Abstract
Purpose :
To investigate the effect of proliferative and nonproliferative diabetic retinopathy (DR) and concurrent diabetic neuropathy on incidence of amputation, disability, and mortality.
Methods :
We performed a retrospective, observational study from January 1st, 2010 to November 1st 2023 and extracted 2,701,998 unique patients with only diabetic neuropathy (DN1), 152,574 patients with diabetic neuropathy and nonproliferative diabetic retinopathy (DN2) and 95,370 patients with diabetic neuropathy and proliferative retinopathy (DN3). Patients were subsequently divided into Type I (T1DM) and Type II diabetes mellitus (T2DM). Data was collected from the EPIC Electronic Medical Record System. All demographic data was collected, all amputations were included, from limb to digit amputation. Disability was compared across cohorts and was an aggregate measure of fine and gross motor impairment, mobility impairment, wheelchair use and crutch use.
Results :
Patients in DN3 were observed to be significantly younger as well as mean higher HbA1c (DN1 7.6% vs DN2 8.3% vs DN3 8.4%; p<0.05). The rate of diabetic foot ulcers was also significantly higher in the DN3 cohort compared to DN1 and DN2, (32.0% vs 13.2% vs 21.3% p<0.05, respectively). Similarly, the rate of amputations was significantly higher in the DN3 cohort, (DN1 8.8% vs DN2 13.8% vs DN3 24.7%; p<0.05). The rate of amputations in nonproliferative DR in patients with T1DM was significantly higher than in T2DM, (9.1% vs 6.3% p<0.05) and similar results were seen in patients with proliferative DR, when comparing T1DM and T2DM, (12.4% vs 11.1%). Significantly higher disability rate was seen in DN3 compared to DN1 and DN2 (DN1 11.9% vs DN2 15.5% vs DN3 18.0%; p<0.05). Significantly higher mortality was seen in DN3 compared to DN1/2 (DN1 6.5% vs DN2 5.7% vs DN3 8.5%; p<0.05) over the study period.
Conclusions :
Our results demonstrate the increased risk of diabetic amputations in the presence of diabetic retinopathy, most significantly in T1DM with proliferative DR. We expand the literature by clarifying the role of proliferative vs nonproliferative with concurrent diagnosed diabetic neuropathy using a very large sample size population to assess association. Work is currently being done to stratify staging of retinopathy, as well as assess for independent risk by evaluating the contribution of comorbidities and using subgroup analysis.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.