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Ethnicity, Race, and Baseline Retinopathy Correlates in the Veterans Affairs Diabetes Trial

¹ Research Service, Hines Veterans Affairs Hospital, Hines, Illinois
² Cooperative Studies Coordinating Center, Hines Veterans Affairs Hospital, Hines, Illinois
³ University of Wisconsin, Madison, Wisconsin
⁴ Research Service, Omaha Veterans Affairs Medical Center, Omaha, Nebraska
⁵ Endocrinology Department, Carl T. Hayden Veterans Affairs Medical Center, Phoenix, Arizona
⁶ Research Service, Miami Veterans Affairs Medical Center, Miami, Florida

Address correspondence and reprint requests to Carlos Abraira, MD, Miami VA Medical Center, Research Service (151), Room 2A103, 1201 NW 16th St., Miami, FL 33125-1693. E-mail: louisa.williams{at}med.va.gov

OBJECTIVE—The Veterans Affairs Diabetes Trial (VADT) cohort is enriched with 20% Hispanics and 20% African Americans, affording a unique opportunity to study ethnic differences in retinopathy.

RESEARCH DESIGN AND METHODS—Cross-sectional analyses on the baseline seven-field stereo fundus photos of 1,283 patients are reported here. Diabetic retinopathy scores are grouped into four classes of increasing severity: none (10–14), minimal nonproliferative diabetic retinopathy (NPDR) (15–39), moderate to severe NPDR (40–59), and proliferative diabetic retinopathy (60+). These four groups have also been dichotomized to none or minimal (10–39) and moderate to severe diabetic retinopathy (40+).

RESULTS—The prevalence of diabetic retinopathy scores >40 was higher for Hispanics (36%) and African Americans (29%) than for non-Hispanic whites (22%). The difference between Hispanics and non-Hispanic whites was significant (P < 0.05). Similarly, the prevalence of diabetic retinopathy scores >40 was significantly higher in African Americans than in non-Hispanic whites (P < 0.05). These differences could not be accounted for by an imbalance in traditional risk factors such as age, duration of diagnosed diabetes, HbA_1c (A1C), and blood pressure. Diabetic retinopathy severity scores were also significantly associated with increasing years of disease duration, A1C, systolic and diastolic blood pressure, the degree of microalbuminuria, fibrinogen, and the percentage of patients with amputations. There was no relationship between retinopathy severity and the percentage of people who had strokes or cardiac revascularization procedures. There was an inverse relationship between retinopathy severity and total cholesterol, triglycerides, and plasminogen activator inhibitor-1 as well as with smoking history. Diabetic retinopathy scores were not associated with age.

CONCLUSIONS—In addition to many well-known associations with retinopathy, a higher frequency of severe diabetic retinopathy was found in the Hispanic and African-American patients at entry into the VADT that is not accounted for by traditional risk factors for diabetic retinopathy, and these substantial ethnic differences remain to be explained.

Abbreviations: NPDR, nonproliferative diabetic retinopathy • PAI, plasminogen activator inhibitor • PDR, proliferative diabetic retinopathy • VADT, Veterans Affairs Diabetes Trial

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