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K.L. Pedula, C.M. Mangione, A.L. Coleman, P.R. Gutierrez, T.A. Hillier, K.E. Ensrud; Diabetic Retinopathy and Functional Disability in Older Women: The Study of Osteoporotic Fractures(SOF) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):164.
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Purpose: To examine the relationship between diabetic retinopathy (DR) and functional disability in a population of older women with diabetes. Methods: We analyzed data from 150 women (≥ 75 years old) with diabetes who were enrolled in the SOF study and had gradable fundus photographs at the 10th year (visit 6) of follow-up. Demographic and medical history measures were obtained at the baseline and visit 6 exam. Self-reported history of diabetes was collected at baseline and every two years through visit 6. DR was assessed using a simplified version of the ETDRS grading scheme on 45o fundus photographs taken through dilated pupils. Functional disability was defined as the inability to do ≥ 1 major functional task: walking 0.25 mile, climbing 10 steps, performing household chores, shopping and cooking meals. A functional disability score was created by adding the number of tasks an individual could not perform. Chi-square and t-tests were used to compare proportions and means, respectively. Logistic and linear regression was used to assess the independent contribution of DR to functional disability after adjusting for other risk factors. Results: Functional disability was more prevalent in women with non-proliferative or proliferative retinopathy (NPR+) in the worst eye compared to women who had either no DR or microaneurisms (≤MA) (76% vs 53%, p=0.025). In the better eye, the relationship was similar but not significant (74% vs 54%, p=0.081). Mean functional disability scores were higher, but not significantly different, in persons with NPR+ compared to persons with ≤MA (2.0 vs 1.4, p=0.10). After adjusting for walking speed, depression score, postural hypotension, physical activity, age, insulin and benzodiazepene use, osteoporosis, hours sitting per day and inability to stand from chair without using arms, DR was no longer significantly associated with functional disability. Conclusions: In this small sample of older women, we found a univariate association between DR and functional status. Upon multivariate adjustment, this relationship was no longer statistically significant. However, this sample consisted of healthy survivors who had better baseline functional status than the much larger cohort of diabetic women originally examined. Thus, further study is necessary to determine if the trends that we found emerge more strongly in a general population of persons with diabetes.
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