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S. A. Skolik, L. E. Caspers; Evaluation and Comparison of Diabetic Retinopathy and HgA1C in Long-Term Diabetic Type-1 and Type-2 Patients With and Without Co-Existing Clinical Arthritis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1409.
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In some long-term diabetic patients (disease >20 years) with clinical arthritis, there appears to be some endogenous protection from the development of diabetic retinopathy. We graded and compared the retinopathy in two groups of diabetic patients, Group-One (diabetics with co-existing clinical arthritis) and Group-Two (diabetics without history of clinical arthritis). We also compared the hemoglobin A1C (HgA1C) of these two groups (when possible).
A double blinded observer evaluated the most recent fundus photography of 96 patients in each group and graded the retinopathy according to the standard modified Airlie's House Classification scheme of grading non-proliferative retinopathy or determined if proliferative disease was present. Patients in Group-One were age 28-90 years, (av.68.3), had clinical arthritis by history and a form of diabetes (56-type1; 40-type2) with duration of 20-53 years (av.26.9). Group-Two was matched for age (33-87 years, av. 62.9), diabetes (65 type-1, 31 type-2) of duration 12-29 years (av. 24.0) and denied a history of clinical arthritis. Further subgroup evaluation for differences in retinopathy between type-1 and type-2 diabetics were also carried out. The two groups were matched also for HgA1C, Group-One 8.0% (30/96 patients) and Group-Two 7.7% (35/96 patients).
Virtually all, 94/96 patients (97.9%) of the Group Two, (those with diabetes without clinical arthritis) manifested proliferative diabetic retinopathy by twenty years of disease, vs 10/96 (10.4%) of patients in Group-One (diabetics with clinical arthritis). Non-proliferative retinopathy among the other 86 Group-One patients (without proliferative disease) ranged using Airlie's Classification grading from 10 to 43, ave.13. The two patients without proliferative disease in Group Two had Airlie Classification scores from 35-43, ave. 41.
Despite very similar hyperglycemic control (HgA1C), comparison of these two groups of long-term diabetics seems to indicate that patients with co-existing clinical arthritis seem to avoid the same rate of development of diabetic retinopathy as their counterparts without clinical arthritis. It may be these arthritic-diabetics have some sort of endogenous protection from expected diabetic vascular changes. Further study is indicated.
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