Risk factors for retinopathy in type 1 diabetes
Year: 2013
Type: dissertation
Abstract: Background Diabetic retinopathy is the leading cause of acquired visual disability among people of working age in all industrialised countries. Established risk factors for diabetic retinopathy include the duration of diabetes, glycaemic control, blood pressure and dyslipidaemia. However, these risk factors explain less than half of the risk for diabetic retinopathy. It is, thus, obvious that a large proportion of the risk remains to be explored. Aim The aim of the present study was to investigate potential risk factors that could affect the development of severe forms of retinopathy in type 1 diabetes. Patients and Methods The study patients were drawn from the large FinnDiane (Finnish Diabetic Nephropathy study) database. The FinnDiane study is an observational cohort study which since 1997 has collected comprehensive data on patients with type 1 diabetes at 92 centers throughout Finland with the aim of identifying genetic and environmental risk factors for diabetic complications. The patients retinopathy status were verified from ophthalmic and medical files and fundus photographs when available and graded with the ETDRS-scale. All patients underwent a thorough clinical characterisation of their clinical diabetes status by the attending physician at the participating study centers. Results Proliferative diabetic retinopathy showed significant familial clustering in siblings with type 1 diabetes and the heritability h2 adjusted for conventional risk factors suggested a significant genetic contribution to the risk. The siblings first affected by type 1 diabetes had a lower risk of proliferative retinopathy as compared to the siblings later affected by type 1 diabetes. The risk of both proliferative retinopathy and clinically significant macular edema were modified by the patient s age at onset of type 1 diabetes. The patients with higher age at onset of type 1 diabetes had a lower risk of proliferative retinopathy but conversely, a higher risk of clinically significant macular edema. The HbA1c variability was lower in those patients with higher age at onset of type 1 diabetes and the patients with lower HbA1c variability had a lower cumulative incidence and risk of laser treatment and proliferative retinopathy. Conclusion In addition to the conventional risk factors, such as diabetes duration, glycaemic control and blood pressure, familial factors, age at onset of type 1 diabetes and glycaemic profile may explain a significant proportion of the risk of severe forms of diabetic retinopathy.
Source: Työväentutkimus Vuosikirja
Author: Kustaa Hietala
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1531802905