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B. E. K. Klein, M. D. Knudtson, M. Y. Tsai, R. Klein; Markers of Inflammation and Endothelial Dysfunction and the Prevalence and Progression of Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4424.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the association of several systemic markers of inflammation and endothelial dysfunction to prevalence and incidence of diabetic retinal outcomes in persons with long duration type 1 diabetes (T1DM).
Examinations, ETDRS standard photography and blood specimens obtained in 1990-92 of a cohort of persons with T1DM (n=671) were analyzed. The cohort was evaluated 15 years later using the same protocols. Markers of inflammation and epithelial dysfunction were measured in serum frozen in 1990-92. Outcomes were severity of diabetic retinopathy (DR) and macular edema (ME).
The mean duration of diabetes was 23 years and 96% had DR and 22% had ME at the 1990-92 examination. 39% of persons had evidence of kidney disease (KD). In the entire group serum VCAM-1, TNF-, and homocysteine were associated with increased prevalence of more severe retinopathy (Odds ratio [OR] 4th vs 1st quartile, 2.43(1.56,3.78), 3.14(1.98,4.99), 3.79 (2.33,6.15), respectively). However, when dichotomizing by absence or presence of KD, these factors were only significant in those with KD. Only homocysteine was associated with increased prevalence of ME (OR 3.80(1.91,7.54)) in those with and without KD. None of the markers was associated with incidence of retinal outcomes 15 years later.
These findings are compatible with the notion that the inflammatory and endothelial dysfunction markers do not precede the retinal findings but are concomitants of microvascular complications of T1DM.
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