Retinopathy in older type II diabetics. Association with glucose control

Non-insulin-dependent (type II) diabetics over the age of 55 comprise most of the diabetic population and are at considerable risk for the development of both macrovascular and microvascular complications. We studied the prevalence of retinopathy and its association with putative risk factors for its development in an elderly (55- to 75-yr-old) population of type II diabetics. Our cross-sectional analysis revealed that duration of diabetes and hemoglobin A1c (HbA1c) concentration were the two major predictors of the presence of retinopathy. Duration effect was seen after 10 yr of diabetes, whereas HbA1c effect was linear over its entire range. Hypertension, which has been reported to be a risk factor for microvascular disease in younger diabetic patients, was not associated with retinopathy in the older type II population. Multiple logistic regression analysis revealed that both the duration of diabetes and HbA1c remained significant independent determinants of retinopathy even after taking age and blood pressure into account. Our results support an etiologic role for metabolic control in the development of retinopathy in the elderly type II population.