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Showing papers by "Ronald Klein published in 1988"


Journal ArticleDOI
18 Nov 1988-JAMA
TL;DR: A strong and consistent relationship between hyperglycemia and incidence and progression of retinopathy is suggested, after controlling for duration of diabetes, age, sex, and baselineretinopathy.
Abstract: The relationship between hyperglycemia, measured by glycosylated hemoglobin at the initial examination, and the four-year incidence and progression of diabetic retinopathy was examined in a population-based study in Wisconsin Younger- (n = 891) and older-onset (n = 987) persons participating in baseline and follow-up examinations were included Glycosylated hemoglobin was measured by microcolumn Retinopathy was determined from stereoscopic fundus photographs In the younger-onset group, comparing the highest with the lowest quartile of glycosylated hemoglobin, the relative risk for developing any diabetic retinopathy was 19; for proliferative retinopathy, 218; and for progression, 40 Among older-onset persons taking insulin, the corresponding relative risks were 19, 40, and 21 Among older-onset persons not taking insulin, relative risks were 40 for any retinopathy and 62 for progression A positive relationship between incidence and progression of retinopathy and glycosylated hemoglobin remained after controlling for duration of diabetes, age, sex, and baseline retinopathy These data suggest a strong and consistent relationship between hyperglycemia and incidence and progression of retinopathy ( JAMA 1988;260:2864-2871)

562 citations


Journal ArticleDOI
01 Jul 1988-Diabetes
TL;DR: The combination of an increased prevalence of NIDDM in MAs plus an increased severity of retinopathy in those MAs who have diabetes suggests that a major public health effort should be made to screen this ethnic group forretinopathy.
Abstract: Mexican Americans (MAs) have a threefold greater prevalence of non-insulin-dependent diabetes mellitus (NIDDM) than non-Hispanic Whites (NHWs). Because MA diabetic subjects have greater hyperglycemia and an earlier age of onset than NHW diabetic subjects, we postulated that diabetic MAs might also have more severe diabetic retinopathy. Stereoscopic retinal photographs of the seven standard fields of each eye were taken in 257 MAs and 56 NHWs with NIDDM. The photographs were read by the University of Wisconsin Fundus Photographic Reading Center and graded with standardized criteria. The MAs had a nonsignificantly increased risk of retinopathy relative to the NHWs [odds ratio (OR) = 1.71; 95% confidence interval (Cl) = (0.93, 3.17)]. The risk of severe retinopathy (proliferative or preproliferative) relative to background or no retinopathy was significantly greater in MAs than in NHWs [OR = 2.37; 95% Cl = (1.04, 5.39)]. After control by logistic regression for duration of disease, severity of hyperglycemia, age, and systolic blood pressure, MAs still had an increased risk of severe retinopathy relative to NHWs [OR = 3.18; 95% Cl = (1.32, 7.66)]. Severe retinopathy was related to duration of disease, hyperglycemia, and insulin therapy in both ethnic groups. Previously diagnosed MA diabetic subjects also had an increased prevalence of any retinopathy [OR = 2.39; 95% Cl = (1.63, 3.50)] and severe retinopathy [OR = 3.21; 95% Cl = (2.24, 4.59)] relative to previously diagnosed White diabetic subjects (n = 896) from Wisconsin.(ABSTRACT TRUNCATED AT 250 WORDS)

212 citations


Journal ArticleDOI
TL;DR: The 4-year incidence of blindness and vision loss was examined in a population-based study of diabetes mellitus and was associated with older age, more severe retinopathy, and presence of macular edema in the three groups.

203 citations


Journal ArticleDOI
TL;DR: Proteinuria was associated with increasing duration of diabetes, high systolic blood pressure, use of digoxin, and being male, but not with a history of cigarette smoking or metabolic control as measured by glycosylated hemoglobin.
Abstract: • In a population-based study in southern Wisconsin, 1370 diabetic persons diagnosed after 29 years of age were examined using standard protocols to determine the prevalence of proteinuria and associated risk variables. Proteinuria (≥0.30 g/L) was present in 18.0% of persons taking insulin and 12.2% of the persons not taking insulin. Proliferative retinopathy and proteinuria were associated with each other. Proteinuria was also associated with increasing duration of diabetes, high systolic blood pressure, use of digoxin, and being male, but not with a history of cigarette smoking or metabolic control as measured by glycosylated hemoglobin. (Arch Intern Med1988;148:181-186)

71 citations


Journal ArticleDOI
TL;DR: Calculated values of incubated HbA1 were an average of 0.4% lower than the actual values, and substitution in a multinomial logistic regression with diabetic retinopathy as the dependent variable resulted in little change in the model.

48 citations


Journal ArticleDOI
TL;DR: It is concluded that DR1 is an additional risk DR allele for IDD to that of DR3 and DR4, and DR5 an additional protective DR allele to thatof DR2.
Abstract: Of the HLA allelic associations with insulin-dependent diabetes (IDD) reported to date, DR3 and DR4 have been the most positive and DR2 the most negative. In 952 Caucasian proband patients reported here, only 57 or 6% had no DR3 or DR4 alleles. When these 57 patients were compared to 249 Caucasian controls similarly lacking DR3 and DR4 antigens, there were excesses of DR1 (P = 0.13) and DRW8 (P = 0.01) and deficiencies of DR2 (P = 0.03) and DR5 (P = 0.03) in the patient group. The most common phenotype in this group of patients was DR1/DR7 (12.3%). Only four DR-homozygous patients involving alleles other than DR3 and DR4 were found by genotyping, and all were DRI homozygotes. Among 506 patients wuth DR3/DRX or DR4/DRX phenotypes, DR1 was more frequent (P = 0.001; Bonferronni P = 0.006), and DR2 (P = 0.001) and DR5 (P = 0.001) less frequent than 243 HLA-matched controls. of 187 patients with a single DR3 and no DR4, DR1 was more frequent (P = 0.02), with DR2 (P = 0.001) and DR5 (P = 0.02) less frequent tha...

37 citations


Journal ArticleDOI
TL;DR: The data suggest that the severity of retinopathy should be considered when counseling a pregnant diabetic woman, and only the last variable significantly predicted an adverse outcome.

33 citations


Journal ArticleDOI
TL;DR: Suggested management and referral strategies are presented in this article for treating diabetic patients not being referred to ophthalmologists for timely treatment.

17 citations


Journal ArticleDOI
TL;DR: The incidence of focal and panretinal photocoagulation and its relationship to demographic and other characteristics were examined in a population-based study of people with diabetes in southern Wisconsin.

17 citations