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Author Spotlight: Understanding Retinal Vessel Resilience and Disease Progression
Published on: January 12, 2024
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Risk Factors for the Development of Retinopathy in Prediabetes and Type 2 Diabetes: The Diabetes Prevention Program
Neil H White1, Qing Pan2, William C Knowler3
1Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO.
Diabetes Care
|September 13, 2022
Summary
Diabetic retinopathy (DR) can occur before type 2 diabetes (T2D) onset. Higher HbA1c levels are a significant risk factor for DR development across the glycemic spectrum.
Area of Science:
- Endocrinology
- Ophthalmology
- Diabetes Research
Background:
- Diabetic retinopathy (DR) is a leading cause of vision loss in individuals with diabetes.
- Identifying risk factors for DR is crucial for early intervention and prevention.
- The Diabetes Prevention Program (DPP) and its Outcome Study (DPPOS) provide a unique dataset to study DR development over time.
Purpose of the Study:
- To identify glycemic and nonglycemic risk factors for diabetic retinopathy (DR) development.
- To analyze DR risk factors before and after the onset of type 2 diabetes (T2D).
Main Methods:
- Fundus photography was used to grade DR in adults at high risk for T2D in the DPP and DPPOS.
- Participants were followed over approximately 20 years.
- Statistical analyses, including univariate and multivariate models, were employed to assess risk factors.
Main Results:
- DR developed in 24% of participants who developed T2D and 14% who did not by DPPOS year 16.
- American Indian race was associated with less DR compared to non-Hispanic White (NHW) race.
- Higher HbA1c, fasting and 2-h plasma glucose, weight, hypertension, dyslipidemia, and smoking were associated with increased DR risk.
Conclusions:
- Diabetic retinopathy can manifest in individuals with prediabetes and in the early stages of T2D.
- HbA1c is a significant predictor of DR development across the full range of glycemic control, from prediabetes to T2D.
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