Development of Proliferative Diabetic Retinopathy in African-Americans and Whites With Type 1 Diabetes
- Cynthia L Arfken, PHD,
- Philip L Reno, AB,
- Julio V Santiago, MD† and
- Ronald Klein, MD, MPH
- Department of Internal Medicine, Washington University School of Medicine St. Louis, Missouri
- Division of Biostatistics, Washington University School of Medicine St. Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine St. Louis, Missouri
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School Madison, Wisconsin
- Address correspondence and reprint requests to Cynthia L. Arfken, PhD, Psychiatry-9B UHC, 4201 St. Antoine, Detroit, MI 48201. E-mail: carfken{at}med.wayne.edu.
Abstract
OBJECTIVE To investigate the comparable risk of developing proliferative diabetic retinopathy (PDR) in African-Americans and whites with type 1 diabetes.
RESEARCH DESIGN AND METHODS Using a cohort design with the sample drawn from medical records, the sample consisted of 312 people with type 1 diabetes (97 African-Americans, 215 whites) having at least two visits to a Model Demonstration Unit with gradeable fundus photographs (stereo, color, 7 standard fields). Excluded were subjects with preexisting or treated PDR or hemoglobinopathy. Masked grading of the fundus photographs was conducted at the Wisconsin Reading Center.
RESULTS At baseline, African-Americans had poorer glycemic control (mean HbA1 of 11.3 vs. 10.0%, P < 0.0001), higher systolic blood pressure (mean of 117 vs. 110 mmHg, P < 0.001), and were older (mean of 26.8 vs. 19.3 years, P < 0.0001) than the white subjects. African-Americans also tended to have slightly longer duration of diabetes and length of follow- up. In the African-Americans, 17.5% developed PDR, compared with 10.2% in the 215 whites, for an odds ratio (OR) of 1.86 (95% CI 0.93–3.70). When adjusted for baseline glycemic control, retinopathy grade, and length of follow-up, race was not a significant risk factor (OR = 0.73, 95% CI 0.30–1.78).
CONCLUSIONS African-Americans with type 1 diabetes may have a higher rate of developing PDR. The observed racial difference, however, is attributable to the presence of a worse risk factor profile, especially to poorer glycemic control. Efforts should be expanded to improve the care for all individuals with poor glycemic control.
- Received October 13, 1997.
- Revision received January 15, 1998.
- Accepted January 15, 1998.
- Copyright © 1998 by the American Diabetes Association
