Sardarinia Mahsa, Asgari Samaneh, Hizomi Arani Reyhane, Eskandari Fatemeh, Azizi Fereidoun, Khalili Davood, Hadaegh Farzad
Eye Research Center, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Diabetes Investig. 2022 Feb;13(2):317-327. doi: 10.1111/jdi.13647. Epub 2021 Sep 13.
AIMS/INTRODUCTION: To examine the incidence rate of severe non-proliferative and proliferative diabetic retinopathy (severe-NPDR/PDR) and determine its potential risk factors.
The study consisted of 1,169 participants (675 women) with type 2 diabetes mellitus, aged ≥20 years. A trained interviewer collected information about the history of pan-retinal photocoagulation as a result of diabetic retinopathy. Multivariable Cox proportional hazards regression models were applied.
We found 187 cases (126 women) of severe-NPDR/PDR during a median follow-up period of 12.7 years; the corresponding incidence rate was 13.6 per 1,000 person-years. Being overweight (hazard ratio [HR], 95% confidence interval [CI] 0.60, 0.39-0.92) and obese (HR 0.48, 95% CI 0.27-0.83) were associated with lower risk, whereas being smoker (HR 1.75, 95% CI 1.12-2.74), having fasting plasma glucose levels 7.22-10.0 mmol/L (HR 2.81, 95% CI 1.70-4.62), fasting plasma glucose ≥10 mmol/L (HR 5.87, 95% CI 3.67-9.41), taking glucose-lowering medications (HR 2.58, 95% CI 1.87-3.56), prehypertension status (HR 1.65, 95% CI 1.05-2.58) and newly diagnosed hypertension (HR 1.96, 95% CI 1.06-3.65) increased the risk of severe-NPDR/PDR. Among newly diagnosed diabetes patients, being male was associated with a 59% lower risk of severe-NPDR/PDR (HR 0.41, 95% CI 0.21-0.79). Furthermore, patients who had an intermediate level of education (6-12 years) had a higher risk of developing PDR (HR 1.86, 95% CI 1.05-3.30) compared with those who had <6 years of education.
Among Iranians with type 2 diabetes mellitus, 1.36% developed severe-NPDR/PDR annually. Normal bodyweight, being a smoker, out of target fasting plasma glucose level, prehypertension and newly diagnosed hypertension status were independent risk factors of severe-NPDR/PDR. Regarding the sight-threatening entity of advanced diabetic retinopathy, the multicomponent strategy to control diabetes, abstinence of smoking and tight control of blood pressure should be considered.
目的/引言：研究重度非增殖性和增殖性糖尿病视网膜病变（重度NPDR/PDR）的发病率，并确定其潜在危险因素。
该研究纳入了1169名年龄≥20岁的2型糖尿病患者（675名女性）。由经过培训的访员收集因糖尿病视网膜病变而进行全视网膜光凝治疗的病史信息。应用多变量Cox比例风险回归模型。
在中位随访期12.7年期间，我们发现了187例重度NPDR/PDR病例（126名女性）；相应的发病率为每1000人年13.6例。超重（风险比[HR]，95%置信区间[CI] 0.60，0.39 - 0.92）和肥胖（HR 0.48，95% CI 0.27 - 0.83）与较低风险相关，而吸烟者（HR 1.75，95% CI 1.12 - 2.74）、空腹血糖水平为7.22 - 10.0 mmol/L（HR 2.81，95% CI 1.70 - 4.62）、空腹血糖≥10 mmol/L（HR 5.87，95% CI 3.67 - 9.41）、服用降糖药物（HR 2.58，95% CI 1.87 - 3.56）、高血压前期状态（HR 1.65，95% CI 1.05 - 2.58）和新诊断的高血压（HR 1.96，95% CI 1.06 - 3.65）会增加重度NPDR/PDR的风险。在新诊断的糖尿病患者中，男性患重度NPDR/PDR的风险降低59%（HR 0.41，95% CI 0.21 - 0.79）。此外，与受教育年限<6年的患者相比，接受中等教育水平（6 - 12年）的患者发生PDR的风险更高（HR 1.86，95% CI 1.05 - 3.30）。
在伊朗2型糖尿病患者中，每年有1.36%发生重度NPDR/PDR。正常体重、吸烟、空腹血糖未达标、高血压前期和新诊断的高血压状态是重度NPDR/PDR的独立危险因素。鉴于晚期糖尿病视网膜病变对视力的威胁，应考虑采取多组分策略来控制糖尿病、戒烟和严格控制血压。
