Chen M S, Kao C S, Fu C C, Chen C J, Tai T Y
Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Int J Epidemiol. 1995 Aug;24(4):787-95. doi: 10.1093/ije/24.4.787.
To assess the incidence and progression of diabetic retinopathy and explore risk factors associated with them among non-insulin-dependent diabetes mellitus (NIDDM) patients.
A total of 471 NIDDM subjects aged > or 40 were recruited from four primary health care centres of northern Taiwan in 1986 and followed up for 4 years. Their ocular fundi were clearly visible by ophthalmoscopy and the status of diabetic retinopathy could be graded. A structured questionnaire interview was conducted to collect basic data. Overnight fasting venous blood was collected every year to measure the levels of glucose, glycosylated haemoglobin (HbA1c), cholesterol and high density lipoprotein cholesterol.
Among the 344 subjects who had no retinopathy initially, 66 subjects developed retinopathy 4 years later giving a 4-year cumulative incidence of 19.2%. Of the 120 subjects initially with background or preproliferative retinopathy, evidence of deterioration developed in 36 subjects. The cumulative incidence of progression was 30%. Seven subjects developed proliferative retinopathy giving a cumulative incidence of progression to proliferative retinopathy of 5.8%. The univariate analysis disclosed that the development of retinopathy was correlated with mean fasting blood glucose (MFBG) and HbA1c, diabetic duration, diabetic treatment and residential area. The progression of retinopathy correlated with MFBG and proteinuria, and the progression to proliferative retinopathy correlated with MFBG. Stepwise logistic regression analysis revealed that MFBG and HbA1c were the significant risk factors related to the development of retinopathy.
Diabetic control assessed by MFBG or HbA1c was the significant risk factor correlated with the incidence and progression of retinopathy.
评估非胰岛素依赖型糖尿病（NIDDM）患者糖尿病视网膜病变的发病率和进展情况，并探讨与之相关的危险因素。
1986年从台湾北部四个基层医疗中心招募了471名年龄≥40岁的NIDDM患者，并进行了4年的随访。通过眼底镜检查可清晰观察到他们的眼底，并对糖尿病视网膜病变的状况进行分级。进行结构化问卷调查以收集基本数据。每年采集过夜空腹静脉血，测量血糖、糖化血红蛋白（HbA1c）、胆固醇和高密度脂蛋白胆固醇水平。
在最初无视网膜病变的344名受试者中，4年后有66名受试者发生了视网膜病变，4年累积发病率为19.2%。在最初患有背景性或增殖前期视网膜病变的120名受试者中，有36名出现了病情恶化的迹象。进展的累积发病率为30%。7名受试者发展为增殖性视网膜病变，增殖性视网膜病变进展的累积发病率为5.8%。单因素分析显示，视网膜病变的发生与平均空腹血糖（MFBG）、HbA1c、糖尿病病程、糖尿病治疗及居住地区有关。视网膜病变的进展与MFBG和蛋白尿有关，而进展为增殖性视网膜病变与MFBG有关。逐步逻辑回归分析显示，MFBG和HbA1c是与视网膜病变发生相关的重要危险因素。
通过MFBG或HbA1c评估的糖尿病控制情况是与视网膜病变的发病率和进展相关的重要危险因素。
