Risk of Proliferative Diabetic Retinopathy in Juvenile-Onset Type I Diabetes: A 40-yr Follow-up Study

The development of proliferative diabetic retinopathy was studied in three cohorts consisting of 292 patients with recent juvenile-onset, type I (insulin-dependent) diabetes who were followed 20–40 yr beginning in 1939, 1949, and 1959. The risk of this severe eye complication was almost nonexistent during the first 10 yr of diabetes, rose abruptly to its maximum level (∼30/1000 person-years), and remained at that level for the next 25 yr. This pattern did not vary with sex, age at onset of diabetes, or level of glycemic control during the first 5 yr of diabetes. However, the risk of proliferative retinopathy was strongly related to the level of glycemic control during the several years preceding onset of this complication. This was a dose-dependent relationship, with patients in the highest quartile of the distribution of the index of frequency of hyperglycemia having a 10-fold higher risk than individuals in the lowest quartile. A virtually identical pattern was observed in patients who developed diabetes in 1959 as was observed in those who developed diabetes in 1949 or 1939. In contrast, diabetic nephropathy as evidenced by persistent proteinuria showed a lower incidence in the 1959 than in the 1939 cohort. In conclusion, these incidence data do not support the notion that the risk of proliferative retinopathy is mainly a function of duration of diabetes. Instead, the pattern of occurrence of this severe eye complication in type I diabetes suggests that the process leading to the development of proliferative retinopathy consists of two or more stages and that progression through each stage may be governed by different factors.

[1]  D. DeMets,et al.  The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. , 1984, Archives of ophthalmology.

[2]  M. Pike,et al.  Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. , 1977, British Journal of Cancer.

[3]  D. Beevers,et al.  Factors protective against retinopathy in insulin-dependent diabetics free of retinopathy for 30 years. , 1982, British medical journal.

[4]  N. Lassen,et al.  Hemodynamic factors in the genesis of diabetic microangiopathy. , 1983, Metabolism: clinical and experimental.

[5]  K. Lundbaek Diabetic angiopathy: a specific vascular disease. , 1954, Lancet.

[6]  N. Ashton Vascular basement membrane changes in diabetic retinopathy. Montgomery lecture, 1973. , 1974, The British journal of ophthalmology.

[7]  M. Pike,et al.  Conservatism of the approximation sigma (O-E)2-E in the logrank test for survival data or tumor incidence data. , 1973, Biometrics.

[8]  Thomas V. Claringbold,et al.  Diabetes and the Eye , 1997 .

[9]  D.,et al.  Regression Models and Life-Tables , 2022 .

[10]  I. Constable,et al.  Assessing the risk of diabetic retinopathy. , 1984, American journal of ophthalmology.

[11]  P. White Natural Course and Prognosis of Juvenile Diabetes , 1956, Diabetes.

[12]  P. Cryer,et al.  The natural history of retinopathy in insulin-dependent juvenile-onset diabetes. , 1981, Ophthalmology.

[13]  J. Ditzel The problems of tissue oxygenation in diabetes mellitus. III. The "three-in-one concept" for the development of diabetic microangiopathy and a rational approach to its prophylaxis. , 2009, Acta medica Scandinavica. Supplementum.

[14]  O. Miettinen,et al.  Estimability and estimation in case-referent studies. , 1976, American journal of epidemiology.

[15]  D. Cogan,et al.  Retinal vascular patterns. VI. Mural cells of the retinal capillaries. , 1963, Archives of ophthalmology.

[16]  Joseph Berkson,et al.  Competing Exponential Risks, with Particular Reference to the Study of Smoking and Lung Cancer , 1960 .

[17]  D TOUSSAINT,et al.  Retinal vascular patterns. IV. Diabetic retinopathy. , 1961, Archives of ophthalmology.

[18]  H. Little The role of abnormal hemorrheodynamics in the pathogenesis of diabetic retinopathy. , 1976, Transactions of the American Ophthalmological Society.

[19]  I. C. Michaelson An examination of the possibilities of preventive therapy in arteriolar retinopathies. , 1979, American journal of ophthalmology.

[20]  J. Wetzels,et al.  The changing natural history of nephropathy in type I diabetes. , 1986, The American journal of medicine.

[21]  Keith A. Soper,et al.  Diagnosis of diabetic eye disease. , 1982, JAMA.

[22]  F. Caird,et al.  The natural history of diabetic retinopathy. , 1968, The Quarterly journal of medicine.

[23]  D. McMillan Plasma protein changes, blood viscosity, and diabetic microangiopathy. , 1976, Diabetes.