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. 2000 Aug;84(8):871–876. doi: 10.1136/bjo.84.8.871

Maculopathy in patients with diabetes mellitus type 1 and type 2: associations with risk factors

E Zander 1, S Herfurth 1, B Bohl 1, P Heinke 1, U Herrmann 1, K Kohnert 1, W Kerner 1
PMCID: PMC1723591  PMID: 10906094

Abstract

AIM—To examine possible relation between diabetic maculopathy and various risk factors for diabetic complications in patients with diabetes mellitus type 1 and type 2.
METHODS—Cross sectional study of two cohorts of diabetic patients, comprising 1796 patients with type 1 diabetes (mean age 47 years, mean duration of diabetes 24 years) and 1563 patients with type 2 diabetes (mean age 62 years, mean duration of diabetes 16 years). Retinopathy levels (R0-RV) and maculopathy were assessed by fluorescence angiography and fundus photography and binocular biomicroscopy. Diabetic neuropathy was assessed by means of computer assisted electrocardiography and by thermal and vibratory sensory examination. Patients were classified as normoalbuminuric (<20 µg/min) or microalbuminuric (20-200 µg/min) according to their albumin excretion rates measured in urine collected overnight. Using univariate analyses, the effects of selected patient characteristics on the presence of maculopathy were evaluated. Multiple logistic regression analyses were performed to determine independent effects of risk variables on diabetic maculopathy.
RESULTS—Background retinopathy (RII) was found to be present in 28% of type 1 diabetic patients and in 38% of type 2 diabetic patients. The prevalence of maculopathy in these patients was remarkably high (42% in type 1 and 53% in type 2 diabetic patients). Patients with maculopathy had significantly impaired visual acuity. Multiple logistic correlation analysis revealed that in both types of diabetes maculopathy exhibited independent associations with duration of diabetes and with neuropathy (p <0.01); in type 1 diabetic patients there were significant associations with age at diabetes onset, serum triglyceride and total cholesterol levels (p <0.05); in type 2 diabetes with serum creatinine levels and with hypertension (p <0.05).
CONCLUSIONS—Irrespective of the type of diabetes, diabetic patients with long standing diabetes have a high risk for the development of diabetic maculopathy. Diabetic maculopathy is closely associated with diabetic nephropathy and neuropathy and with several atherosclerotic risk factors which suggests that these factors might have an important role in the pathogenesis of maculopathy. However, prospective trials are necessary to evaluate the predictive value of such factors. The findings of the present cross sectional study reinforce the arguments of previous studies by others for tight control of hypertension and hyperglycaemia.



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Selected References

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  1. Aiello L. M., Rand L. I., Briones J. C., Wafai M. Z., Sebestyen J. G. Diabetic retinopathy in Joslin Clinic patients with adult-onset diabetes. Ophthalmology. 1981 Jul;88(7):619–623. doi: 10.1016/s0161-6420(81)34982-3. [DOI] [PubMed] [Google Scholar]
  2. Arend O., Wolf S., Jung F., Bertram B., Pöstgens H., Toonen H., Reim M. Retinal microcirculation in patients with diabetes mellitus: dynamic and morphological analysis of perifoveal capillary network. Br J Ophthalmol. 1991 Sep;75(9):514–518. doi: 10.1136/bjo.75.9.514. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bresnick G. H. Diabetic maculopathy. A critical review highlighting diffuse macular edema. Ophthalmology. 1983 Nov;90(11):1301–1317. doi: 10.1016/s0161-6420(83)34388-8. [DOI] [PubMed] [Google Scholar]
  4. Cunha-Vaz J. G., Travassos A. Breakdown of the blood-retinal barriers and cystoid macular edema. Surv Ophthalmol. 1984 May;28 (Suppl):485–492. doi: 10.1016/0039-6257(84)90230-3. [DOI] [PubMed] [Google Scholar]
  5. Cunha-Vaz J., Faria de Abreu J. R., Campos A. J. Early breakdown of the blood-retinal barrier in diabetes. Br J Ophthalmol. 1975 Nov;59(11):649–656. doi: 10.1136/bjo.59.11.649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Feke G. T., Buzney S. M., Ogasawara H., Fujio N., Goger D. G., Spack N. P., Gabbay K. H. Retinal circulatory abnormalities in type 1 diabetes. Invest Ophthalmol Vis Sci. 1994 Jun;35(7):2968–2975. [PubMed] [Google Scholar]
  7. Ferris F. L., 3rd, Davis M. D., Aiello L. M. Treatment of diabetic retinopathy. N Engl J Med. 1999 Aug 26;341(9):667–678. doi: 10.1056/NEJM199908263410907. [DOI] [PubMed] [Google Scholar]
  8. Ferris F. L., 3rd, Patz A. Macular edema. A complication of diabetic retinopathy. Surv Ophthalmol. 1984 May;28 (Suppl):452–461. doi: 10.1016/0039-6257(84)90227-3. [DOI] [PubMed] [Google Scholar]
  9. Fong D. S., Warram J. H., Aiello L. M., Rand L. I., Krolewski A. S. Cardiovascular autonomic neuropathy and proliferative diabetic retinopathy. Am J Ophthalmol. 1995 Sep;120(3):317–321. doi: 10.1016/s0002-9394(14)72161-0. [DOI] [PubMed] [Google Scholar]
  10. Furukawa H. Autonomic innervation of preretinal blood vessels of the rabbit. Invest Ophthalmol Vis Sci. 1987 Nov;28(11):1752–1760. [PubMed] [Google Scholar]
  11. Gottschling H. D., Jahr D., Diaz-Alonso J. H., Keilacker H., Besch W., Werner S., Ziegler M. Enzymimmunoassay zur Bestimmung von Albumin im Urin. Z Med Lab Diagn. 1991;32(2):84–90. [PubMed] [Google Scholar]
  12. Grunwald J. E., DuPont J., Riva C. E. Retinal haemodynamics in patients with early diabetes mellitus. Br J Ophthalmol. 1996 Apr;80(4):327–331. doi: 10.1136/bjo.80.4.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Grunwald J. E., Riva C. E., Baine J., Brucker A. J. Total retinal volumetric blood flow rate in diabetic patients with poor glycemic control. Invest Ophthalmol Vis Sci. 1992 Feb;33(2):356–363. [PubMed] [Google Scholar]
  14. Klein B. E., Klein R., Moss S. E., Palta M. A cohort study of the relationship of diabetic retinopathy to blood pressure. Arch Ophthalmol. 1995 May;113(5):601–606. doi: 10.1001/archopht.1995.01100050069033. [DOI] [PubMed] [Google Scholar]
  15. Klein B. E., Moss S. E., Klein R., Surawicz T. S. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XIII. Relationship of serum cholesterol to retinopathy and hard exudate. Ophthalmology. 1991 Aug;98(8):1261–1265. doi: 10.1016/s0161-6420(91)32145-6. [DOI] [PubMed] [Google Scholar]
  16. Klein R., Klein B. E., Moss S. E., Cruickshanks K. J. The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XVII. The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmology. 1998 Oct;105(10):1801–1815. doi: 10.1016/S0161-6420(98)91020-X. [DOI] [PubMed] [Google Scholar]
  17. Klein R., Klein B. E., Moss S. E., Cruickshanks K. J. The Wisconsin Epidemiologic Study of diabetic retinopathy. XIV. Ten-year incidence and progression of diabetic retinopathy. Arch Ophthalmol. 1994 Sep;112(9):1217–1228. doi: 10.1001/archopht.1994.01090210105023. [DOI] [PubMed] [Google Scholar]
  18. Klein R., Klein B. E., Moss S. E., Davis M. D., DeMets D. L. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol. 1984 Apr;102(4):527–532. doi: 10.1001/archopht.1984.01040030405011. [DOI] [PubMed] [Google Scholar]
  19. Klein R., Klein B. E., Moss S. E., Davis M. D., DeMets D. L. The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macular edema. Ophthalmology. 1984 Dec;91(12):1464–1474. doi: 10.1016/s0161-6420(84)34102-1. [DOI] [PubMed] [Google Scholar]
  20. Klein R., Klein B. E., Moss S. E. Epidemiology of proliferative diabetic retinopathy. Diabetes Care. 1992 Dec;15(12):1875–1891. doi: 10.2337/diacare.15.12.1875. [DOI] [PubMed] [Google Scholar]
  21. Klein R., Moss S. E., Klein B. E. New management concepts for timely diagnosis of diabetic retinopathy treatable by photocoagulation. Diabetes Care. 1987 Sep-Oct;10(5):633–638. doi: 10.2337/diacare.10.5.633. [DOI] [PubMed] [Google Scholar]
  22. Kohner E. M., Hamilton A. M., Saunders S. J., Sutcliffe B. A., Bulpitt C. J. The retinal blood flow in diabetes. Diabetologia. 1975 Feb;11(1):27–33. doi: 10.1007/BF00422814. [DOI] [PubMed] [Google Scholar]
  23. Maser R. E., Steenkiste A. R., Dorman J. S., Nielsen V. K., Bass E. B., Manjoo Q., Drash A. L., Becker D. J., Kuller L. H., Greene D. A. Epidemiological correlates of diabetic neuropathy. Report from Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes. 1989 Nov;38(11):1456–1461. doi: 10.2337/diab.38.11.1456. [DOI] [PubMed] [Google Scholar]
  24. Moss S. E., Klein R., Klein B. E. The incidence of vision loss in a diabetic population. Ophthalmology. 1988 Oct;95(10):1340–1348. doi: 10.1016/s0161-6420(88)32991-x. [DOI] [PubMed] [Google Scholar]
  25. Patel V., Rassam S., Newsom R., Wiek J., Kohner E. Retinal blood flow in diabetic retinopathy. BMJ. 1992 Sep 19;305(6855):678–683. doi: 10.1136/bmj.305.6855.678. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Stefansson E., Landers M. B., 3rd, Wolbarsht M. L. Oxygenation and vasodilatation in relation to diabetic and other proliferative retinopathies. Ophthalmic Surg. 1983 Mar;14(3):209–226. [PubMed] [Google Scholar]
  27. Zatz R., Brenner B. M. Pathogenesis of diabetic microangiopathy. The hemodynamic view. Am J Med. 1986 Mar;80(3):443–453. doi: 10.1016/0002-9343(86)90719-9. [DOI] [PubMed] [Google Scholar]
  28. Ziegler D., Gries F. A., Spüler M., Lessmann F. The epidemiology of diabetic neuropathy. Diabetic Cardiovascular Autonomic Neuropathy Multicenter Study Group. J Diabetes Complications. 1992 Jan-Mar;6(1):49–57. doi: 10.1016/1056-8727(92)90049-q. [DOI] [PubMed] [Google Scholar]
  29. Ziegler D., Laux G., Dannehl K., Spüler M., Mühlen H., Mayer P., Gries F. A. Assessment of cardiovascular autonomic function: age-related normal ranges and reproducibility of spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses. Diabet Med. 1992 Mar;9(2):166–175. doi: 10.1111/j.1464-5491.1992.tb01754.x. [DOI] [PubMed] [Google Scholar]

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