Ethnicity/race and end-stage renal disease, but not glycemic control, are significantly associated with proliferative diabetic retinopathy

Abstract

Purpose : The development of sight-threatening complications of diabetes, namely proliferative diabetic retinopathy (PDR), is understood to be a consequence of several modifiable and non-modifiable factors. We performed a cross-sectional, observational study to identify these factors that are significantly associated with the development of PDR.

Methods : Data was collected from two patient cohorts with type 1 or type 2 diabetes seen between February 1, 2018 and February 1, 2020: a group of 293 patients with confirmed PDR and a control group of 69 patients with confirmed mild nonproliferative diabetic retinopathy (NPDR). Patients in the PDR group were identified by ICD-10 codes and confirmed with a history of panretinal photocoagulation and/or pars plana vitrectomy for vitreous hemorrhage. Data was obtained by an extensive chart review of several systemic parameters. Statistical analysis was done via two-sample t-test for continuous variables and Chi-squared test or Fisher exact test for categorical variables.

Results : Our analysis revealed that the development of PDR was significantly associated with exogenous insulin use (p<0.001), elevated systolic BP (p=0.004), presence of macroalbuminuria (p<0.001), history of dialysis (p=0.002), and decreased GFR (p=0.024). In our cohort, the prevalence of PDR was higher in both Hispanics and American Indians than for Whites/Anglos. There was a lack of association between HbA_1c levels and PDR (p=0.784). The majority of PDR patients (56.8%) had good glycemic control (HbA_1c<7.5%); similarly, the majority of mild NPDR patients (58%) had poor glycemic control (HbA_1c≥7.5%). No association was found with total cholesterol (p=0.713), LDL (p=0.355), HDL (p=0.440), and triglyceride (p=0.412) levels.

Conclusions : The data suggests that glycemic control is unrelated to the development of PDR, as the majority of our PDR cohort had good glycemic control. The highest incidence of PDR was seen among American Indians and Hispanics. There is a strong association between end-stage renal disease (ESRD) and PDR. Our findings indicate that “other factors,” such as genomics, may play a stronger role in development of PDR.

This is a 2021 ARVO Annual Meeting abstract.