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Multicenter Study
. 2008 Mar 1;371(9614):736-43.
doi: 10.1016/S0140-6736(08)60343-8.

Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies

Tien Y Wong  1 , Gerald Liew, Robyn J Tapp, Maria Inês Schmidt, Jie Jin Wang, Paul Mitchell, Ronald Klein, Barbara E K Klein, Paul Zimmet, Jonathan Shaw
Affiliations
Multicenter Study

Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies

Tien Y Wong et al. Lancet. .

Erratum in

  • Lancet. 2008 May 31;371(9627):1838

Abstract

Background: The WHO and American Diabetes Association criteria for diagnosing diabetes mellitus assume the presence of a glycaemic threshold with high sensitivity for identifying retinopathy. However, this assumption is based on data from three previous studies that had important limitations in detecting retinopathy. We aimed to provide updated data for the relation between fasting plasma glucose (FPG) and retinopathy, and to assess the diagnostic accuracy of current FPG thresholds in identifying both prevalent and incident retinopathy.

Methods: We examined the data from three cross-sectional adult populations: those in the Blue Mountains Eye Study (BMES, Australia, n=3162), the Australian Diabetes, Obesity and Lifestyle Study (AusDiab, Australia, n=2182), and the Multi-Ethnic Study of Atherosclerosis (MESA, USA, n=6079). Retinopathy was diagnosed from multiple retinal photographs of each eye, and graded according to the modified Airlie House Classification system. Plasma glucose concentrations were measured from fasting venous blood samples.

Findings: The overall prevalence of retinopathy was 11.5% in BMES (95% CI 10.4-12.6%), 9.6% in AusDiab (8.4-10.9), and 15.8% in MESA (14.9-16.7). However, we found inconsistent evidence of a uniform glycaemic threshold for prevalent and incident retinopathy, with analyses suggesting a continuous relation. The widely used diabetes FPG cutoff of 7.0 mmol/L or higher had sensitivity less than 40% (range 14.8-39.1) for detecting retinopathy, with specificity between 80.8% and 95.8%. The area under receiver operating characteristic curves for FPG and retinopathy was low and ranged from 0.56 to 0.61.

Interpretation: We saw no evidence of a clear and consistent glycaemic threshold for the presence or incidence of retinopathy across different populations. The current FPG cutoff of 7.0 mmol/L used to diagnose diabetes did not accurately identify people with and without retinopathy. These findings suggest that the criteria for diagnosing diabetes could need reassessment.

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Conflict of interest statement

Conflict of interest statement

Wong had full access to all the data in the study and has final responsibility for the decision to submit the manuscript for publication. All authors state that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Relationship between Fasting Plasma Glucose and Retinopathy. Intervals Chosen to include the traditional Diabetes Cut-offs of 7.0 and 7.8 mmol/l. To convert from mmol/l to mg/dl, multiply by 18.
Figure 2
Figure 2
Receiver Operating Characteristic (ROC) curves for Fasting Plasma Glucose (mmol/l) and Prevalent Retinopathy (A: Blue Mountains Eye Study, B: The AusDiab Study and C: The MESA Study)
Figure 3
Figure 3
Relationship between Baseline Fasting Plasma Glucose and Incident Retinopathy, the Blue Mountains Eye Study; Relationship between Glycosylated Haemoglobin and Retinopathy, the Multi-Ethnic Study of Atherosclerosis. To convert from mmol/l to mg/dl, multiply by 18.
Figure 3
Figure 3
Relationship between Baseline Fasting Plasma Glucose and Incident Retinopathy, the Blue Mountains Eye Study; Relationship between Glycosylated Haemoglobin and Retinopathy, the Multi-Ethnic Study of Atherosclerosis. To convert from mmol/l to mg/dl, multiply by 18.
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Comment in

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