Retinal Arteriolar Dilation Predicts Retinopathy in Adolescents With Type 1 Diabetes

Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
Diabetes care (Impact Factor: 8.57). 09/2008; 31(9):1842-6. DOI: 10.2337/dc08-0189
Source: PubMed

ABSTRACT Alterations in retinal vascular caliber may reflect early subclinical microvascular dysfunction. In this study, we examined the association of retinal vascular caliber to incident retinopathy in young patients with type 1 diabetes.
This was a prospective cohort study of 645 initially retinopathy-free type 1 diabetic patients, aged 12-20 years. Participants had seven-field stereoscopic retinal photographs taken of both eyes at baseline and follow-up. Retinal vascular caliber was measured from baseline photographs using a computer-based program following a standardized protocol. Incident retinopathy was graded according to the modified Airlie House classification from follow-up photographs.
Over a median follow-up of 2.5 years, 274 participants developed retinopathy (14.8 per 100 person-years). After adjustments for age, sex, diabetes duration, glycemia, mean arterial blood pressure, BMI, and cholesterol levels, larger retinal arteriolar caliber (fourth versus first quartile) was associated with a more than threefold higher risk of retinopathy (hazard rate ratio 3.44 [95% CI 2.08-5.66]). Each SD increase in retinal arteriolar caliber was associated with a 46% increase in retinopathy risk (1.46 [1.22-1.74]). This association was stronger in female than in male participants. After similar adjustments, retinal venular caliber was not consistently associated with incident retinopathy.
Retinal arteriolar dilatation predicts retinopathy development in young patients with type 1 diabetes. Our data suggest that arteriolar dysfunction may play a critical role in the pathogenesis of early diabetic retinopathy and that computer-based retinal vascular caliber measurements may provide additional prognostic information regarding risk of diabetes microvascular complications.

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Available from: Sophie Rogers, Aug 23, 2015
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    • "One of the most specific chronic diabetic complications is diabetic microangiopathy [3] [4] [5] [6]. Clinically, microangiopathy manifests as retinopathy, nephropathy, and diabetic neuropathy— somatic as well as autonomic [4] [5] [6]. Many trials have also shown that the main determinants of the vessel damage in the course of diabetes are hyperglycemia and diabetes duration [7] [8] [9]. "
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    • "In the Wisconsin Epidemiology Study of Diabetic Retinopathy (WESDR), an increase in retinal venular caliber of 10 í µí¼‡m was associated with higher 6-year incidence of DR, progression of DR, and incidence of proliferative DR [6]. Longitudinal studies from our group have demonstrated that larger retinal arteriolar caliber [7] [8] and changes in length-diameter ratio and tortuosity [9] predict the development of DR. In cross-sectional studies, increased vessel tortuosity [10] and increase fractal dimension [11] have also been associated with increased risk of DR independent of known risk factors of microvascular complications. "
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