TY - JOUR
T1 - Risk Factors for the Development of Retinopathy in Prediabetes and Type 2 Diabetes
T2 - The Diabetes Prevention Program Experience
AU - White, Neil H.
AU - Pan, Qing
AU - Knowler, William C.
AU - Schroeder, Emily B.
AU - Dabelea, Dana
AU - Chew, Emily Y.
AU - Blodi, Barbara
AU - Goldberg, Ronald B.
AU - Pi-Sunyer, Xavier
AU - Darwin, Christine
AU - Schlogl, Mathias
AU - Nathan, David M.
N1 - Funding Information:
This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award numbers U01 DK048489, U01 DK048339, U01 DK048377, U01 DK048349, U01 DK048381, U01 DK048468, U01 DK048434, U01 DK048485, U01 DK048375, U01 DK048514, U01 DK048437, U01 DK048413, U01 DK048411, U01 DK048406, U01 DK048380, U01 DK048397, U01 DK048412, U01 DK048404, U01 DK048387, U01 DK048407, U01 DK048443, and U01 DK048400, providing funding during DPP and DPPOS to the clinical centers and the coordinating center for the design and conduct of the study, and collection, management, analysis, and interpretation of the data. Funding was also provided by the National Institute of Child Health and Human Development; National Institute on Aging; National Eye Institute; National Heart, Lung, and Blood Institute; National Cancer Institute; Office of Research on Women’s Health, National Institute on Minority Health and Health Disparities, Centers for Disease Control and Prevention, and American Diabetes Association. The Southwest-ern American Indian Centers were supported di-rectly by the National Institute of Diabetes and Digestive and Kidney Diseases, including its intramural research program, and the Indian Health Service. The General Clinical Research Center Program, National Center for Research Resources, and Department of Veterans Affairs supported data collection at many of the clinical centers. Merck KGaA provided medication for DPPOS. DPP and DPPOS have also received donated materials, equipment, or medicines for concomitant conditions from Bristol-Myers Squibb, Parke-Davis, LifeScan, Health-o-Meter, Hoechst Marion Roussel, Merck-Medco Man-aged Care, Merck and Co., Nike Sports Mar-keting, Slim Fast Foods, and Quaker Oats. McKesson BioServices, Matthews Media Group, and the Henry M. Jackson Founda-tion provided support services under sub-contract with the coordinating center. No other potential conflicts of interest relevant to this article were reported. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The sponsor of this study was represented on the steering committee and played a part in the study design, how the study was done, and publication. The opinions expressed are those of the study group and do not necessarily re-flect the views of the funding agencies. Author Contributions. N.H.W. wrote the man-.
Funding Information:
Acknowledgments. The DPP Research Group gratefully acknowledges the commitment and dedication of the participants of the DPP and DPPOS. Funding and Duality of Interest. This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award numbers U01 DK048489, U01 DK048339, U01 DK048377, U01 DK048349, U01 DK048381, U01 DK048468, U01 DK048434, U01 DK048485, U01 DK048375, U01 DK048514, U01 DK048437, U01 DK048413, U01 DK048411, U01 DK048406, U01 DK048380, U01 DK048397, U01 DK048412, U01 DK048404, U01 DK048387, U01 DK048407, U01 DK048443, and U01 DK048400, providing funding during DPP and DPPOS to the clinical centers and the coordinating center for the design and conduct of the study, and collection, management, analysis, and interpretation of the data. Funding was also provided by the National Institute of Child Health and Human Development; National Institute on Aging; National Eye Institute; National Heart, Lung, and Blood Institute; National Cancer Institute; Office of Research on Women’s Health, National Institute on Minority Health and Health Disparities, Centers for Disease Control and Prevention, and American Diabetes Association. The Southwestern American Indian Centers were supported directly by the National Institute of Diabetes and Digestive and Kidney Diseases, including its intramural research program, and the Indian Health Service. The General Clinical Research Center Program, National Center for Research Resources, and Department of Veterans Affairs supported data collection at many of the clinical centers. Merck KGaA provided medication for DPPOS. DPP and DPPOS have also received donated materials, equipment, or medicines for concomitant conditions from Bristol-Myers Squibb, Parke-Davis, LifeScan, Health-o-Meter, Hoechst Marion Roussel, Merck-Medco Managed Care, Merck and Co., Nike Sports Marketing, Slim Fast Foods, and Quaker Oats. McKesson BioServices, Matthews Media Group, and the Henry M. Jackson Foundation provided support services under subcontract with the coordinating center. No other potential conflicts of interest relevant to this article were reported.
Publisher Copyright:
© 2022 by the American Diabetes Association.
PY - 2022/11
Y1 - 2022/11
N2 - OBJECTIVE To determine glycemic and nonglycemic risk factors that contribute to the presence of diabetic retinopathy (DR) before and after the onset of type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS During the Diabetes Prevention Program (DPP) and DPP Outcome Study (DPPOS), we performed fundus photography over time in adults at high risk for developing T2D, including after they developed diabetes. Fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) grading system, with DR defined as typical lesions of DR (microaneurysms, exudates, hemorrhage, or worse) in either eye. RESULTS By DPPOS year 16 (20 years after random assignment into DPP), 24% of 1,614 participants who had developed T2D and 14% of 885 who remained without diabetes had DR. In univariate analyses, using results from across the entire duration of follow-up, American Indian race was associated with less frequent DR compared with non-Hispanic White (NHW) race, and higher HbA1c, fasting and 2-h plasma glucose levels during an oral glucose tolerance test, weight, and history of hyper-tension, dyslipidemia, and smoking, but not treatment group assignment, were associated with more frequent DR. On multivariate analysis, American Indian race was associated with less DR compared with NHW (odds ratio [OR] 0.36, 95% CI 0.20–0.66), and average HbA1c was associated with more DR (OR 1.92, 95% CI 1.46–1.74 per SD [0.7%] increase in HbA1c). CONCLUSIONS DR may occur in adults with prediabetes and early in the course of T2D. HbA1c was an important risk factor for the development of DR across the entire glycemic range from prediabetes to T2D.
AB - OBJECTIVE To determine glycemic and nonglycemic risk factors that contribute to the presence of diabetic retinopathy (DR) before and after the onset of type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS During the Diabetes Prevention Program (DPP) and DPP Outcome Study (DPPOS), we performed fundus photography over time in adults at high risk for developing T2D, including after they developed diabetes. Fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) grading system, with DR defined as typical lesions of DR (microaneurysms, exudates, hemorrhage, or worse) in either eye. RESULTS By DPPOS year 16 (20 years after random assignment into DPP), 24% of 1,614 participants who had developed T2D and 14% of 885 who remained without diabetes had DR. In univariate analyses, using results from across the entire duration of follow-up, American Indian race was associated with less frequent DR compared with non-Hispanic White (NHW) race, and higher HbA1c, fasting and 2-h plasma glucose levels during an oral glucose tolerance test, weight, and history of hyper-tension, dyslipidemia, and smoking, but not treatment group assignment, were associated with more frequent DR. On multivariate analysis, American Indian race was associated with less DR compared with NHW (odds ratio [OR] 0.36, 95% CI 0.20–0.66), and average HbA1c was associated with more DR (OR 1.92, 95% CI 1.46–1.74 per SD [0.7%] increase in HbA1c). CONCLUSIONS DR may occur in adults with prediabetes and early in the course of T2D. HbA1c was an important risk factor for the development of DR across the entire glycemic range from prediabetes to T2D.
UR - http://www.scopus.com/inward/record.url?scp=85141344219&partnerID=8YFLogxK
U2 - 10.2337/dc22-0860
DO - 10.2337/dc22-0860
M3 - Article
C2 - 36098658
AN - SCOPUS:85141344219
SN - 0149-5992
VL - 45
SP - 2653
EP - 2661
JO - Diabetes care
JF - Diabetes care
IS - 11
ER -