Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases-Prevention and Control and IDF Centre of Education, Gopalapuram, Chennai, India.
Diabetes Technol Ther. 2010 Oct;12(10):755-61. doi: 10.1089/dia.2010.0069.
This study assessed the relationship between and risk factors for microvascular complications of diabetes in an urban South Indian type 2 diabetes population.
Subjects with diabetes (n = 1,736) were selected from the population-based Chennai Urban Rural Epidemiology Study (CURES) Eye Study conducted on a representative population of Chennai city in south India. Four-field stereo retinal color photography was done, and diabetic retinopathy (DR) was classified according to the Early Treatment DR Study grading system. Neuropathy was diagnosed if the vibratory perception threshold of the big toe using biothesiometry was ≥ 20V. Overt nephropathy was diagnosed if the subjects had persistent macroalbuminuria (urinary albumin excretion ≥ 300 μg/mg of creatinine) and microalbuminuria if it was between 30 and 299 μg/mg of creatinine. Among the 1,715 subjects with gradable fundus photographs, 1,608 individuals who had information on all test parameters were included.
Overall, DR was present in 282 (17.5%), neuropathy in 414 (25.7%), overt nephropathy in 82 (5.1%), and microalbuminuria in 426 (26.5%) subjects. Eighteen subjects had all three microvascular complications of diabetes. The risk of nephropathy (odds ratio [OR] = 5.3, P<0.0001) and neuropathy (OR = 2.9, P<0.0001) was significantly higher among the subjects with sight-threatening DR compared to those without DR. Common risk factors identified for all the three microvascular complications of diabetes were age, glycated hemoglobin, duration of diabetes, and serum triglycerides. DR was associated with nephropathy after adjusting for age, gender, hemoglobin A1c, systolic blood pressure, serum triglycerides, and duration of diabetes (OR = 2.140, 95% confidence interval = 1.261-3.632, P = 0.005).
This is the first population-based study from India to report on all microvascular complications of diabetes and reveals that the association between DR and nephropathy is stronger than that with neuropathy.
本研究评估了印度南部城市 2 型糖尿病患者微血管并发症的发生与风险因素之间的关系。
从印度南部城市钦奈的人群为基础的 Chennai Urban Rural Epidemiology Study (CURES) Eye 研究中选择了糖尿病患者（n=1736）。进行了 4 象限立体视网膜彩色摄影，并根据早期治疗糖尿病视网膜病变研究的分级系统对糖尿病视网膜病变（DR）进行分类。如果使用生物感觉测量法的大脚趾振动感觉阈值≥20V，则诊断为神经病。如果受试者持续存在大量白蛋白尿（尿白蛋白排泄量≥300μg/mg 肌酐），则诊断为显性肾病，如果尿白蛋白排泄量在 30-299μg/mg 肌酐之间，则诊断为微量白蛋白尿。在可分级眼底照片的 1715 名受试者中，纳入了 1608 名有所有测试参数信息的个体。
总体而言，282 名（17.5%）受试者存在 DR，414 名（25.7%）受试者存在神经病，82 名（5.1%）受试者存在显性肾病，426 名（26.5%）受试者存在微量白蛋白尿。18 名受试者存在所有三种糖尿病微血管并发症。与无 DR 的受试者相比，有威胁视力的 DR 的受试者发生肾病（比值比[OR] = 5.3，P<0.0001）和神经病（OR = 2.9，P<0.0001）的风险显著更高。所有三种糖尿病微血管并发症的共同危险因素是年龄、糖化血红蛋白、糖尿病病程和血清甘油三酯。在调整年龄、性别、糖化血红蛋白、收缩压、血清甘油三酯和糖尿病病程后，DR 与肾病相关（OR=2.140，95%置信区间=1.261-3.632，P=0.005）。
这是印度第一项关于所有糖尿病微血管并发症的基于人群的研究，结果表明 DR 与肾病的关联强于与神经病的关联。
