Marques-Couto Pedro, Villard Arthur, Mota-Moreira Pedro, Ferrão-Mendes António, Leite Ana Rita, Neves João Sérgio, Falcão Manuel, Laiginhas Rita
Department of Ophthalmology, Unidade Local de Saúde de São João, Porto, Portugal.
Faculty of Medicine of the University of Porto, Porto, Portugal.
Endocrine. 2025 Jun 2. doi: 10.1007/s12020-025-04295-8.
Treatment and monitoring developments markedly improved the survival rate of individuals with type 1 diabetes (T1D). Nevertheless, literature remains scarce on long-term incidence of diabetic macular edema (DME) in this population, with the major study existing in the field - Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) - reporting its development at 30 years of disease. We aimed to estimate the long-term risk of DME and associated factors in a representative sample of type 1 diabetic patients.
This retrospective cohort study included 235 patients with T1D from a tertiary center in Portugal. Data on demographics and clinical characteristics were extracted from digital medical records and analyzed using descriptive statistics. Kaplan-Meier survival analysis was used to assess DME development over the follow-up period. Potential predictors of DME, including age at T1D diagnosis, duration of T1D, glycated hemoglobin (HbA1c), body mass index (BMI), severity of diabetic retinopathy (DR), systolic and diastolic blood pressure (SBP and DBP), and smoking habits, were analyzed using multivariate Cox regression.
The overall prevalence of DME was 18.7%. The cumulative risk of developing DME escalated from 7.6% at 20 years to 51.1% at 65 years of T1D duration (p < 0.001). Patients with severe or proliferative DR had a significantly higher prevalence of DME (p < 0.001). The prevalence of microvascular complications was higher in the DME group (54.5% versus 19.4%, p < 0.001). Age at T1D diagnosis and DR severity were the strongest predictors of DME, with hazard ratios of 1.03 (95% CI [1.00-1.06]; p = 0.029) and 1.46 (95% CI [1.20-1.77]; p < 0.001), respectively. HbA1c and SBP were associated with DME in univariate analysis but lost significance in multivariate models.
This study highlights the time-dependent nature of DME development in T1D, with a marked increase in risk beyond 20 years of disease duration, a pattern that appears to differ from what is typically observed in T2D. DR severity was a key predictor of DME. DME was associated with the presence of microvascular, but not macrovascular complications. These findings emphasize the importance of tailored surveillance strategies to improve outcomes in this high-risk population.
治疗和监测方面的进展显著提高了1型糖尿病（T1D）患者的生存率。然而，关于该人群糖尿病性黄斑水肿（DME）长期发病率的文献仍然稀少，该领域的主要研究——糖尿病控制与并发症试验/糖尿病干预与并发症流行病学研究（DCCT/EDIC）——报告了其在病程30年时的发病情况。我们旨在估计1型糖尿病患者代表性样本中DME的长期风险及相关因素。
这项回顾性队列研究纳入了葡萄牙一家三级中心的235例T1D患者。从数字医疗记录中提取人口统计学和临床特征数据，并使用描述性统计进行分析。采用Kaplan-Meier生存分析评估随访期间DME的发生情况。使用多变量Cox回归分析DME的潜在预测因素，包括T1D诊断时的年龄、T1D病程、糖化血红蛋白（HbA1c）、体重指数（BMI）、糖尿病视网膜病变（DR）的严重程度、收缩压和舒张压（SBP和DBP）以及吸烟习惯。
DME的总体患病率为18.7%。T1D病程从20年时DME发生的累积风险7.6%上升至65年时的51.1%（p < 0.001）。重度或增殖性DR患者DME的患病率显著更高（p < 0.001）。DME组微血管并发症的患病率更高（54.5%对19.4%，p < 0.001）。T1D诊断时的年龄和DR严重程度是DME最强的预测因素，风险比分别为1.03（95%置信区间[1.00 - 1.06]；p = 0.029）和1.46（95%置信区间[1.20 - 1.77]；p < 0.001）。HbA1c和SBP在单变量分析中与DME相关，但在多变量模型中失去显著性。
本研究强调了T1D中DME发生的时间依赖性，病程超过20年后风险显著增加，这种模式似乎与2型糖尿病（T2D）中通常观察到的情况不同。DR严重程度是DME 的关键预测因素。DME与微血管并发症的存在相关，但与大血管并发症无关。这些发现强调了制定针对性监测策略以改善这一高危人群预后的重要性。
