1School of Population Health & Environmental Sciences, King's College London, London, U.K.
2Optima Partners, Edinburgh, U.K.
Diabetes Care. 2023 May 1;46(5):1091-1097. doi: 10.2337/dc22-2118.
There is limited information on the effect of ethnicity on the development of referable sight-threatening diabetic retinopathy (STDR) in people with type 1 diabetes. This study describes the risk factors for STDR in a diverse cohort of people with type 1 diabetes attending a regional diabetes eye screening service.
Clinical and digital retinal imaging data from 1,876 people with type 1 diabetes (50% women, 72.1% Caucasian, 17.3% African Caribbean, 2.9% Asian, and 7.6% other) with no retinopathy at baseline, attending surveillance eye screening were reviewed. Referable STDR was defined as the presence of any moderate to severe nonproliferative or preproliferative diabetic retinopathy or proliferative diabetic retinopathy or maculopathy in either eye as per U.K. National Diabetic Eye Screening criteria. Median follow-up was 6 years.
The median (interquartile range) age of the cohort was 29 (21, 41) years. Of the cohort of 1,876 people, 359 (19%) developed STDR. People who developed STDR had higher baseline HbA1c, raised systolic blood pressure (SBP), longer diabetes duration, and were more often of African Caribbean origin (24% vs. 15.6%; P < 0.05 for all). In multivariable Cox regression analyses, African Caribbean ethnicity (hazard ratio [HR] 1.39, 95% CI 1.09-1.78, P = 0.009), baseline SBP (HR 1.01, 95% CI 1.00-1.01, P = 0.033), and baseline HbA1c (HR 1.01, 95% CI 1.00-1.01, P = 0.0001) emerged as independent risk factors for STDR.
We observed that people with type 1 diabetes of African Caribbean ethnicity are at significantly greater risk of STDR. Further research is required to understand the mechanisms that explain this novel observation.
关于种族对 1 型糖尿病患者发生可致盲的糖尿病视网膜病变（STDR）的影响，目前信息有限。本研究描述了在参加区域性糖尿病眼部筛查服务的 1876 名 1 型糖尿病患者这一多样化队列中，STDR 的危险因素。
对基线时无视网膜病变且正在接受眼部监测筛查的 1876 名 1 型糖尿病患者（50%为女性，72.1%为白种人，17.3%为非裔加勒比人，2.9%为亚洲人，7.6%为其他种族）的临床和数字视网膜成像数据进行了回顾。根据英国国家糖尿病眼部筛查标准，将任何一眼出现中度至重度非增殖性或前增殖性糖尿病视网膜病变或增殖性糖尿病视网膜病变或黄斑病变定义为可致盲的 STDR。中位随访时间为 6 年。
队列的中位（四分位间距）年龄为 29（21，41）岁。在 1876 名患者中，有 359 名（19%）发生了 STDR。发生 STDR 的患者基线时的糖化血红蛋白（HbA1c）、收缩压（SBP）较高，糖尿病病程较长，且更常来自非裔加勒比地区（24%比 15.6%；所有差异 P<0.05）。多变量 Cox 回归分析显示，非裔加勒比人种族（风险比[HR]1.39，95%可信区间[CI]1.09-1.78，P=0.009）、基线 SBP（HR 1.01，95%CI 1.00-1.01，P=0.033）和基线 HbA1c（HR 1.01，95%CI 1.00-1.01，P=0.0001）是 STDR 的独立危险因素。
我们发现，非裔加勒比裔 1 型糖尿病患者发生 STDR 的风险显著增加。需要进一步研究以了解解释这一新观察结果的机制。
