Grauslund Jakob, Green Anders, Sjølie Anne Katrin
Department of Ophthalmology, Odense University Hospital, Odense, Denmark.
Ophthalmology. 2009 Nov;116(11):2170-4. doi: 10.1016/j.ophtha.2009.04.043. Epub 2009 Sep 10.
To assess the long-term incidence of blindness and to evaluate risk factors for blindness in a population-based cohort of type 1 diabetic patients.
Retrospective cohort study.
A population-based cohort of 573 type 1 diabetic patients, all of whom participated in a clinical ophthalmologic examination in 1981 and 1982 and were followed up for 25 years.
At the baseline examination in 1981 and 1982, visual acuity, level of retinopathy, maculopathy, hemoglobin A(1) (HbA(1)), proteinuria, smoking habits, and blood pressure were evaluated and related to the subsequent development of blindness. Blindness was defined as present in patients who were registered as members of the Danish Association of the Blind between baseline and January 2007. The Danish Association of the Blind is a voluntary organization open for all patients with a best-corrected visual acuity in the best eye of <or=6/60 (20/200) or with complications (i.e., visual fields <10 degrees ) subjectively leading to a best-corrected visual acuity in the best eye of <or=6/60 (20/200).
Evaluation of 25-year incidence of blindness, predictors for blindness, and gender-specific incidence rates for blindness.
The 25-year cumulative crude incidence of blindness was 7.5% (men, 8.0%; women, 6.8%; P = 0.61), corresponding to a mortality-adjusted cumulative incidence of blindness of 9.5% (95% confidence interval [CI], 7.1%-12.0%) and an overall incidence rate of blindness of 4.11 per 1000 person-years (95% CI, 3.03-5.59 per 1000 person-years). Blindness was predicted by HbA(1) and maculopathy at baseline. The odds ratio of blindness during follow-up was 1.69 (95% CI, 1.01-2.84) for a 1% increase in baseline HbA(1) and was 6.18 (95% CI, 1.18-32.47) and 8.61 (95% CI, 2.54-29.23) for patients with maculopathy in combination with nonproliferative retinopathy and proliferative retinopathy, respectively. Age and duration at baseline, gender, proteinuria, smoking, systolic and diastolic blood pressure, and visual acuity at baseline were not associated with the development of blindness. Mortality was higher in patients who had become blind (61.0% vs. 42.1%; P = 0.02).
Blindness is still a common complication in type 1 diabetes. Glycemic regulation and the presence of maculopathy are important risk factors for the development of blindness.
评估1型糖尿病患者群体中失明的长期发病率，并评估失明的危险因素。
回顾性队列研究。
一个基于人群的队列，包含573名1型糖尿病患者，他们均于1981年和1982年参加了临床眼科检查，并接受了25年的随访。
在1981年和1982年的基线检查中，评估了视力、视网膜病变程度、黄斑病变、糖化血红蛋白A1（HbA1）、蛋白尿、吸烟习惯和血压，并将其与随后失明的发生情况相关联。失明定义为在基线至2007年1月期间被登记为丹麦盲人协会成员的患者。丹麦盲人协会是一个志愿组织，向所有最佳矫正视力在最佳眼中≤6/60（20/200）或有并发症（即视野<10度）且主观上导致最佳眼中最佳矫正视力≤6/60（20/200）的患者开放。
评估25年失明发病率、失明预测因素以及失明的性别特异性发病率。
25年累积失明粗发病率为7.5%（男性为8.0%；女性为6.8%；P = 0.61），对应经死亡率调整后的累积失明发病率为9.5%（95%置信区间[CI]，7.1%-12.0%），总体失明发病率为每1000人年4.11例（95%CI，每1000人年3.03 - 5.59例）。基线时的HbA1和黄斑病变可预测失明。随访期间，基线HbA1每增加1%，失明的比值比为1.69（95%CI，1.01 - 2.84），黄斑病变合并非增殖性视网膜病变和增殖性视网膜病变的患者失明的比值比分别为6.18（95%CI，1.18 - 32.47）和8.61（95%CI，2.54 - 29.23）。基线时的年龄、病程、性别、蛋白尿、吸烟、收缩压和舒张压以及视力与失明的发生无关。失明患者的死亡率更高（61.0%对42.1%；P = 0.
