Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
NIHR Biomedical Research Center at Moorfield's Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Ophthalmic Epidemiol. 2021 Apr;28(2):122-130. doi: 10.1080/09286586.2020.1800753. Epub 2020 Sep 29.
This study investigates the relationship between diabetic retinopathy (DR) and birth weight (BW) in diabetic subjects sampled from the general population.
The Gutenberg Health Study (GHS) is a population-based, observational cohort study in participants aged from 35 to 74 years. Criteria for diabetes diagnosis were HbA1c ≥6.5% at study entry, a doctor-diagnosis of diabetes, or diabetes medication. The presence of DR was determined by evaluating fundus photographs. BW was assessed by self-reports. GHS participants were divided into three different BW groups (low: <2500 g; normal: 2500-4000 g; high:>4000 g). Logistic regression analysis was conducted as uni- and multivariable analysis with adjustment for age and sex. Effect mediators were separately investigated.
A total of 1,124 GHS participants (7.5% of the cohort) had diabetes at study entry. Of these, 402 subjects (35.8%) had gradable fundus photographs, reported BW data and were included into this study. Overall, 91/402 subjects (23%) had DR. With regard to BW groups, DR was descriptively more frequent in subjects with low (28.1% [95%-CI: 14.4-47.0%; n = 32]) and high BW (30.8% [95%-CI: 19.1-45.3%; n = 52]) compared to normal BW (20.8% [95%-CI: 16.5-25.7%; n = 318]). Both high and low BW were associated with DR in multivariable analysis (high: OR = 1.68, = .037; low: OR = 1.81, = .05). The BW effect was mediated by duration of diabetes in both BW groups and by arterial hypertension in the low BW group.
Low and high BW in persons with diabetes is related to higher risk of diabetic retinopathy. Longer duration of diabetes and higher prevalence of arterial hypertension are factors in these subjects explaining the elevated risk.
本研究旨在调查一般人群中糖尿病患者的糖尿病视网膜病变（DR）与出生体重（BW）之间的关系。
哥廷根健康研究（GHS）是一项基于人群的观察性队列研究，参与者年龄在 35 至 74 岁之间。糖尿病的诊断标准为研究开始时 HbA1c≥6.5%、医生诊断为糖尿病或使用糖尿病药物。通过评估眼底照片来确定 DR 的存在。BW 通过自我报告进行评估。GHS 参与者被分为三个不同的 BW 组（低：<2500g；正常：2500-4000g；高：>4000g）。使用单变量和多变量分析进行逻辑回归分析，并调整年龄和性别。分别调查了效应中介物。
共有 1124 名 GHS 参与者（队列的 7.5%）在研究开始时患有糖尿病。其中，402 名受试者（35.8%）有可分级的眼底照片，报告了 BW 数据，并被纳入本研究。总体而言，402 名受试者中有 91 名（23%）患有 DR。就 BW 组而言，低 BW 组（28.1%[95%-CI：14.4-47.0%；n=32]）和高 BW 组（30.8%[95%-CI：19.1-45.3%；n=52]）中 DR 的发生率明显高于正常 BW 组（20.8%[95%-CI：16.5-25.7%；n=318]）。在多变量分析中，高 BW 和低 BW 均与 DR 相关（高 BW：OR=1.68， =0.037；低 BW：OR=1.81， =0.05）。在两个 BW 组中，BW 效应由糖尿病病程介导，在低 BW 组中由动脉高血压介导。
糖尿病患者的低 BW 和高 BW 与糖尿病视网膜病变的风险增加有关。糖尿病病程较长和动脉高血压患病率较高是这些受试者中解释风险增加的因素。
