Prevalence and Relationship Between Diabetic Retinopathy and Nephropathy, and its Risk Factors in the North-East of Spain, a Population-Based Study

Purpose: To determine the prevalence of microangiopathy, and its risk factors in a population-based study of diabetes mellitus patients in the north-eastern area of Spain. Methods: A population-based transversal study of 8,187 type 2 (83.37% of the diagnosed patients) and 488 type 1 (85.76% of the diagnosed patients) underwent a detailed medical history that included: diagnoses of diabetic retinopathy, macular edema, microalbuminuria or overt nephropathy. A study of its risk factors, and the relationship between diabetic retinopathy and renal lesion was performed. Results: In type 1 diabetes patients we observed a prevalence of 36.47% of diabetic retinopathy and 5.73% with macular edema; in type 2 diabetes patients the prevalence of diabetic retinopathy was 26.11% and 6.44% with macular edema. Microalbuminuria prevalence was 25.61% in type 1 and 17.78% in type 2 patients, and overt nephropathy prevalence was 8.60% in type 1 and 6.74% in type 2 diabetic patients. The risk factors for diabetic retinopathy were: diabetes duration, high glycosylated level, and arterial hypertension, and insulin treatment in type 2. The Total-cholesterol/High Density-cholesterol (TC/HDL) ratio and triglycerides were significant for diabetic macular edema (DME). Microalbuminuria and overt nephropathy were well correlated to diabetes duration, arterial hypertension and glycosylated haemoglobin. Conclusions: Prevalence and risk factors for microangiopathy are similar to other studies, and the important finding is that the TC/HDL ratio was significant for DME. Microalbuminuria is a risk factor for diabetic retinopathy in type 1 diabetes mellitus patients but not for type 2. Overt nephropathy is well correlated with diabetic retinopathy.

[1]  V. Mohan,et al.  Increased LDL cholesterol in non-insulin-dependent diabetics with maculopathy. , 1984, Acta diabetologica latina.

[2]  Pd redaction.  Oświadczenie w sprawie konfliktu interesów , 2001 .

[3]  T. Skrivarhaug,et al.  Low risk of overt nephropathy after 24 yr of childhood‐onset type 1 diabetes mellitus (T1DM) in Norway , 2006, Pediatric diabetes.

[4]  R. Klein,et al.  Is serum cholesterol associated with progression of diabetic retinopathy or macular edema in persons with younger-onset diabetes of long duration? , 1999, American journal of ophthalmology.

[5]  W. Scherbaum,et al.  Prevalence of Chronic Complications, Metabolic Control and Nutritional Intake in Type 1 Diabetes: Comparison Between Different European Regions , 1999, Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme.

[6]  H. King,et al.  Global Burden of Diabetes, 1995–2025: Prevalence, numerical estimates, and projections , 1998, Diabetes Care.

[7]  F. Brancati,et al.  Epidemiology and prevention of diabetic nephropathy. , 1995, Current opinion in nephrology and hypertension.

[8]  R. Weinshilboum,et al.  The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. , 1997, Archives of internal medicine.

[9]  J. Pastor,et al.  Prevalence of diabetic retinopathy and eye care in a rural area of Spain , 2002, Ophthalmic epidemiology.

[10]  N. Unwin,et al.  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Detection, Evaluation, and Treatment of High Blood Cholesterol Education Program (NCEP) Expert Panel on Executive Summary of the Third Report of the National , 2009 .

[11]  Stephen J. Aldington,et al.  United Kingdom Prospective Diabetes Study, 30: diabetic retinopathy at diagnosis of non-insulin-dependent diabetes mellitus and associated risk factors. , 1998, Archives of ophthalmology.

[12]  D L DeMets,et al.  The Wisconsin epidemiologic study of diabetic retinopathy. XI. The incidence of macular edema. , 1989, Ophthalmology.

[13]  J. Mckenney,et al.  National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) , 2002 .

[14]  P. Raskin,et al.  Report of the expert committee on the diagnosis and classification of diabetes mellitus. , 1999, Diabetes care.

[15]  L. Aiello,et al.  Detection of diabetic macular edema. Ophthalmoscopy versus photography--Early Treatment Diabetic Retinopathy Study Report Number 5. The ETDRS Research Group. , 1989, Ophthalmology.

[16]  R. Klein,et al.  The 30-Year Natural History of Type 1 Diabetes Complications , 2006, Diabetes.

[17]  R. Klein,et al.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XIII. Relationship of serum cholesterol to retinopathy and hard exudate. , 1991, Ophthalmology.

[18]  B Kirchhof,et al.  Leukocyte-mediated endothelial cell injury and death in the diabetic retina. , 2001, The American journal of pathology.

[19]  R. Holman,et al.  U.K. Prospective Diabetes Study 22: Effect of age at diagnosis on diabetic tissue damage during the first 6 years of NIDDM , 1997, Diabetes Care.

[20]  R. Tresserras,et al.  Prevalence of diabetes in Catalonia (Spain): an oral glucose tolerance test-based population study. , 1999, Diabetes research and clinical practice.

[21]  V. Fonseca,et al.  Diabetic nephropathy and retinopathy. , 2004, The Medical clinics of North America.

[22]  H. Drexler,et al.  Endothelial Dysfunction in Hypercholesterolemia: Mechanisms, Pathophysiological Importance, and Therapeutic Interventions , 2000, Seminars in thrombosis and hemostasis.

[23]  B. Hoogwerf,et al.  Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy. Early Treatment Diabetic Retinopathy Study (ETDRS) Report 22. , 1996, Archives of ophthalmology.

[24]  C. Mogensen,et al.  The Stages in Diabetic Renal Disease: With Emphasis on the Stage of Incipient Diabetic Nephropathy , 1983, Diabetes.

[25]  M. Fowler.  Clinical Practice Recommendations , 2009, Clinical Diabetes.

[26]  D. Cucinotta,et al.  Identifying patients with type 2 diabetes at high risk of microalbuminuria: results of the DEMAND (Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes) Study. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[27]  D L DeMets,et al.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy. VI. Retinal photocoagulation. , 1987, Ophthalmology.

[28]  Detection.  The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) , 1997 .

[29]  H. Parving,et al.  Decreasing incidence of severe diabetic microangiopathy in type 1 diabetes. , 2003, Diabetes care.

[30]  B. Lundman,et al.  Diabetes and it's complications in a Swedish county. , 1998, Diabetes research and clinical practice.

[31]  J. Mckenney,et al.  Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). , 2001, JAMA.

[32]  H. Schatz,et al.  Guidelines for Diabetes Care , 2009 .

[33]  R. Klein,et al.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XVII. The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. , 1998, Ophthalmology.

[34]  N Rifai,et al.  Proposed cardiovascular risk assessment algorithm using high-sensitivity C-reactive protein and lipid screening. , 2001, Clinical chemistry.

[35]  L. Masana,et al.  Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention , 2009, Vascular health and risk management.

[36]  Matthew D. Davis,et al.  Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. , 2003, Ophthalmology.

[37]  Bernd Kirchhof,et al.  Nonsteroidal anti‐inflammatory drugs prevent early diabetic retinopathy via TNF‐α suppression , 2002, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[38]  Stephen J. Aldington,et al.  Methodology for retinal photography and assessment of diabetic retinopathy: the EURODIAB IDDM Complications Study , 1995, Diabetologia.

[39]  C. Pérez,et al.  Prevalencia de retinopatía diabética en la Comunidad Autónoma de Extremadura: 1997-2001 (Proyecto Extremadura para Prevención de la Ceguera) , 2005 .

[40]  David M Nathan,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. , 2008, Archives of ophthalmology.