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Ulrik Frydkjaer-Olsen, Rebecca Broe, Malin Lundberg Rasmussen, Tunde Peto, Jakob Grauslund; Smaller Retinal Arterioles and Wider Retinal Venules Predict 16-Year Microvascular Complications in Type 1 Diabetes Mellitus. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5328.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the predictive value of retinal vascular calibers on microvascular complications in a 16-year prospective study of a young Danish population based cohort with type 1 diabetes mellitus.
Participants were identified from a population-based cohort of children with type 1 diabetes; the Danish Cohort of Pediatric Diabetes 1987. In 1995, 339 were included in a baseline examination. In 2011, 185 (54.6%) were re-examined where presence of peripheral neuropathy (vibration perception threshold>25Volt), nephropathy (albumin/creatinine ratio≥300mg/g) and proliferative retinopathy (Early Treatment Diabetic Retinopathy Study level>53) was assessed. On disc centered baseline retinal photos of the right eye, diameters of all vessels coursing completely through a zone 0.5-1 disc diameter from the disc margin were measured with image analysis software (IVAN). Calibers of the central retinal artery and vein were estimated by the ‘Big-6 formula’ and summarized as the central artery and vein equivalents (CRAE and CRVE). Multiple logistic regression analyzes were used to evaluate CRAE and CRVE as predictors of microvascular complications. All models were adjusted for baseline sex, age, diabetes duration, HbA1c, blood pressure, BMI, vibration perception threshold, mean albumin excretion rate and level of retinopathy.
Mean age and diabetes duration at baseline of the 185 participants were 21.0 and 13.5 years, respectively, and 49.7% were males. In 16 years, 10.5% developed peripheral neuropathy, 7.8% developed nephropathy and 27.2% progressed to proliferative diabetic retinopathy. Multiple regression models found each 10µm decrease in baseline CRAE to predict incident neuropathy (OR 2.96, 95%CI 1.37-6.39), nephropathy (OR 3.45, 95%CI 1.19-10.0) and proliferative diabetic retinopathy (OR 1.54, 95%CI 1.06-2.25). Similar each 10µm increase in baseline CRVE was also predictive of incident neuropathy (OR 1.53, 95%CI 1.01-2.33), nephropathy (OR 2.09, 95%CI 1.10-3.99) and proliferative diabetic retinopathy (OR 1.35, 95%CI 1.05-1.73).
Smaller retinal arterioles and wider retinal venules predict long-term microvascular complications in type 1 diabetes. This indicates that diabetic microvascular complications share a common pathogenic pathway and might help to identify patients at risk at an early stage.
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