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. 2011 Jan;34(1):145-50.
doi: 10.2337/dc10-1206. Epub 2010 Oct 26.

Glycemic thresholds for diabetes-specific retinopathy: implications for diagnostic criteria for diabetes

Stephen Colagiuri  1 , Crystal M Y Lee, Tien Y Wong, Beverley Balkau, Jonathan E Shaw, Knut Borch-Johnsen; DETECT-2 Collaboration Writing Group
Affiliations

Glycemic thresholds for diabetes-specific retinopathy: implications for diagnostic criteria for diabetes

Stephen Colagiuri et al. Diabetes Care. 2011 Jan.

Erratum in

  • Diabetes Care. 2011 Aug;34(8):1888

Abstract

Objective: To re-evaluate the relationship between glycemia and diabetic retinopathy.

Research design and methods: We conducted a data-pooling analysis of nine studies from five countries with 44,623 participants aged 20-79 years with gradable retinal photographs. The relationship between diabetes-specific retinopathy (defined as moderate or more severe retinopathy) and three glycemic measures (fasting plasma glucose [FPG; n = 41,411], 2-h post oral glucose load plasma glucose [2-h PG; n = 21,334], and A1C [n = 28,010]) was examined.

Results: When diabetes-specific retinopathy was plotted against continuous glycemic measures, a curvilinear relationship was observed for FPG and A1C. Diabetes-specific retinopathy prevalence was low for FPG <6.0 mmol/l and A1C <6.0% but increased above these levels. Based on vigintile (20 groups with equal numbers) distributions, glycemic thresholds for diabetes-specific retinopathy were observed over the range of 6.4-6.8 mmol/l for FPG, 9.8-10.6 mmol/l for 2-h PG, and 6.3-6.7% for A1C. Thresholds for diabetes-specific retinopathy from receiver-operating characteristic curve analyses were 6.6 mmol/l for FPG, 13.0 mmol/l for 2-h PG, and 6.4% for A1C.

Conclusions: This study broadens the evidence based on diabetes diagnostic criteria. A narrow threshold range for diabetes-specific retinopathy was identified for FPG and A1C but not for 2-h PG. The combined analyses suggest that the current diabetes diagnostic level for FPG could be lowered to 6.5 mmol/l and that an A1C of 6.5% is a suitable alternative diagnostic criterion.

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Figures

Figure 1
Figure 1
Prevalence of diabetes-specific retinopathy (moderate or more severe retinopathy) with 95% confidence intervals, number of retinopathy cases, and participants within each interval by 0.5 unit intervals for FPG and 2-h PG, and A1C.
Figure 2
Figure 2
Prevalence of diabetes-specific retinopathy (moderate or more severe retinopathy) by vigintiles of the distribution of FPG, 2-h PG, and A1C.
See this image and copyright information in PMC

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