Journal ArticleDOI
Risk of Proliferative Diabetic Retinopathy in Juvenile-Onset Type I Diabetes: A 40-yr Follow-up Study
TLDR
The pattern of occurrence of this severe eye complication in type I diabetes suggests that the process leading to the development of proliferative retinopathy consists of two or more stages and that progression through each stage may be governed by different factors.Abstract:
The development of proliferative diabetic retinopathy was studied in three cohorts consisting of 292 patients with recent juvenile-onset, type I (insulin-dependent) diabetes who were followed 20–40 yr beginning in 1939, 1949, and 1959. The risk of this severe eye complication was almost nonexistent during the first 10 yr of diabetes, rose abruptly to its maximum level (∼30/1000 person-years), and remained at that level for the next 25 yr. This pattern did not vary with sex, age at onset of diabetes, or level of glycemic control during the first 5 yr of diabetes. However, the risk of proliferative retinopathy was strongly related to the level of glycemic control during the several years preceding onset of this complication. This was a dose-dependent relationship, with patients in the highest quartile of the distribution of the index of frequency of hyperglycemia having a 10-fold higher risk than individuals in the lowest quartile. A virtually identical pattern was observed in patients who developed diabetes in 1959 as was observed in those who developed diabetes in 1949 or 1939. In contrast, diabetic nephropathy as evidenced by persistent proteinuria showed a lower incidence in the 1959 than in the 1939 cohort. In conclusion, these incidence data do not support the notion that the risk of proliferative retinopathy is mainly a function of duration of diabetes. Instead, the pattern of occurrence of this severe eye complication in type I diabetes suggests that the process leading to the development of proliferative retinopathy consists of two or more stages and that progression through each stage may be governed by different factors.read more
Citations
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Journal ArticleDOI
The Wisconsin epidemiologic study of diabetic retinopathy. VI: Retinal photocoagulation
TL;DR: Seventy-two percent of eyes of younger onset and 45% of Eyes of older onset persons that had received panretinal photocoagulation treatment were found to have incomplete regression of retinal new vessels, and in approximately half of these eyes severe proliferative retinopathy (Diabetic Retinopathy Study High Risk Characteristics [DRS-HRC]) was present.
Journal ArticleDOI
Long-term complications of diabetes mellitus
TL;DR: Retinopathy is so characteristic of diabetes that its presence has been incorporated into the nosologic definition of NIDDM, while lower levels of hyperglycemia that are of sufficient magnitude to be associated with retinopathy are classified as NID DM.
Journal ArticleDOI
Hyperglycemia and microvascular and macrovascular disease in diabetes.
TL;DR: There is a need to understand the relation of hyperglycemia to pathogenetic mechanisms that lead to the development of specific complications, to develop new methods to detect and physiologically treat hyperglyCEmia, and to develop better methods of primary and secondary prevention of diabetic complications in people with IDDM and NIDDM.
Journal ArticleDOI
The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XVII. The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes
TL;DR: The data suggest relatively high 14-year rates of progression of retinopathy and incidence of macular edema and suggest that a reduction of hyperglycemia and hypertension may result in a beneficial decrease in the progression to proliferative Retinopathy.
Journal ArticleDOI
Magnitude and determinants of coronary artery disease in juvenile-onset, insulin-dependent diabetes mellitus.
Andrzej S. Krolewski,E J Kosinski,J H Warram,O S Leland,E J Busick,Asmal Ac,Larry Rand,A R Christlieb,R F Bradley,C R Kahn +9 more
TL;DR: The pattern suggests that juvenile-onset diabetes and its renal complications are modifiers of the natural history of atherosclerosis in that although they profoundly accelerate progression of early atherosclerotic lesions to very severe CAD, they may not contribute to initiation of Atherosclerosis.
References
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Journal ArticleDOI
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TL;DR: In a population-based study in southern Wisconsin, 996 insulin-taking, younger-onset diabetic persons were examined using standard protocols to determine the prevalence and severity of diabetic retinopathy and associated risk variables.
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Journal ArticleDOI
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