Janghorbani M B, Jones R B, Allison S P
Department of Public Health, University of Glasgow, Glasgow, Scotland.
Ophthalmic Epidemiol. 2000 Mar;7(1):13-25.
The incidence of and risk factors for cataract during a mean (standard deviation (SD)) follow-up period of 5.0 (3.0) (range 0.1-12.4) years were examined among 3606 patients (2001 male and 1605 female) with diabetes mellitus from three outpatient clinics at the University Hospital, Nottingham. Among the 3606 patients free of cataract at initial registration who attended the clinic at least twice in the period 1979-1992, the mean (SD) age was 49.2 (17.8) years with a mean (SD) duration of diabetes of 7.6 (9.8) years at initial registration. The incidence of cataract was 10.4 (95% confidence interval (CI), 9.0, 11.9) per 1000 person-years based on 18089 person-years of follow-up. The incidence for females (13.6 (95% CI, 11.0, 16.1)) was greater than in males (8 (95% CI, 6.3, 9. 7)) (P<0.001). The incidence of cataract in insulin-dependent diabetes mellitus (IDDM), non-insulin-treated and insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) were 7.1 (95% CI, 5. 4, 8.9), 11.7 (95% CI, 9.1, 14.3) and 17.8 (95% CI, 12.9, 22.7) per 1000 person-years, respectively. Age-adjustment substantially changed the ordering of risk associated with different types of diabetes. Using a Cox's Proportional Hazards Model for IDDM and NIDDM (insulin and non-insulin-treated) diabetes separately, age and any retinopathy were significant independent predictors of cataract for all groups. Poor metabolic control also was a significant independent predictor of cataract for the IDDM and insulin-treated NIDDM diabetes groups. Duration of diabetes was a significant independent predictor of cataract for the IDDM group. Age at diagnosis of diabetes, systolic and diastolic blood pressure, body mass index, proteinuria, cigarette smoking and creatinine had no significant independent association with cataract when other covariates were considered. These findings will help the identification of those diabetic patients at particular risk of cataract so that clinic time for screening of eyes can be appropriately focused and health care planning for people with diabetes considered.
在诺丁汉大学医院的三家门诊诊所中，对3606例糖尿病患者（2001例男性和1605例女性）进行了平均（标准差（SD））5.0（3.0）年（范围0.1 - 12.4年）随访期内白内障的发病率及危险因素研究。在1979 - 1992年期间至少就诊两次的3606例初诊时无白内障的患者中，初诊时平均（SD）年龄为49.2（17.8）岁，糖尿病平均（SD）病程为7.6（9.8）年。基于18089人年的随访，白内障发病率为每1000人年10.4（95%置信区间（CI），9.0，11.9）。女性发病率（13.6（95%CI，11.0，16.1））高于男性（8（95%CI，6.3，9.7））（P<0.001）。胰岛素依赖型糖尿病（IDDM）、非胰岛素治疗和胰岛素治疗的非胰岛素依赖型糖尿病（NIDDM）的白内障发病率分别为每1000人年7.1（95%CI，5.4，8.9）、11.7（95%CI，9.1，14.3）和17.8（95%CI，12.9，22.7）。年龄调整显著改变了与不同类型糖尿病相关的风险排序。分别对IDDM和NIDDM（胰岛素治疗和非胰岛素治疗）糖尿病使用Cox比例风险模型，年龄和任何视网膜病变是所有组白内障的显著独立预测因素。代谢控制不佳也是IDDM和胰岛素治疗的NIDDM糖尿病组白内障的显著独立预测因素。糖尿病病程是IDDM组白内障的显著独立预测因素。当考虑其他协变量时，糖尿病诊断时的年龄、收缩压和舒张压、体重指数、蛋白尿、吸烟和肌酐与白内障无显著独立关联。这些发现将有助于识别那些有白内障特别风险的糖尿病患者，以便能适当地集中眼科筛查门诊时间，并考虑糖尿病患者的医疗保健规划。
