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P. Patel, S. Reddy; Determining the Risk Factors Associated With the Development and Severity of Retinopathy in a Cohort of Poorly Controlled and Underserved Diabetic Patients. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2078.
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To determine what factors influence the development and severity of diabetic retinopathy in a cohort of underserved and poorly controlled diabetic patients.
A total of 94 poorly controlled type II diabetic patients (defined by HgbA1c >7 ) were categorized by level of diabetic retinopathy (none, mild, moderate, severe, and proliferative). Data was collected on HgbA1c, the number of years since diagnosis, presence of hypertension or nephropathy, and the use of ace inhibitors. Student t-test and single factor ANOVA were performed for statistical analysis.
Mean HgbA1c amongst our cohort was 8.71. Among our diabetic patients, HgbA1c did not differ between those with (8.58) and without retinopathy (8.83) (p=0.47). The level of HgbA1c also did not correlate with the severity of retinopathy (p=0.38). However, those with retinopathy did have a significantly longer average disease duration (12.8 yrs vs. 8.59 yrs). Similarly, those with severe nonproliferative and proliferative retinopathy also showed a longer duration of diabetes when compared to those with mild and moderate retinopathy (p=0.01). Chi square analysis revealed that the presence of hypertension and nephropathy were more prevalent in those with retinopathy, with the highest percentage of patients having both comorbidities in the severe nonproliferative and proliferative groups (p=0.009, 0.015). There was no statistical difference in age, sex, or use of ace-inhibitors, between those with and without retinopathy.
In patients with poorly controlled diabetes, disease duration and the presence of comorbidities, such as hypertension and nephropathy, appears to play a more important role than the actual level of hyperglycemia in the development and severity of retinopathy.
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