UKPDS 50: risk factors for incidence and progression of retinopathy in type II diabetes over 6 years from diagnosis
UKPDS 50: risk factors for incidence and progression of retinopathy in type II diabetes over 6 years from diagnosis
Aims/hypothesis: to determine risk factors related to the incidence and progression of diabetic retinopathy over 6 years from diagnosis of Type II (non-insulin-dependent) diabetes mellitus.
Methods: this report describes 1919 patients from within the United Kingdom Prospective Diabetes Study (UKPDS), with retinal photographs taken at diagnosis and 6 years later and with complete data available. Photographs were centrally graded for lesions of diabetic retinopathy using the modified Early Treatment of Diabetic Retinopathy Study Final scale. Risk factors were assessed after 3 months diet from the time of diagnosis of diabetes. Patients were seen every 3 months in a hospital setting. Biochemical measurements were done by a central laboratory. End points of vitreous haemorrhage and photocagulation were confirmed by independent adjudication of systematically collected clinical data. The main outcome measures were incidence and progression of retinopathy defined as a two-step Early Treatment of Diabetic Retinopathy Study (ETDRS) final scale change.
Results: of the 1919 patients, 1216 (63%) had no retinopathy at diagnosis. By 6 years, 22% of these had developed retinopathy, that is microaneurysms in both eyes or worse. In the 703 (37%) patients with retinopathy at diagnosis, 29% progressed by two scale steps or more. Development of retinopathy (incidence) was strongly associated with baseline glycaemia, glycaemic exposure over 6 years, higher blood pressure and with not smoking. In those who already had retinopathy, progression was associated with older age, male sex, hyperglycaemia (as evidenced by a higher HbA1c) and with not smoking.
Conclusion/interpretation: the findings re-emphasise the need for good glycaemic control and assiduous treatment of hypertension if diabetic retinopathy is to be minimised.
Glycaemia, HbA, Hypertension, Incidence, Progression, Randomised clinical trial, Retinopathy, Risk factors, Smoking, Type II (non-insulin-dependent) diabetes mellitus
156-163
Stratton, I.M.
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Kohner, E.M.
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Aldington, S.J.
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Turner, R.C.
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Holman, R.R.
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Manley, S.E.
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Matthews, D.R.
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February 2001
Stratton, I.M.
772f25b9-23c0-4240-a3f6-1e76b03b172f
Kohner, E.M.
8183570a-a9b8-4b2e-8fc8-9265fd296329
Aldington, S.J.
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Turner, R.C.
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Holman, R.R.
336fb2f7-edb5-4d65-a7b0-465111cbd047
Manley, S.E.
46bacfff-cf40-4894-86d8-4aa07e302e70
Matthews, D.R.
534e59ea-8166-4609-a269-1d4e354d6bdf
Stratton, I.M., Kohner, E.M., Aldington, S.J., Turner, R.C., Holman, R.R., Manley, S.E. and Matthews, D.R.
(2001)
UKPDS 50: risk factors for incidence and progression of retinopathy in type II diabetes over 6 years from diagnosis.
Diabetologia, 44 (2), .
(doi:10.1007/s001250051594).
Abstract
Aims/hypothesis: to determine risk factors related to the incidence and progression of diabetic retinopathy over 6 years from diagnosis of Type II (non-insulin-dependent) diabetes mellitus.
Methods: this report describes 1919 patients from within the United Kingdom Prospective Diabetes Study (UKPDS), with retinal photographs taken at diagnosis and 6 years later and with complete data available. Photographs were centrally graded for lesions of diabetic retinopathy using the modified Early Treatment of Diabetic Retinopathy Study Final scale. Risk factors were assessed after 3 months diet from the time of diagnosis of diabetes. Patients were seen every 3 months in a hospital setting. Biochemical measurements were done by a central laboratory. End points of vitreous haemorrhage and photocagulation were confirmed by independent adjudication of systematically collected clinical data. The main outcome measures were incidence and progression of retinopathy defined as a two-step Early Treatment of Diabetic Retinopathy Study (ETDRS) final scale change.
Results: of the 1919 patients, 1216 (63%) had no retinopathy at diagnosis. By 6 years, 22% of these had developed retinopathy, that is microaneurysms in both eyes or worse. In the 703 (37%) patients with retinopathy at diagnosis, 29% progressed by two scale steps or more. Development of retinopathy (incidence) was strongly associated with baseline glycaemia, glycaemic exposure over 6 years, higher blood pressure and with not smoking. In those who already had retinopathy, progression was associated with older age, male sex, hyperglycaemia (as evidenced by a higher HbA1c) and with not smoking.
Conclusion/interpretation: the findings re-emphasise the need for good glycaemic control and assiduous treatment of hypertension if diabetic retinopathy is to be minimised.
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Published date: February 2001
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Acknowledgements. We would like to thank the following participating centres for their help: Royal Infirmary, Aberdeen; City Hospital, Belfast; Royal Victoria Hospital, Belfast; General Hospital, Birmingham; St.Helier Hospital, Carshalton; Derbyshire Royal Hospital, Derby; Ninewells Hospital, Dundee; Royal Devon and Exeter Hospital, Exeter; Ipswich Hospital, Ipswich; Leicester General Hospital, Leicester; St. George's Hospital, London; Hammersmith Hospital, London; Whittington Hospital, London; Royal Infirmary, Manchester; Norfolk and Norwich Hospital, Norwich; Northampton General Hospital, Northampton; Radcliffe Infirmary, Oxford; Pe-terborough Hospital, Peterborough; Hope Hospital, Salford; Lister Hospital, Stevenage; North Staffordshire Royal Infirmary, Stoke-on-Trent; Torbay Hospital, Torbay. The authors are indebted to the participating patients. This work was supported by grants from: The National Eye Institute 2 UO1 EY07049–09, Bethesda, Maryland; British Diabetic Association; Medical Research Council; National Institutes of Digestive Disorders and Kidney Disease NIH, Bethesda, Maryland; UK Department of Health; British Heart Foundation and from pharmaceutical companies including: Bayer, Bristol My-ers Squibb, Hoechst, Lilly, Novo-Nordisk, Lipha and Farmita-lia Carlo Erba and from additional companies including Secu-ricor, Kodak and Cortecs Diagnostics. Other funding companies and agencies, the supervising committees, and all participating staff listed in an earlier paper [3]. We thank Carol Hill for assistance with the preparation of this paper.
Keywords:
Glycaemia, HbA, Hypertension, Incidence, Progression, Randomised clinical trial, Retinopathy, Risk factors, Smoking, Type II (non-insulin-dependent) diabetes mellitus
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Local EPrints ID: 487110
URI: http://eprints.soton.ac.uk/id/eprint/487110
ISSN: 0012-186X
PURE UUID: a7f9d2e6-6766-4c14-9017-88bd3d254665
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Date deposited: 14 Feb 2024 17:35
Last modified: 18 Mar 2024 04:01
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Author:
I.M. Stratton
Author:
E.M. Kohner
Author:
S.J. Aldington
Author:
R.C. Turner
Author:
R.R. Holman
Author:
S.E. Manley
Author:
D.R. Matthews
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