Abstract
Purpose :
Currently it remains unclear whether the addition of other potential risk indicators [e.g. glycated hemoglobin (HbA1c) level, systolic/diastolic blood pressure, serum lipids (LDL, HDL, triglycerides) levels and body mass index (BMI)] enhance the accuracy of the prediction of development of RDR based solely on outcome of previous digital image based ophthalmic evaluation. To determine factors associated with progression to RDR from a regional population-based screening programme in people with T2D in Ireland.
Methods :
A dynamic cohort study of 2770 people with T2D identified during a diabetes programme operated at 20 general practices in four counties in Ireland. Patients were recruited between April 2005 and July 2013. Systemic parameters [systolic and diastolic blood pressure; glycosylated hemoglobin (HbA1c); serum lipid levels; body mass index (BMI)] and diabetic retinopathy grading were serially evaluated at four-month and yearly intervals, respectively. Associations between risk factors
i a) baseline ophthalmic evaluation outcome i b) baseline measurement of systemic variable parameter
ii) most recently recorded value of systemic parameter
iii) weighted mean of the rate of change in value between each pair of consecutive systemic parameter evaluations
and hazard of development of RDR were estimated using proportional hazard models.
Results :
There was a four-fold increased risk of progression to RDR when the initial retinopathy evaluation outcome showed minimal retinopathy when compared with no retinopathy (hazard ratio 4.02, [C.I. 2.80, 5.78] p=<0.001). Higher HbA1c at baseline and recent increase in HbA1c increased the risk of RDR [hazard ratio 1.29 (C.I. 1.13, 1.48) p=<0.001 and hazard ratio 1.22, (C.I. 1.11, 1.34) p=<0.001; respectively]. Higher recent systolic BP was associated with increased referral risk (H.R.1.29 [C.I. 1.15, 1.45] p=<0.001).A recent increase in triglycerides level was associated also with an increased risk of RDR development (H.R. 1.10 [C.I. 1.03, 1.18] p=0.004).
Conclusions :
Presence of overt retinopathy was strongly associated with risk of RDR. Modest associations between elevation of HbA1c,systolic BP and triglyceride levels were also detected.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.