Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Nov;115(11):1859-68.
doi: 10.1016/j.ophtha.2008.08.023.

The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes

Ronald Klein  1 , Michael D Knudtson, Kristine E Lee, Ronald Gangnon, Barbara E K Klein
Affiliations

The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes

Ronald Klein et al. Ophthalmology. 2008 Nov.

Abstract

Objective: To examine the 25-year cumulative progression and regression of diabetic retinopathy (DR) and its relation to various risk factors.

Design: Population-based study.

Participants: A total of 955 insulin-taking persons living in an 11-county area in southern Wisconsin with type 1 diabetes diagnosed before age 30 years who participated in a baseline examination (1980-1982) and at least 1 of 4 follow-up (4-, 10-, 14-, and 25-year) examinations or died before the first follow-up examination (n = 64).

Methods: Stereoscopic color fundus photographs were graded using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study retinopathy severity scheme.

Main outcome measures: Progression and regression of DR status.

Results: The 25-year cumulative rate of progression of DR was 83%, progression to proliferative DR (PDR) was 42%, and improvement of DR was 18%. Progression of DR was more likely with less severe DR, male sex, higher glycosylated hemoglobin, an increase in glycosylated hemoglobin level, and an increase in diastolic blood pressure level from the baseline to the 4-year follow-up. Increased risk of incidence of PDR was associated with higher glycosylated hemoglobin, higher systolic blood pressure, proteinuria greater body mass index at baseline, and an increase in the glycosylated hemoglobin between the baseline and 4-year follow-up examinations. Lower glycosylated hemoglobin and male sex, as well as decreases in glycosylated hemoglobin and diastolic blood pressure during the first 4 years of follow-up, were associated with improvement in DR. Persons diagnosed most recently with a similar duration of diabetes had a lower prevalence of PDR independently of glycosylated hemoglobin level, blood pressure level, and presence of proteinuria.

Conclusions: These data show relatively high 25-year cumulative rates of progression of DR and incidence of PDR. The lower risk of prevalent PDR in more recently diagnosed persons possibly reflects improvement in care over the period of the study.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Reasons for nonparticipation in the 25-year follow-up in the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). * After baseline examination, no longer contacted 178 of those eligible (excluded from W2 – W6 numbers) † Retinopathy data not collected at Wisconsin Epidemiologic Study of Cardiovascular Disease (WESCID) in Type 1 Diabetes.
Figure 2
Figure 2
Estimated annual rates for progression of diabetic retinopathy, incidence of proliferative diabetic retinopathy and improvement of diabetic retinopathy for four periods of the study.
Figure 3
Figure 3
Relationship of prevalence of proliferative diabetic retinopathy to duration of diabetes by period of diabetes diagnosis in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Abbreviation: PDR=proliferative diabetic retinopathy
See this image and copyright information in PMC

Comment in

References

    1. Klein R, Klein BE. Diabetes in America. 2nd ed. National Institutes of Health; Bethesda, MD: 1995. Vision disorders in diabetes. National Diabetes Data Group; pp. 293–338. NIH Publication No. 95–1468. Available at http://diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter14.pdf. Accessed July 18, 2008.
    1. Prevent Blindness America . Vision problems in the U.S: A report on blindness and vision impairment in adults age 40 and older. Prevent Blindness America; Schaumburg, IL: 1995.
    1. Moss SE, Klein R, Klein BE. Ten-year incidence of visual loss in a diabetic population. Ophthalmology. 1994;101:1061–70. - PubMed
    1. Ballard DJ, Melton LJI, Dwyer MS, et al. Risk factors for diabetic retinopathy: a population-based study in Rochester, Minnesota. Diabetes Care. 1986;9:334–42. - PubMed
    1. Nielsen NV. Diabetic retinopathy I. The course of retinopathy in insulin-treated diabetics. A one year epidemiological cohort study of diabetes mellitus. The Island of Falster, Denmark. Acta Ophthalmol (Copenh) 1984;62:256–65. - PubMed

Publication types

MeSH terms