engleski

Clinical and metabolic predictors of nonproliferative and proliferative/laser treated retinopathy in normoalbuminuric type 1 diabetic patients with normal or mildly impaired renal function

It is assumed that retinopathy and nephropathy, as most important microvascular complications in diabetes, occurs at the same time and that retinovascular pathology reflects renal disease. However, several studies demonstrated that albuminuria is not a risk factor for diabetic retinopathy and that retinopathy might be present already in normoalbuminuric state in type 1 diabetic patients (T1DM). The aim of this study was to evaluate the prevalence and predictors of nonproliferative (NPR) and proliferative/laser- treated retinopathy (PR) in normoalbuminuric T1DM.Study included 333 (198 without retinopathy, 114 with NPR and 21 with PR) normoalbuminuric T1DM with normal or mildly decreased renal function (estimated glomerular filtration rate (eGFR) > 60 ml min-1 1.73m-2) and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. Patients without retinopathy compared to those with NPR and PR were younger (31 vs 39 vs 45 years, p<0.001), had longer duration of diabetes (7 vs 18 vs 23 years, p<0.001), lower hemoglobin A1c (7.2±1.5 vs 7.8±1.6 vs 7.8±1.4%, p=0.003), lower total cholesterol (4.8±0.9 vs 5.0±0.9 vs 5.6±1.0 ol/L, p=0.02), lower LDL cholesterol (2.7±0.7 vs 2.8±0.7 vs 3.1±0.9 mmol/L, p=0.03), lower heart rate (HR) (70 vs 78 vs 85 beats/min, p<0.001) and higher eGFR (104 vs 94 vs 81 ml/min). Stratifying clinical and metabolic characteristics of patients for degree of eGFR, trends across quartiles for age (43±9 vs 23±4 years, p<0.001), duration of diabetes (17±10 vs 9±6 years, p<0.001), hemoglobin A1c (7.1±1.2 vs 8.4±1.9%, p=0.002), total cholesterol (5.1±0.7 vs 4.6±0.7 mmol/L, p=0.02), and LDL cholesterol (2.9±0.7 vs 2.4±0.7 mmol/L, p=0.006) were statistically significant. Retinopathy might be present already in normoalbuminuric state in T1DM. Age, duration of diabetes, hemoglobin A1c, total and LDL cholesterol are major risk factors associated with progression of retinopathy and renal disease.

type 1 diabetes; retinopathy; renal function

nije evidentirano