Glycemic Thresholds for Diabetes-Specific Retinopathy
Implications for diagnostic criteria for diabetes
- Stephen Colagiuri, MBBS1,
- Crystal M.Y. Lee, PHD1,
- Tien Y. Wong, PHD2,3,
- Beverley Balkau, PHD4,5,
- Jonathan E. Shaw, MD6,
- Knut Borch-Johnsen, DMSC7,8 and
- the DETECT-2 Collaboration Writing Group*
- 1Boden Institute of Obesity, Nutrition, and Exercise, University of Sydney, Sydney, Australia;
- 2Center for Eye Research Australia, University of Melbourne, Melbourne, Australia;
- 3Singapore Eye Research Institute, National University of Singapore, Singapore;
- 4Institut National de la Santé et de la Recherche Médicale, Centre de Recherche en Epidémiologie et Santé des Populations, Epidemiology of Diabetes, Obesity, and Chronic Kidney Disease Over the Lifecourse, Villejuif, France;
- 5Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris Sud, Villejuif, France;
- 6Heart and Diabetes Institute, Baker International Diabetes Institute, Melbourne, Australia;
- 7Steno Diabetes Center, Gentofte, Denmark;
- 8Faculty of Health Science, University of Aarhus, Aarhus, Denmark.
- Corresponding author: Stephen Colagiuri, .
OBJECTIVE To re-evaluate the relationship between glycemia and diabetic retinopathy.
RESEARCH DESIGN AND METHODS We conducted a data-pooling analysis of nine studies from five countries with 44,623 participants aged 20–79 years with gradable retinal photographs. The relationship between diabetes-specific retinopathy (defined as moderate or more severe retinopathy) and three glycemic measures (fasting plasma glucose [FPG; n = 41,411], 2-h post oral glucose load plasma glucose [2-h PG; n = 21,334], and A1C [n = 28,010]) was examined.
RESULTS When diabetes-specific retinopathy was plotted against continuous glycemic measures, a curvilinear relationship was observed for FPG and A1C. Diabetes-specific retinopathy prevalence was low for FPG <6.0 mmol/l and A1C <6.0% but increased above these levels. Based on vigintile (20 groups with equal numbers) distributions, glycemic thresholds for diabetes-specific retinopathy were observed over the range of 6.4–6.8 mmol/l for FPG, 9.8–10.6 mmol/l for 2-h PG, and 6.3–6.7% for A1C. Thresholds for diabetes-specific retinopathy from receiver-operating characteristic curve analyses were 6.6 mmol/l for FPG, 13.0 mmol/l for 2-h PG, and 6.4% for A1C.
CONCLUSIONS This study broadens the evidence based on diabetes diagnostic criteria. A narrow threshold range for diabetes-specific retinopathy was identified for FPG and A1C but not for 2-h PG. The combined analyses suggest that the current diabetes diagnostic level for FPG could be lowered to 6.5 mmol/l and that an A1C of 6.5% is a suitable alternative diagnostic criterion.
↵*A complete list of the members of the DETECT-2 Collaboration Writing Group are listed in the online appendix available at http://care.diabetesjournals.org/cgi/content/full/dc10-1206/DC1.
This article was prepared using limited-access datasets obtained from the NHLBI and does not necessarily reflect the opinions or views of MESA or the NHLBI.
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- Received June 23, 2010.
- Accepted October 8, 2010.
- © 2011 by the American Diabetes Association.
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