Retinal Vascular Lesions in Patients of Caucasian and Asian Origin With Type 2 Diabetes

doi:10.2337/dc07-1657

Retinal Vascular Lesions in Patients of Caucasian and Asian Origin With Type 2 Diabetes

Baseline results from the ADVANCE Retinal Measurements (AdRem) study

Ronald P. Stolk, MD1 2,
Mary J. van Schooneveld, MD2,
J. Kennedy Cruickshank, MD3,
Alun D. Hughes, PHD4,
Alice Stanton, MD5,
Juming Lu, MD6,
Anushka Patel, MD7,
Simon A. McG. Thom, MD4,
Diederick E. Grobbee, MD2,
Johannes R. Vingerling, MD8 and
on behalf of the AdRem Project Team and ADVANCE Management Committee*

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

Address correspondence and reprint requests to Prof. R.P. Stolk, Department of Epidemiology, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, Netherlands. E-mail: r.p.stolk{at}epi.umcg.nl

Abstract

OBJECTIVE—The objective of this study was to describe prevalent vascular retinal lesions among patients with type 2 diabetes enrolled in the ADVANCE Retinal Measurements (AdRem) study, a substudy of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial.

RESEARCH DESIGN AND METHODS—Seven-field stereoscopic photographs of both eyes were obtained at the baseline assessment of the ADVANCE trial. All photographs were graded in a central reading center. Gradable retinal images were received from 1,605 patients.

RESULTS—The number of patients with any retinopathy (Early Treatment of Diabetic Retinopathy Study [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 score ≥50). Focal arterial narrowing, venous beading, and arteriovenous 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 score (49.4, 46.0, and 31.3%, respectively; P < 0.001, adjusted for age, sex, A1C, systolic blood pressure, and duration of diabetes) and specific vascular lesions (e.g., arteriovenous nicking 12.3, 8.5, and 7.5%, respectively; adjusted P < 0.005). A1C, 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 the AdRem study had retinal lesions at baseline. Despite differences in prevalence and severity of retinopathy among Chinese, South-Asian, and Caucasian patients included in this study, the cross-sectional associations among established risk factors for retinopathy and retinal lesions were similar across ethnic groups.

Footnotes

Published ahead of print at http://care.diabetesjournals.org on 9 January 2008. DOI: 10.2337/dc07-1657.
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↵* A complete list of the members of the AdRem Project Team and ADVANCE Management Committee can be found in the appendix.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
- Accepted December 26, 2007.
- Received August 22, 2007.
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