Retinal Arteriolar Dilation Predicts Retinopathy in Adolescents With Type 1 Diabetes

  1. Ning Cheung, MBBS12,
  2. Sophie L. Rogers, MEPI1,
  3. Kim C. Donaghue, MBBS, PHD3,
  4. Alicia J. Jenkins, MBBS, MD4,
  5. Gabriella Tikellis, PHD5 and
  6. Tien Yin Wong, MBBS, PHD126
  1. 1Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
  2. 2Royal Victorian Eye and Ear Hospital, Melbourne, Australia
  3. 3The Children's Hospital at Westmead, University of Sydney, Westmead, Australia
  4. 4Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
  5. 5Baker Heart Research Institute, Melbourne, Australia
  6. 6Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  1. Corresponding author: Dr. Ning Cheung, dannycheung{at}hotmail.com

Abstract

OBJECTIVE—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.

RESEARCH DESIGN AND METHODS—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.

RESULTS—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.

CONCLUSIONS—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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 3 June 2008.

    Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    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 May 26, 2008.
    • Received January 26, 2008.
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  1. Published online before print June 3, 2008, doi: 10.2337/dc08-0189 Diabetes Care September 2008 vol. 31 no. 9 1842-1846
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