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Ecosse L. Lamoureux, Jing Xie, Eva Fenwick, Gwyn Rees, Rehab Benarous, Mohamed Dirani, Tien Y. Wong; The Relationship of Poor Diabetes Control on Diabetic Retinopathy and other Complications: The Diabetes Management Project. Invest. Ophthalmol. Vis. Sci. 2011;52(14):598.
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Hyperglycemia and hypertension are established risk factors for diabetic retinopathy (DR) and the concomitant diabetic complications are related to DR. However, it remains unclear how important diabetes control is in the presence of concomitant diabetes complications on the risk of DR in clinical settings.
Patients were prospectively recruited from specialised eye clinics in Melbourne (Australia) at baseline. Each underwent a comprehensive eye examination and blood samples were collected for fasting blood glucose and serum lipids. Fundus photographs were obtained and DR severity was assessed using the modified Airlie House classification system. Other self reported diabetes complications were obtained. Poor diabetes control (PDC) was defined as HbA1c ≥7% and systolic blood pressure ≥140mmHg.
497 patients (66% males and median age=65.0yr) participated. The estimated prevalence of PDC was 35.6% (95% confidence interval [CI]: 31.4%-40.0%). The estimated prevalence of any DR, non-proliferative DR and proliferative DR were 65.5% (95% CI: 60.9% - 69.5%), 38.0% (95% CI: 33.7% - 42.5%), and 27.2% (95% CI: 23.3% - 31.4%), respectively. PDC was associated with significantly higher prevalence of DR than those with good control (74.7% vs. 59.7, p<0.05). Those with any diabetic complication were more likely to have DR than those without (73.7% vs. 35.2%, p<0.001). In multivariate models, persons with PDC (Odds Ratio [OR]: 2.10, 95% confidence interval [CI]: 1.16, 3.79) and any diabetic complications (OR: 3.73, 95% CI: 1.85, 7.51) were independently associated with DR. Patients with PDC and any complication were seven times (OR: 7.67, 95% CI: 3.14, 18.72) more likely to have any DR than people with good control and no diabetic complication.
Poor diabetes management, coupled with diabetes complications, is associated with a significant higher probability of DR. Improving diabetes control, particularly when other complications are present, will likely have a significant impact in preventing DR.
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