scholarly journals Effect of Intensive Diabetes Therapy on the Progression of Diabetic Retinopathy in Patients With Type 1 Diabetes: 18 Years of Follow-up in the DCCT/EDIC

Diabetes ◽  
2014 ◽  
Vol 64 (2) ◽  
pp. 631-642 ◽  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Diabetes Therapy

scholarly journals Comment on Pongrac Barlovic et al. The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes: A Longitudinal Follow-up. Diabetes Care 2018;41:2487–2494

Diabetes Care ◽  
2019 ◽  
Vol 42 (3) ◽  
pp. e48-e48 ◽  
Author(s):  
Marion Camoin ◽  
Marie-Noelle Delyfer ◽  
Jean-François Korobelnik ◽  
Kamel Mohammedi ◽  
Laurence Blanco ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Diabetes Care ◽  
Cardiovascular Outcomes

scholarly journals Frequent physical activity is associated with reduced risk of severe diabetic retinopathy in type 1 diabetes

2019 ◽  
Vol 57 (5) ◽  
pp. 527-534 ◽  
Author(s):  
Heidi Tikkanen-Dolenc ◽  
◽  
Johan Wadén ◽  
Carol Forsblom ◽  
Valma Harjutsalo ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Laser Treatment ◽  
Lower Incidence ◽  
Cox Regression ◽  
Age At Onset ◽  
Self Report

Abstract Aims The aim of this study was to investigate whether leisure-time physical activity (LTPA) is associated with the development of severe diabetic retinopathy in individuals with type 1 diabetes. Methods Prospective observational analysis as part of the Finnish diabetic nephropathy (FinnDiane) Study with a mean follow-up time of 10.7 years was performed. A total of 1612 individuals with type 1 diabetes were recruited, and LTPA was assessed at baseline using a validated self-report questionnaire. Severe diabetic retinopathy was defined as the initiation of laser treatment due to severe nonproliferative, proliferative retinopathy or diabetic maculopathy (identified from the Care Register for Health Care). Results A total of 261 patients received laser treatment during the follow-up. Higher frequency of LTPA was associated with a lower incidence of severe diabetic retinopathy (p = 0.024), a finding that remained significant after adjustment for gender, duration, age at onset of diabetes, kidney function, BMI, triglycerides and systolic blood pressure. However, when HbA1c and smoking were added to the Cox regression model the association was no more significant. Conclusions Frequent LTPA is associated with a lower incidence of severe diabetic retinopathy during the follow-up. The total amount or the other components of LTPA (intensity or duration of a single session) were not associated with severe diabetic retinopathy.

scholarly journals Influence of Age at Diagnosis and Time-Dependent Risk Factors on the Development of Diabetic Retinopathy in Patients with Type 1 Diabetes

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Luis Forga ◽  
María José Goñi ◽  
Berta Ibáñez ◽  
Koldo Cambra ◽  
Marta García-Mouriz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Glycemic Control ◽  
Diastolic Blood Pressure ◽  
Hdl Cholesterol ◽  
Time Dependent

Aim. To determine the influence of age at onset of type 1 diabetes and of traditional vascular risk factors on the development of diabetic retinopathy, in a cohort of patients who have been followed up after onset.Methods. Observational, retrospective study. The cohort consists of 989 patients who were followed up after diagnosis for a mean of 10.1 (SD: 6.8) years. The influence of age at diagnosis, glycemic control, duration of diabetes, sex, blood pressure, lipids, BMI, and smoking is analyzed using Cox univariate and multivariate models with fixed and time-dependent variables.Results. 135 patients (13.7%) developed diabetic retinopathy. The cumulative incidence was 0.7, 5.9, and 21.8% at 5-, 10-, and 15-year follow-up, respectively. Compared to the group with onset at age <10 years, the risk of retinopathy increased 2.5-, 3-, 3.3-, and 3.7-fold in the groups with onset at 10–14, 15–29, 30–44, and >44 years, respectively. During follow-up we also observed an association between diabetic retinopathy and HbA1c levels, HDL-cholesterol, and diastolic blood pressure.Conclusion. The rate of diabetic retinopathy is higher in patients who were older at type 1 diabetes diagnosis. In addition, we confirmed the influence of glycemic control, HDL-cholesterol, and diastolic blood pressure on the occurrence of retinopathy.

scholarly journals The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes: A Longitudinal Follow-up

Diabetes Care ◽  
2018 ◽  
Vol 41 (12) ◽  
pp. 2487-2494 ◽  
Author(s):  
Drazenka Pongrac Barlovic ◽  
Valma Harjutsalo ◽  
Daniel Gordin ◽  
Milla Kallio ◽  
Carol Forsblom ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Cardiovascular Outcomes

scholarly journals Bacterial infections as novel risk factors of severe diabetic retinopathy in individuals with type 1 diabetes

2020 ◽  
pp. bjophthalmol-2020-316202
Author(s):  
Johan Rasmus Simonsen ◽  
Asko Järvinen ◽  
Kustaa Hietala ◽  
Valma Harjutsalo ◽  
Carol Forsblom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Diabetic Complications ◽  
Bacterial Infections ◽  
Survival Models ◽  
Increased Risk ◽  
Treatment Data

Background/AimsDiabetic retinopathy (DR) is associated and shares many risk factors with other diabetic complications, including inflammation. Bacterial infections, potent inducers of inflammation have been associated with the development of diabetic complications apart from DR. Our aim was to investigate the association between bacterial infections and DR.MethodsAdult individuals with type 1 diabetes (n=1043) were recruited from the Finnish Diabetic Nephropathy Study (FinnDiane), a prospective follow-up study. DR was defined as incident severe diabetic retinopathy (SDR), identified as first laser treatment. Data on DR were obtained through fundus photographs and medical records, data on bacterial infections from comprehensive national registries (1 January 1995 to 31 December 2015). Risk factors for DR and serum bacterial lipopolysaccharide (LPS) activity were determined at baseline.ResultsIndividuals with incident SDR (n=413) had a higher mean number of antibiotic purchases/follow-up year compared with individuals without incident SDR (n=630) (0.92 [95% CI 0.82 to 1.02] vs 0.67 [0.62–0.73], p=0.02), as well as higher levels of LPS activity (0.61 [0.58–0.65] vs 0.56 [0.54–0.59] EU/mL, p=0.03). Individuals with on average ≥1 purchase per follow-up year (n=269) had 1.5 times higher cumulative incidence of SDR, compared with individuals with <1 purchase (n=774) per follow-up year (52% vs 35%, p<0.001). In multivariable Cox survival models, the mean number of antibiotic purchases per follow-up year as well as LPS activity were risk factors for SDR after adjusting for static confounders (HR 1.16 [1.05–1.27], p=0.002 and HR 2.77 [1.92–3.99], p<0.001, respectively).ConclusionBacterial infections are associated with an increased risk of incident SDR in type 1 diabetes.

HbA1c levels in children with type 1 diabetes and correlation to diabetic retinopathy

2018 ◽  
Vol 31 (4) ◽  
pp. 369-374 ◽  
Author(s):  
Rebecka Andreasson ◽  
Charlotte Ekelund ◽  
Mona Landin-Olsson ◽  
Charlotta Nilsson
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Glycosylated Hemoglobin ◽  
Acute Onset ◽  
Diabetes Diagnosis ◽  
Adequate Treatment ◽  
The Mean ◽  
Hba1c Levels

AbstractBackground:Type 1 diabetes mellitus (T1D) is a metabolic disease causing hyperglycemia due to β-cell destruction. Despite adequate treatment, complications such as diabetic retinopathy (DR) are common. The first aim was to investigate if acute onset of type 1 diabetes differed between those who had developed retinopathy and who had not after 15 years from diagnosis. The second aim was to investigate if mean glycosylated hemoglobin (HbA1c) levels affect the time to development of DR.Methods:The medical records of all children and adolescents diagnosed with type 1 diabetes during 1993–2001 in our area in Sweden were studied retrospectively and the mean HbA1ceach year until the development of retinopathy was investigated. In total 72 patients were included and the follow-up time was between 15 and 23 years. Gender, p-glucose, age and HbA1cat diagnosis were analyzed for possible correlations to years to retinopathy.Results:HbA1cwas significantly higher among those who had developed DR after 15 years from diagnosis, 98±9.2 (n=25) vs. 86±9.2 (n=46; p=0.025). A negative correlation was found between age at diagnosis and years to DR (rs=−0.376; p=0.026). Mean HbA1clevels at years 6–10 after diabetes diagnosis correlated significantly (rs=−0.354, p=0.037) to years until retinopathy. Mean HbA1clevels at years 1–15 after diabetes diagnosis were significantly higher at years 2–3 and years 5–8 for those who had developed retinopathy after 15 years from diagnosis.Conclusions:Higher HbA1clevels shortened the time to development of retinopathy. It is therefore important to keep HbA1cas close to normal as possible.

scholarly journals Management of Acute Proliferative Diabetic Retinopathy Related Complications During the First COVID-19 Wave

2021 ◽  
Author(s):  
Niku Dhillon ◽  
Cynthia Santiago
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Retrospective Study ◽  
Proliferative Diabetic Retinopathy ◽  
Neovascular Glaucoma ◽  
Ophthalmic Pathology ◽  
Retinal Screening ◽  
Set Up

Abstract Background. Routine hospital eye services (HES) and diabetic retinal screening were paused during COVID lockdown in March 2020. Alternate pathways for managing acute ophthalmic pathology were devised in NHS Grampian: Emergency eye treatment centres (EETC) manned by community optometrists were set up to treat and triage referrals to HES. Methods. Retrospective study analysing patients referred to HES with proliferative diabetic retinopathy (PDR) related complications between March and August 2020. Results. 52 eyes of 46 patients with PDR related complications were identified. HES appointment had been delayed or cancelled in 43% due to COVID. Mean age was 54.5 years (± 15.1), 46% were female, 46% had type 1 diabetes; mean HbA1c was 78 mmol/l (± 18.7). Vision ranged from 6/6 to perception of light. 36 patients had unilateral vitreous haemorrhage (VH), 6 bilateral, 2 tractional retinal detachments and 3 had neovascular glaucoma. Following assessment, 23 eyes received anti-VEGF injection within 3 days, two had PRP on the same day, 16 were rebooked for urgent PRP, 13 referred for urgent surgical review and 17 advised observation. After a mean follow-up of 6 months, 12 eyes (23%) of 11 patients progressed to have vitrectomy. Conclusion. Despite lockdown, hospital appointment cancellations and recommended footfall reduction limiting capacity due to COVID19, patients reaching out with PDR complications were promptly referred to HES and appropriate treatments carried out with COVID precautions as recommended.

scholarly journals Microvascular impairment as a biomarker of diabetic retinopathy progression in the long-term follow up in type 1 diabetes

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Fabio Scarinci ◽  
Fabiana Picconi ◽  
Gianni Virgili ◽  
Monica Varano ◽  
Paola Giorno ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Linear Trend ◽  
Diabetic Patients ◽  
Time Points ◽  
Significant Difference ◽  
Capillary Plexus ◽  
Over Time

Abstract This study aimed to explore differences in vascular and structural parameters using optical coherence tomography angiography in patients with type 1 diabetes (DM1) with mild signs of diabetic retinopathy (DR) over a two-year follow-up period. Parafoveal vessel density (PVD) and foveal avascular zone (FAZ) area were analyzed. The thickness of three predefined retinal slabs was measured, including the inner limiting membrane (ILM)–inner plexiform layer (IPL), IPL–inner nuclear layer (INL), and the IPL–outer nuclear layer (ONL). Twenty-two patients with DM1 and 21 controls were included. There was no significant difference in the FAZ area, perimeter and acircularity index between cohorts over time. Baseline superficial capillary plexus PVD was approximately 10% lower in patients with diabetes than in controls (p = 0.001), and was 12% lower at 2 years (p = 0.002). There was no difference in the annual linear trend between the groups (− 0.5% in diabetics vs. controls, p = 0.736). Baseline deep capillary plexus (DCP) PVD was slightly lower in diabetics than in controls (− 4.4%, p = 0.047) and the difference increased at 2 years (− 12.6%, p < 0.001). The annual linear trend was − 2.7% in diabetic patients compared to controls (p = 0.009). In addition, the PVD of the DCP and the intermediate capillary plexus (ICP) were evaluated separately. Regarding the DCP PVD, no statistically significant difference at any time points in diabetic patients compared to controls and no statistically significant difference in the linear trend was found (p > 0.1). Conversely, no difference was recorded for parafoveal ICP density at individual time points (p > 0.1), but a statistically significant difference in the linear trend over time in diabetic patients compared to controls was recoded (− 3.2% per year, p = 0.001). Despite the apparent intergroup differences at baseline in structural OCT parameters, the differences including ILM–IPL (p = 0.273), IPL–INL (p = 0.708), and IPL–ONL (p = 0.054) were modest and not statistically significant with time. Therefore, the microvascular change of the deeper vessels might be a robust biomarker to evaluate the clinical progression of DR in DM1.

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