Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO.
The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD.
Diabetes Care. 2022 Nov 1;45(11):2653-2661. doi: 10.2337/dc22-0860.
To determine glycemic and nonglycemic risk factors that contribute to the presence of diabetic retinopathy (DR) before and after the onset of type 2 diabetes (T2D).
During the Diabetes Prevention Program (DPP) and DPP Outcome Study (DPPOS), we performed fundus photography over time in adults at high risk for developing T2D, including after they developed diabetes. Fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) grading system, with DR defined as typical lesions of DR (microaneurysms, exudates, hemorrhage, or worse) in either eye.
By DPPOS year 16 (∼20 years after random assignment into DPP), 24% of 1,614 participants who had developed T2D and 14% of 885 who remained without diabetes had DR. In univariate analyses, using results from across the entire duration of follow-up, American Indian race was associated with less frequent DR compared with non-Hispanic White (NHW) race, and higher HbA1c, fasting and 2-h plasma glucose levels during an oral glucose tolerance test, weight, and history of hypertension, dyslipidemia, and smoking, but not treatment group assignment, were associated with more frequent DR. On multivariate analysis, American Indian race was associated with less DR compared with NHW (odds ratio [OR] 0.36, 95% CI 0.20-0.66), and average HbA1c was associated with more DR (OR 1.92, 95% CI 1.46-1.74 per SD [0.7%] increase in HbA1c).
DR may occur in adults with prediabetes and early in the course of T2D. HbA1c was an important risk factor for the development of DR across the entire glycemic range from prediabetes to T2D.
确定 2 型糖尿病（T2D）发病前后导致糖尿病视网膜病变（DR）发生的血糖和非血糖危险因素。
在糖尿病预防计划（DPP）和 DPP 结果研究（DPPOS）期间，我们对处于发生 T2D 高危状态的成年人进行了随时间进行眼底摄影，包括在他们发生糖尿病之后。使用糖尿病眼病早期治疗研究（ETDRS）分级系统对眼底照片进行分级，将任何一只眼出现典型的 DR 病变（微动脉瘤、渗出物、出血或更严重病变）定义为 DR。
在 DPPOS 第 16 年（随机分配进入 DPP 后约 20 年），24%的 1614 名已发生 T2D 的参与者和 14%的 885 名未发生糖尿病的参与者患有 DR。在单变量分析中，使用整个随访期间的结果，与非西班牙裔白人（NHW）相比，美洲印第安人种族与较少发生 DR 相关，而较高的糖化血红蛋白（HbA1c）、空腹和口服葡萄糖耐量试验 2 小时血糖水平、体重以及高血压、血脂异常和吸烟史与更多发生 DR 相关，但与治疗组分配无关。在多变量分析中，与 NHW 相比，美洲印第安人种族与较少的 DR 相关（比值比 [OR] 0.36，95%可信区间 [CI] 0.20-0.66），平均 HbA1c 与更多的 DR 相关（OR 1.92，95%CI 1.46-1.74，HbA1c 每增加 0.7% [0.7%]）。
DR 可能发生在糖尿病前期和 T2D 早期的成年人中。HbA1c 是从糖尿病前期到 T2D 的整个血糖范围内发生 DR 的重要危险因素。
