Pan Chen-Wei, Wang Shan, Xu Cai-Lian, Song E
1School of Public Health, Medical College of Soochow University, Suzhou, China.
2Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, China.
Diabetol Metab Syndr. 2018 Oct 1;10:73. doi: 10.1186/s13098-018-0377-7. eCollection 2018.
To explore the associations of glycemic and blood pressure (BP) control with diabetic retinopathy (DR), with special focus on whether different combinations of categories of these two interventions are additive.
A community-based survey including 913 patients with known type-2 diabetes mellitus (T2DM) was conducted in Suzhou, China. Retinal photographs were graded for the presence of DR using the Airlie House classification system. BP and blood hemoglobin A1c (HbA1C) levels were measured by standardized protocols. Binary logistic regression models were established to examine the associations of risk factors with DR.
The overall prevalence of any DR was 18.0% [95% confidence interval (95% CI) 15.5-20.6%] in this population. Stratified by conventional control thresholds, lower levels of either systolic blood pressure (SBP, < 140 mmHg) or HbA1C (< 7.0%) were not significantly associated with decreased susceptibility to DR, while patients simultaneously with lower HbA1C and SBP levels demonstrated 43% reduced likelihood of developing DR [adjusted odds ratio (OR) = 0.57, 95% CI 0.33-0.99, = 0.045)], comparing with those with both higher levels of HbA1C (≥ 7.0%) and SBP (≥ 140 mmHg). Meanwhile, the group achieved intensive HbA1C (< 6.5%) and SBP (< 120 mmHg) control goals were found to have the smallest OR, but failed in yielding statistical significance (P = 0.10).
In this community-based DR screening study of Chinese adults with T2DM, combination but not individual of lower SBP (< 140 mmHg) and HbA1C (< 7.0%) levels, were suggested to be associated with a significantly reduced likelihood of having DR.
探讨血糖和血压（BP）控制与糖尿病视网膜病变（DR）之间的关联，特别关注这两种干预措施不同类别组合是否具有叠加性。
在中国苏州开展了一项基于社区的调查，纳入913例已知2型糖尿病（T2DM）患者。使用艾利屋分类系统对视网膜照片进行DR分级。通过标准化方案测量血压和糖化血红蛋白（HbA1C）水平。建立二元逻辑回归模型以检验危险因素与DR的关联。
该人群中任何DR的总体患病率为18.0%[95%置信区间（95%CI）15.5 - 20.6%]。按传统控制阈值分层，收缩压（SBP，<140 mmHg）或HbA1C（<7.0%）水平较低与DR易感性降低无显著关联，而HbA1C和SBP水平均较低的患者发生DR的可能性降低43%[调整优势比（OR）=0.57，95%CI 0.33 - 0.99，P = 0.045]，与HbA1C（≥7.0%）和SBP（≥140 mmHg）水平均较高的患者相比。同时，实现强化HbA1C（<6.5%）和SBP（<120 mmHg）控制目标的组OR最小，但未达到统计学显著性（P = 0.10）。
在这项针对中国成年T2DM患者的基于社区的DR筛查研究中，SBP（<140 mmHg）和HbA1C（<7.0%）水平的联合而非单独作用，与DR发生可能性显著降低相关。
