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Kristen H. Nwanyanwu, Nidhi Talwar, Thomas W. Gardner, James S. Wrobel, Joshua D. Stein; Risk factors Associated with Progression from Nonproliferative to Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5753.
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To identify risk factors associated with progression from non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) using a large managed care database.
Claims data of all beneficiaries age ≥ 30 enrolled in a large national managed care network was reviewed to identify all enrollees who were diagnosed with NPDR. Enrollees with NPDR were followed longitudinally to determine whether they progressed from NPDR to PDR. A multivariable Cox regression analysis was used to identify sociodemographic factors, ocular and nonocular medicalconditions, and medications that were associated with progression from NPDR to PDR.
Among the 4,617 enrollees with NPDR, 307 (6.6%) went on to later develop PDR. The mean length of time (standard deviation) the overall group was followed in the plan was 5.61 (2.11) years. For those who progressed to PDR, the mean length of time in the plan until first record of PDR was 5.97 (2.10) years. After adjustment for confounding factors, every one point increase in glycosylated hemoglobin was associated with a 14% (adjusted hazard ratio (HR) =1.14, 95% CI (confidence interval) 1.07 - 1.21) increased hazard of developing PDR. Those with NPDR who had non-healing ulcers had a 54% (HR=1.54, 95% CI:1.15 -2.07) increased hazard of progressing to PDR and enrollees with diabetic nephropathy had a marginally significant increased hazard of progressing from NPDR to PDR (HR=1.29, 95% CI 0.99-1.67) relative to those without these conditions. There was no significant association of progression from NPDR to PDR with age, sex, race, diabetic neuropathy, hypertension, hyperlipidemia, ACE inhibitor, statin, metformin, or insulin use. (p>0.05 for all comparisons).
Non-ophthalmologic manifestations of diabetes mellitus (ex: nephropathy and non-healing ulcers) are associated with an increased risk of progression from NPDR to PDR. Coordination of care among different medical specialists who care for patients with diabetes mellitus and timely communication of diabetic complications to eye care providers may help identify those individuals most at risk for diabetic retinopathy progression.
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