Wellcome-Wolfson Institute for Experimental Medicine, Belfast, UK.
Centre for Public Health, Queens University, Belfast, UK.
Diabet Med. 2020 Jun;37(6):1000-1007. doi: 10.1111/dme.14278. Epub 2020 Mar 17.
To determine factors associated with progression to referable diabetic retinopathy in people with type 2 diabetes in the Republic of Ireland.
The study was conducted in a dynamic cohort of 2770 people with type 2 diabetes, recruited between April 2005 and July 2013. Systemic factors (systolic and diastolic blood pressure, HbA , lipid levels, BMI) and baseline diabetic retinopathy grading results were evaluated at 4-monthly and yearly intervals, respectively. Associations between risk factors (most recently recorded value, and rate of change in value between pairs of consecutive systemic evaluations) and development of referable diabetic retinopathy were estimated using Cox proportional hazards models.
There was a fourfold increased risk of progression to referral when retinopathy was present at baseline vs no retinopathy at baseline (hazard ratio 4.02, 95% CI 2.80-5.78; P<0.001). Higher current values of HbA (hazard ratio 1.22, 95% CI 1.11-1.34; P<0.001), systolic blood pressure (hazard ratio 1.29, 95% CI 1.15-1.45; P<0.001) and triglycerides (hazard ratio 1.10, 95% CI 1.03-1.18; P=0.004) were associated with increased risk of referral. Higher current BMI (hazard ratio 0.83, 95% CI 0.73-0.95; P=0.007) and diastolic blood pressure (hazard ratio 0.91, 95% CI 0.85-0.97; P=0.006) were associated with reduced risk of referral.
Presence of retinopathy at baseline was strongly associated with increased risk of referral. Modest associations between systemic factors and risk of progression to referable retinopathy were detected.
确定与爱尔兰 2 型糖尿病患者进展为可转诊的糖尿病视网膜病变相关的因素。
本研究纳入了 2005 年 4 月至 2013 年 7 月期间招募的 2770 名 2 型糖尿病患者的动态队列。分别在每 4 个月和每年评估系统因素（收缩压和舒张压、HbA1c、血脂水平、BMI）和基线糖尿病视网膜病变分级结果。使用 Cox 比例风险模型估计危险因素（最近记录的值以及连续两次系统评估之间值的变化率）与发展为可转诊的糖尿病视网膜病变之间的关联。
与基线时无视网膜病变相比，基线时存在视网膜病变患者进展为转诊的风险增加了四倍（风险比 4.02，95%CI 2.80-5.78；P<0.001）。当前较高的 HbA1c 值（风险比 1.22，95%CI 1.11-1.34；P<0.001）、收缩压（风险比 1.29，95%CI 1.15-1.45；P<0.001）和甘油三酯（风险比 1.10，95%CI 1.03-1.18；P=0.004）与转诊风险增加相关。当前较高的 BMI（风险比 0.83，95%CI 0.73-0.95；P=0.007）和舒张压（风险比 0.91，95%CI 0.85-0.97；P=0.006）与转诊风险降低相关。
基线时存在视网膜病变与转诊风险增加密切相关。检测到系统因素与进展为可转诊的糖尿病视网膜病变风险之间存在适度关联。
