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Observational Study
. 2019 May;42(5):875-882.
doi: 10.2337/dc18-2308. Epub 2019 Mar 4.

Risk Factors for Retinopathy in Type 1 Diabetes: The DCCT/EDIC Study

Dean P Hainsworth  1 , Ionut Bebu  2 , Lloyd P Aiello  3 , William Sivitz  4 , Rose Gubitosi-Klug  5 , John Malone  6 , Neil H White  7 , Ronald Danis  8 , Amisha Wallia  9 , Xiaoyu Gao  2 , Andrew J Barkmeier  10 , Arup Das  10 , Shriji Patel  11 , Thomas W Gardner  12 , John M Lachin  13 ; Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group
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Observational Study

Risk Factors for Retinopathy in Type 1 Diabetes: The DCCT/EDIC Study

Dean P Hainsworth et al. Diabetes Care. 2019 May.

Abstract

Objective: The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy reduced the development and progression of retinopathy in type 1 diabetes (T1D) compared with conventional therapy. The Epidemiology of Diabetes Interventions and Complications (EDIC) study observational follow-up showed persistent benefits. In addition to glycemia, we now examine other potential retinopathy risk factors (modifiable and nonmodifiable) over more than 30 years of follow-up in DCCT/EDIC.

Research design and methods: The retinopathy outcomes were proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME), and ocular surgery. The survival (event-free) probability was estimated using the Kaplan-Meier method. Cox proportional hazards models assessed the association between risk factors and subsequent risk of retinopathy. Both forward- and backward-selection approaches determined the multivariable models.

Results: Rate of ocular events per 1,000 person-years was 12 for PDR, 14.5 for CSME, and 7.6 for ocular surgeries. Approximately 65%, 60%, and 70% of participants remained free of PDR, CSME, and ocular surgery, respectively. The greatest risk factors for PDR in descending order were higher mean HbA1c, longer duration of T1D, elevated albumin excretion rate (AER), and higher mean diastolic blood pressure (DBP). For CSME, risk factors, in descending order, were higher mean HbA1c, longer duration of T1D, and greater age and DBP and, for ocular surgeries, were higher mean HbA1c, older age, and longer duration of T1D.

Conclusions: Mean HbA1c was the strongest risk factor for the progression of retinopathy. Although glycemic control is important, elevated AER and DBP were other modifiable risk factors associated with the progression of retinopathy.

Trial registration: ClinicalTrials.gov NCT00360893 NCT00360815.

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Figures

Figure 1
Figure 1
The joint distribution of the number of participants with PDR, CSME, and ocular surgery over the follow-up.
See this image and copyright information in PMC

References

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    1. The DCCT/EDIC Research Group Epidemiology of Diabetes Interventions and Complications (EDIC). Design, implementation, and preliminary results of a long-term follow-up of the diabetes control and complications trial cohort. Diabetes Care 1999;22:99–111 - PMC - PubMed
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    1. White NH, Sun W, Cleary PA, et al. . Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial. Arch Ophthalmol 2008;126:1707–1715 - PMC - PubMed
    1. Lachin JM, White NH, Hainsworth DP, et al. .; Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group . Effect of intensive diabetes therapy on the progression of diabetic retinopathy in patients with type 1 diabetes: 18 years of follow-up in the DCCT/EDIC. Diabetes 2015;64:631–642 - PMC - PubMed

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