Rajalakshmi Ramachandran, Shanthi Rani Coimbatore Subramanian, Venkatesan Ulagamathesan, Unnikrishnan Ranjit, Anjana Ranjit Mohan, Jeba Rani Saravanan, UmaSankari Ganesan, Sivaprasad Sobha, Raman Rajiv, Mohan Viswanathan
Ophthalmology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
BMJ Open Diabetes Res Care. 2020 May;8(1). doi: 10.1136/bmjdrc-2020-001325.
Previous epidemiological studies have reported on the prevalence of diabetic kidney disease (DKD) and diabetic retinopathy (DR) from India. The aim of this study is to evaluate the effect of DKD on the development of new-onset DR and sight-threatening diabetic retinopathy (STDR) in Asian Indians with type 2 diabetes (T2D).
The study was done on anonymized electronic medical record data of people with T2D who had undergone screening for DR and renal work-up as part of routine follow-up at a tertiary care diabetes center in Chennai, South India. The baseline data retrieved included clinical and biochemical parameters including renal profiles (serum creatinine, estimated glomerular filtration rate (eGFR) and albuminuria). Grading of DR was performed using the modified Early Treatment Diabetic Retinopathy Study grading system. STDR was defined as the presence of proliferative diabetic retinopathy (PDR) and/or diabetic macular edema. DKD was defined by the presence of albuminuria (≥30 µg/mg) and/or reduction in eGFR (<60 mL/min/1.73 m). Cox regression analysis was used to evaluate the hazard ratio (HR) for DR and STDR.
Data of 19 909 individuals with T2D (mean age 59.6±10.2 years, mean duration of diabetes 11.1±12.1 years, 66.1% male) were analyzed. At baseline, DR was present in 7818 individuals (39.3%), of whom 2249 (11.3%) had STDR. During the mean follow-up period of 3.9±1.9 years, 2140 (17.7%) developed new-onset DR and 980 individuals with non-proliferative DR (NPDR) at baseline progressed to STDR. Higher serum creatinine (HR 1.5, 95% CI 1.3 to 1.7; p<0.0001), eGFR <30 mL/min/1.73 m (HR 4.9, 95% CI 2.9 to 8.2; p<0.0001) and presence of macroalbuminuria >300 µg/mg (HR 3.0, 95% CI 2.4 to 3.8; p<0.0001) at baseline were associated with increased risk of progression to STDR.
DKD at baseline is a risk factor for progression to STDR. Physicians should promptly refer their patients with DKD to ophthalmologists for timely detection and management of STDR.
此前的流行病学研究报告了印度糖尿病肾病（DKD）和糖尿病视网膜病变（DR）的患病率。本研究旨在评估DKD对亚洲2型糖尿病（T2D）印度患者新发DR和威胁视力的糖尿病视网膜病变（STDR）发生发展的影响。
本研究对在印度南部金奈一家三级护理糖尿病中心进行常规随访时接受DR筛查和肾脏检查的T2D患者的匿名电子病历数据进行分析。检索的基线数据包括临床和生化参数，包括肾脏指标（血清肌酐、估计肾小球滤过率（eGFR）和蛋白尿）。使用改良的早期糖尿病视网膜病变研究分级系统对DR进行分级。STDR定义为存在增殖性糖尿病视网膜病变（PDR）和/或糖尿病黄斑水肿。DKD定义为存在蛋白尿（≥30μg/mg）和/或eGFR降低（<60mL/min/1.73m²）。采用Cox回归分析评估DR和STDR的风险比（HR）。
分析了19909例T2D患者的数据（平均年龄59.6±10.2岁，平均糖尿病病程11.1±12.1年，男性占66.1%）。基线时，7818例患者（39.3%）存在DR，其中2249例（11.3%）患有STDR。在平均3.9±1.9年的随访期内，2140例（17.7%）发生新发DR，980例基线时患有非增殖性DR（NPDR）的患者进展为STDR。基线时血清肌酐升高（HR 1.5，95%CI 1.3至1.7；p<0.0001）、eGFR<30mL/min/1.73m²（HR 4.9，95%CI 2.9至8.2；p<0.0001）以及存在大量蛋白尿>300μg/mg（HR 3.0，95%CI 2.4至3.8；p<0.0001）与进展为STDR的风险增加相关。
基线时的DKD是进展为STDR的危险因素。医生应及时将DKD患者转诊给眼科医生，以便及时发现和管理STDR。
