODOLOGY:
- Researchers assessed the prevalence and 5-year risk for incident DR along with the associated risk markers in a patient population with type 1 diabetes.
- They evaluated 16,999 patients with type 1 diabetes (median age, 45 years; 57.5% men) from the Danish Registry of Diabetic Retinopathy, who attended a national screening between 2013 and 2018 and had diabetes for an average duration of 16.7 years.
- The degree of DR in the worse eye during the first screening was used to grade its severity from 0 (no retinopathy), 1-3 (mild, moderate, and severe non-proliferative retinopathy), and 4 (proliferative retinopathy present or previously treated with panretinal laser therapy).
TAKEAWAY:
- At the time of the first screening, 44.2% patients reported DR, with 26.9%, 6.7%, 1.3%, and 9.3% reporting levels 1, 2, 3, and 4, respectively.
- The 5-year cumulative incidence of any retinopathy and its progression to proliferative disease were 8.9% and 2%, respectively.
- The likelihood of retinopathy was higher in younger people, those who had had diabetes longer, patients with a Charlson Comorbidity Index above 0, men, and users of drugs to control blood pressure and cholesterol (odds ratio, > 1.10 for all).
- Those risk factors, with the exception of younger age, male sex, and use of cholesterol-lowering medications, also were associated with progression to proliferative DR (hazard ratio, > 1.10 for all).
IN PRACTICE:
"We have identified duration of diabetes, systemic comorbidity, and use of blood pressure–lowering therapy as common risk factors of all endpoints," the authors wrote.
SOURCE:
Lonny Stokholm, PhD, from Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark, led the study, which was published online on May 18, 2024, in Acta Ophthalmologica.
LIMITATIONS:
The authors did not have access to blood glucose, blood pressure, or lipid measurements. Diabetic macular edema could not be chosen as an endpoint because it has not been validated in the Danish national registers. Moreover, self-selection bias may have occurred in this study, as attending the screening program was optional.
DISCLOSURES:
This study was funded by Velux Fonden. No disclosures were reported by the authors.