Research Articles in Diabetes and Diabetic
Retinopathy
The Wisconsin Epidemiologic Study of Diabetic
Retinopathy: XIV. Ten-Year Incidence and Progression of Diabetic Retinopathy
(From Archives of Ophthalmology 1994;112:1217-1228,
Klein R, MD, et al.)
OVERVIEW:
The purpose of this study is to describe the 10-year incidence and
progression of diabetic retinopathy in a large population of people with
diabetes both taking and not taking insulin. The people in the study live in
southern Wisconsin. The study groups consist of
-
765 insulin-taking diabetic individuals diagnosed before
age 30
-
251 insulin-taking diabetics diagnosed at age 30 years or
older
-
282 non-insulin-taking individuals diagnosed at age 30 or
greater
These individuals participated in the baseline, 4 year, and
10 year follow-up examinations. There was no exclusion from the study based
on other medical problems nor on prior treatment of diabetic retinopathy.
This study did not look at control of blood glucose or hypertension as an
issue.
RESULTS:
Generally, the 10-year incidence and progression of retinopathy were high in
all three diabetic groups. Overall, the 10-year results in the three groups
combined were:
-
A 74% incidence of any retinopathy
-
A 64% rate of progression (worsening) of retinopathy
-
A 17% progression to proliferative retinopathy
Of participants with no retinopathy at baseline, after 10
years:
-
89% of the younger onset insulin-taking group developed
retinopathy.
76% of the younger onset insulin- taking group without proliferative
retinopathy developed worsened retinopathy.
30% of the younger onset insulin- taking group developed proliferative
retinopathy.
-
79% of the older onset insulin-taking group developed
retinopathy.
69% of the older onset insulin- taking group without proliferative
retinopathy developed worsened retinopathy.
24% of the older onset insulin- taking group developed proliferative
retinopathy.
-
67% of the older onset group not taking insulin developed
retinopathy.
53% of the older onset group not taking insulin without proliferative
retinopathy developed worsened retinopathy.
10% of the older onset group not taking insulin developed proliferative
retinopathy.
Other findings:
-
Younger onset diabetics taking insulin who were less than
10 years of age at the time of the first examination had the lowest
10-year incidence of retinopathy.
-
However, younger onset diabetics taking insulin who were
between 10 and 29 at the time of the first examination had the highest
rate of progression of retinopathy.
-
There was noted to be a strong relationship between having
more severe retinopathy at baseline and progressing to proliferative
retinopathy after 10 years.
-
40.1% of those in the younger-onset, insulin-taking group
who had proliferative retinopathy in at least one eye at the baseline
examination died by 10 years. Of the older-onset diabetics (insulin-taking
or not), 73% had died by 10 years if proliferative retinopathy was seen in
at least one eye at baseline.
COMMENTS:
This study looked at the rate of development of diabetic retinopathy over a
10 year period in 3 different groups of patients. It is important to
remember that this particular study does not attempt to make any comment
regarding the control of blood glucose, or of the impact of other medical
problems on the development of diabetic retinopathy.
For information about diabetic eye disease in general, and
for an explanation of terminology used below, go to
Diabetic Eye Disease.
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