Fig. 1Clinical course of diabetic retinopathy in this cohort. PRP, panretinal photocoagulation; DR, diabetic retinopathy; NPDR, nonproliferative diabetic retinopathy; IR, incidence rate; PDR, proliferative.
Fig. 2Cumulative incidence for diabetic retinopathy according to the (A) mean glycosylated hemoglobin (HbA1c), (B) mean low density lipoprotein cholesterol (LDL-C) level, and (C) duration of diabetes.
Table 1Comparison of baseline parameters between the patients with and without diabetic retinopathy
Variable |
Total |
DR (−) |
Any DR (+) |
P value |
Number |
523 |
288 |
235 |
|
Female sex |
303 (57.9) |
161 (55.9) |
142 (60.4) |
0.297 |
Age, yr |
54.3±10.0 |
53.6±9.4 |
55.0±10.6 |
0.130 |
Diabetes duration, yr |
6.7±5.3 |
5.4±5.1 |
7.3±5.4 |
<0.001 |
Hypertension |
230 (44.0) |
128 (44.4) |
102 (43.4) |
0.812 |
CVD history |
28 (5.4) |
18 (6.3) |
10 (4.3) |
0.313 |
Body mass index, kg/m2
|
24.9±3.2 |
25.0±3.0 |
24.7±3.4 |
0.214 |
Smoking |
126 (24.1) |
70 (24.3) |
56 (23.8) |
0.899 |
Alcohol |
131 (25.0) |
77 (26.7) |
54 (23.0) |
0.324 |
Insulin |
99 (18.9) |
29 (10.1) |
70 (29.8) |
<0.001 |
ACE inhibitor/ARBs |
147 (28.1) |
83 (28.8) |
64 (27.2) |
0.688 |
Aspirin |
37 (7.1) |
18 (6.3) |
19 (8.1) |
0.416 |
Statin |
62 (11.9) |
39 (13.5) |
23 (9.8) |
0.186 |
Fenofibrate |
44 (8.4) |
27 (9.4) |
17 (7.2) |
0.380 |
Diabetic nephropathy |
101 (19.3) |
48 (16.7) |
53 (22.6) |
0.090 |
CAN |
78 (14.9) |
38 (13.2) |
40 (17.0) |
0.222 |
Laboratory finding at baseline |
|
|
|
|
FPG, mmol/L |
9.72±3.60 |
9.21±3.12 |
10.35±4.04 |
0.001 |
PPG, mmol/L |
16.55±5.37 |
15.59±5.21 |
17.71±5.36 |
<0.001 |
eGFR, mL/min/1.73 m2
|
93.9±16.6 |
94.2±15.3 |
93.7±18.1 |
0.729 |
Baseline HbA1c, % |
8.7±2.0 |
8.2±1.8 |
9.3±2.0 |
<0.001 |
Total cholesterol, mmol/L |
4.74±0.98 |
4.74±1.01 |
4.74±0.95 |
0.974 |
Triglyceride, mmol/L |
1.85±1.17 |
1.91±1.37 |
1.77±0.87 |
0.255 |
HDL-C, mmol/L |
1.13±0.25 |
1.11±0.25 |
1.15±0.25 |
0.102 |
LDL-C, mmol/L |
2.77±0.86 |
2.76±0.87 |
2.78±0.85 |
0.934 |
UAE, mg/day |
10.0 (5.9–23.6) |
10.0 (5.6–21.5) |
10.1 (6.4–28.0) |
0.056 |
Table 2Crude and adjusted hazard ratio for the development of diabetic retinopathy
Variable |
Crude HR (95% CI) |
P value |
Adjusted HR (95% CI) |
P value |
Female sex |
1.22 (0.94–1.58) |
0.137 |
1.02 (0.77–1.33) |
0.913 |
Age, yr |
|
|
|
|
<60 |
Reference |
|
Reference |
|
≥60 |
1.46 (1.12–1.91) |
0.005 |
1.40 (1.06–1.83) |
0.018 |
Diabetes duration, yr |
|
|
|
|
<5 |
Reference |
|
Reference |
|
5 to <10 |
1.60 (1.17–2.18) |
0.004 |
1.50 (1.09–2.06) |
0.012 |
≥10 |
2.16 (1.58–2.96) |
<0.001 |
1.98 (1.43–2.73) |
<0.001 |
Diabetic nephropathy |
|
|
|
|
Albuminuria (−) |
Reference |
|
Reference |
|
Albuminuria (+) |
1.32 (0.97–1.79) |
0.078 |
1.41 (1.04–1.93) |
0.029 |
Hypertension (yes vs. no) |
1.01 (0.78–1.30) |
0.965 |
0.92 (0.71–1.20) |
0.559 |
Mean HbA1c, % |
|
|
|
|
<7.0 |
Reference |
|
Reference |
|
7.0–8.9 |
1.87 (1.11–3.16) |
0.016 |
1.83 (1.08–3.09) |
0.025 |
≥9.0 |
4.35 (2.56–7.39) |
<0.001 |
4.32 (2.52–7.40) |
<0.001 |
Mean LDL-C, mmol/L |
|
|
|
|
<2.6 |
Reference |
|
Reference |
|
≥2.6 |
1.31 (1.01–1.70) |
0.046 |
1.09 (0.84–1.43) |
0.509 |
Table 3Association between major variables and development of diabetic retinopathy
Variable |
Adjusted hazard ratio (95% CI) |
P value |
Mean HbA1c <7.0% (n =71) |
|
|
Age, per 10 years |
1.07 (0.56–2.06) |
0.835 |
Diabetes duration, yr |
1.13 (1.04–1.23) |
0.003 |
Albuminuria |
0.85 (0.29–2.75) |
0.846 |
Hypertension |
1.60 (0.56–4.58) |
0.386 |
Mean HbA1c, per 1% increment |
2.91 (0.35–24.60) |
0.325 |
Mean LDL-C, mmol/L |
0.61 (0.21–1.76) |
0.363 |
Mean HbA1c ≥9.0% (n=140) |
|
|
Age, per 10 years |
1.13 (0.92–1.39) |
0.238 |
Diabetes duration, yr |
1.05 (1.01–1.09) |
0.015 |
Albuminuria |
1.36 (0.80–2.30) |
0.256 |
Hypertension |
0.88 (0.57–1.36) |
0.554 |
Mean HbA1c, per 1% increment |
1.61 (1.23–2.11) |
<0.001 |
Mean LDL-C, mmol/L |
1.01 (0.69–1.48) |
0.972 |
Age <60 years (n=359) |
|
|
Age, per 10 years |
1.04 (0.81–1.33) |
0.779 |
Diabetes duration, yr |
1.06 (1.02–1.09) |
0.003 |
Albuminuria |
1.24 (0.82–1.88) |
0.312 |
Hypertension |
0.99 (0.69–1.42) |
0.958 |
Mean HbA1c, per 1% increment |
1.68 (1.46–1.93) |
<0.001 |
Mean LDL-C, mmol/L |
1.13 (0.82–1.55) |
0.474 |
Age ≥60 years (n=174) |
|
|
Age, per 10 years |
1.01 (0.58–1.76) |
0.985 |
Diabetes duration, yr |
1.05 (1.00–1.07) |
0.028 |
Albuminuria |
1.25 (0.75–2.06) |
0.391 |
Hypertension |
1.02 (0.67–1.56) |
0.935 |
Mean HbA1c, per 1% increment |
1.38 (1.15–1.65) |
0.001 |
Mean LDL-C, mmol/L |
1.06 (0.71–1.58) |
0.786 |
Diabetes duration <5 years (n=246) |
|
|
Age, per 10 years |
1.10 (0.88–1.38) |
0.391 |
Diabetes duration, yr |
1.22 (1.01–1.48) |
0.038 |
Albuminuria |
1.13 (0.66–1.96) |
0.654 |
Hypertension |
1.16 (0.72–1.86) |
0.538 |
Mean HbA1c, per 1% increment |
1.69 (1.41–2.03) |
<0.001 |
Mean LDL-C, mmol/L |
1.08 (0.70–1.66) |
0.732 |
Diabetes duration ≥10 years (n=127) |
|
|
Age, per 10 years |
1.42 (1.06–1.90) |
0.019 |
Diabetes duration, yr |
0.99 (0.94–1.05) |
0.759 |
Albuminuria |
1.72 (1.01–2.93) |
0.047 |
Hypertension |
0.98 (0.62–1.56) |
0.934 |
Mean HbA1c, per 1% increment |
1.37 (1.10–1.72) |
0.005 |
Mean LDL-C, mmol/L |
1.04 (0.66–1.61) |
0.878 |