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Retinal vascular lesions in patients with type 2 diabetes mellitus of Caucasian and Asian origin - baseline results from the AdRem study

¹ Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands
² Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
³ Cardiovascular Sciences Research Group, University of Manchester & Royal Infirmary, Manchester, United Kingdom
⁴ International Centre for Circulatory Health, National Heart & Lung Institute, Imperial College London, United Kingdom
⁵ Molecular and Cellular Therapeutics and RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland
⁶ Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
⁷ The George Institute for International Health, University of Sydney, Sydney, Australia
⁸ Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
⁹ Department of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands

R.P.Stolk{at}epi.umcg.nl

ABSTRACT

Objective: To describe prevalent vascular retinal lesions among patients with type 2 diabetes enrolled in the ADVANCE Retinal measurement study (AdRem), a sub-study of the Action in Diabetes and Vascular disease – Preterax and Diamicron Controlled Evaluation (ADVANCE) trial.

Research Design and Methods: Seven field stereoscopic photographs of both eyes were obtained at the baseline assessment of ADVANCE. All photographs were graded in a central reading center. Gradable retinal images were received from 1605 patients.

Results: The number of patients with any retinopathy (ETDRS score 20) was 645 (40.2%, 95%CI 37.8-42.6), of these 35 (2.2%, 1.6-3.0) had severe diabetic retinopathy (ETDRS 50). Focal arterial narrowing, venous beading and arteriovenous (AV) nicking were present in 3.8%, 5.1% and 9.8% of participants, respectively. Among participants included in this study, Chinese and South-Asian patients had more retinopathy than Caucasians, as defined both by ETDRS (49.4%, 46.0%, 31.3%; p<0.001 adjusted for age, gender, HbA1c, systolic blood pressure and duration of diabetes) and specific vascular lesions (e.g. AV nicking 12.3%, 8.5%, 7.5%; adjusted p<0.005). HbA1c, duration of diabetes and systolic blood pressure were similarly associated with increased retinal lesions in Chinese, South-Asian and Caucasian patients.

Conclusions: Using a sensitive diagnostic procedure, more than one third of patients with type 2 diabetes enrolled in AdRem had retinal lesions at baseline. Despite differences in prevalence and severity of retinopathy between Chinese, South-Asian and Caucasian patients included in this study, the cross-sectional associations between established risk factors for retinopathy and retinal lesions were similar across ethnic groups.

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