Risk factors for diabetic retinopathy in people with Type 2 diabetes: A case–control study in a UK primary care setting

  • Author Footnotes
    1 Present address: División de Farmacoepidemiología y Farmacovigilancia, Subdirección General de Medicamentos de Uso Humano, Agencia Española de Medicamentos y Productos Santiarios – AEMPS, Calle Campezo 1 Edificio 8, 28022 Madrid, Spain.
    Elisa Martín-Merino
    Correspondence
    Corresponding author at: c/ Almirante 28, 2°, 28005 Madrid, Spain. Tel.: +34 915 240 237; fax: +34 915 312 871.
    Footnotes
    1 Present address: División de Farmacoepidemiología y Farmacovigilancia, Subdirección General de Medicamentos de Uso Humano, Agencia Española de Medicamentos y Productos Santiarios – AEMPS, Calle Campezo 1 Edificio 8, 28022 Madrid, Spain.
    Affiliations
    Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain
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  • Joan Fortuny
    Affiliations
    DS&E – Global Clinical Epidemiology, Novartis Farmaceutica S.A., Barcelona, Spain
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  • Elena Rivero-Ferrer
    Affiliations
    DS&E – Global Clinical Epidemiology, Novartis Farmaceutica S.A., Barcelona, Spain
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  • Marcus Lind
    Affiliations
    Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden
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  • Luis Alberto Garcia-Rodriguez
    Affiliations
    Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain
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  • Author Footnotes
    1 Present address: División de Farmacoepidemiología y Farmacovigilancia, Subdirección General de Medicamentos de Uso Humano, Agencia Española de Medicamentos y Productos Santiarios – AEMPS, Calle Campezo 1 Edificio 8, 28022 Madrid, Spain.
Published:February 06, 2016DOI:https://doi.org/10.1016/j.pcd.2016.01.002

      Highlights

      • Numerous DR near the diabetes diagnosis suggest frequent delay in this diagnosis.
      • Patients with glaucoma or retinal arterial occlusion showed a reduced risk of DR.
      • Patients with retinal vein occlusion showed an increased risk of DR.
      • Desirable HDL levels showed a decreased risk of DR.

      Abstract

      Aim

      To identify risk factors of diabetic retinopathy (DR) among people with Type 2 diabetes mellitus in UK primary care.

      Methods

      A case–control study nested in a cohort of incident Type 2 diabetes identified in The Health Improvement Network database from 2000 to 2007. Cases were people with DR (N = 7735) and controls were a DR-free sample (N = 9395). No age restrictions were applied. Adjusted odds ratios and 95% CIs were estimated.

      Results

      21% of DR cases were identified during the first semester after Type 2 diabetes diagnosis. After controlling for delay on the Type 2 diabetes diagnosis, the DR risk increased with the duration of diabetes. DR increased with a mean systolic BP ≥150 mmHg (1.18; 1.10–1.27), high alcohol consumption (1.34; 1.11–1.61), glycated haemoglobin (≥75 to <86: 1.14; 1.00–1.31; ≥86 to <97 mmol/mol: 1.25; 1.07–1.45; ≥97 mmol/mol: 1.21; 1.07–1.37), microalbuminuria (1.16; 1.06–1.27), and retinal vein occlusion (2.47; 1.67–3.66). Glaucoma and retinal arterial occlusion showed an OR of 0.71 (0.60–0.84) and 0.63 (0.40–1.01), respectively. HDL ≥1.55 mmol/l (0.88; 0.80–0.98), high triglycerides (2.3–5.6 mmol/l: 0.90; 0.82–0.99; >5.6 mmol/l: 0.85; 0.64–1.13) or smoking (0.89; 0.81–0.97) had a slightly reduced DR risk. Users of hypoglycaemic agents had an increased DR risk.

      Conclusion

      Some DR cases were identified near the diabetes diagnosis date suggesting that a delayed diabetes diagnosis is still common. Glaucoma, retinal arterial occlusion and high HDL levels were inversely associated with DR, while retinal vein occlusion, alcohol and other well-known risk factors were positively associated.

      Keywords

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