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Prevalence and risk factors for diabetic retinopathy at diagnosis (DRAD) in patients recently diagnosed with type 2 diabetes (T2D) or latent autoimmune diabetes in the adult (LADA)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. (Cardiovascular disease and diabetes)ORCID iD: 0000-0002-6060-6229
Lund Univ, Dept Clin Sci Malmo, Uppsala, Sweden..ORCID iD: 0000-0002-2478-1409
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Lund Univ, Dept Clin Sci Malmo, Uppsala, Sweden..ORCID iD: 0000-0002-7655-3731
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2016 (English)In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 30, no 8, 1456-1461 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: 

To study prevalence of diabetic retinopathy (DR) at diagnosis (DRAD) and to estimate contributing risk by sociodemographic, cardiovascular and metabolic characteristics present in patients recently diagnosed with type 2 diabetes (T2D) or latent autoimmune diabetes in the adult (LADA).

METHODS: 

Patients (n=2174) recently diagnosed T2D (93%) or LADA (7%) were included upon arrival for their baseline DR screening. Fundus photographs of 4902 eyes were graded by a senior ophthalmologist according to the International Diabetic Retinopathy Disease Severity Scale. Official registers held by Statistics Sweden provided sociodemographic variables. The National Patient Register and Swedish Prescribed Drug Register were used to assess cardiovascular risk. Beta cell function (HOMA2%b) and insulin sensitivity (HOMA2%s) were estimated from fasting (f) C-Peptide using the homeostasis model assessment (HOMA) 2 calculator. Odds ratios (OR) for DRAD were estimated using generalized estimating equation models.

RESULTS: 

The prevalence of DRAD was 12% (7% mild and 5% moderate) and of diabetic macular edema it was 11% (all within vascular arch). The prevalence did not significantly differ between T2D and LADA. Due to sample size, the regression analysis of LADA patients did not yield any significant estimates. In T2D low educational level (≤9years) increased risk for DRAD by 44% (OR 1.44; 95% CI 1.07-1.93) and <50% beta-cell function adjusted for HbA1c and insulin sensitivity at diagnosis increased the risk by 77% (OR 1.77; 95% CI 1.28-2.44). For every unit increase in BMI, risk for DRAD decreased by 3% (OR 0.97; 95% CI 0.95-0.99).

CONCLUSIONS: 

DRAD prevalence in patients recently diagnosed with T2D or is 12%. Low educational level and low beta cell function at diagnosis are risk factors for DRAD. Estimation of beta cell function from (f)C-Peptide and (f)P-Glucose may be a valuable tool in identifying patients at risk for DRAD.

Place, publisher, year, edition, pages
2016. Vol. 30, no 8, 1456-1461 p.
Keyword [en]
Diabetes, Diabetic macular edema, Diabetic retinopathy, Diabetic retinopathy at diagnosis (DRAD), Latent autoimmune diabetes in the adult (LADA), Type 2 diabetes (T2D)
National Category
Endocrinology and Diabetes
Research subject
Endocrinology and Diabetology
Identifiers
URN: urn:nbn:se:uu:diva-319750DOI: 10.1016/j.jdiacomp.2016.08.009ISI: 000399434900009PubMedID: 27593902OAI: oai:DiVA.org:uu-319750DiVA: diva2:1087598
Available from: 2017-04-08 Created: 2017-04-08 Last updated: 2017-08-22Bibliographically approved
In thesis
1. Diabetes Mellitus at the Time for Diagnosis: Studies on Prognostic Factors
Open this publication in new window or tab >>Diabetes Mellitus at the Time for Diagnosis: Studies on Prognostic Factors
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim for this thesis was to identify prognostic factors for chronic diabetes complications that exist at the time of diabetes diagnosis.

Low level of education (<12 years) and low income (<60% of median) was found to increase the risk to have high (>70 mmol/mol) HbA1c at the time of diagnosis with 34 % and 35 %, respectively.

Prevalence of diabetic retinopathy (DR) was 12% in a cohort of patients newly diagnosed with diabetes. Diabetic macular edema was present in 11% of patients with type 2 diabetes (T2D) and 13% of those with Latent Autoimmune Diabetes in Adults (LADA). Low beta cell function and low level of education increased the risk for DR with 110% and 43%, respectively. For every unit of increase in body mass index, the risk for DR was reduced by 3%.

The cellular immunology of LADA patients was a mixture of that observed in both type 1 (T1D) and T2D patients. Compared to patients with T1D, LADA patients had more B-regulatory lymphocytes and antigen presenting cells capable of producing interleukine-35. This indicates a higher anti-inflammatory capacity in LADA patients compared to type T1D patients.

By imputing age, body mass index, HbA1c at diagnosis, beta cell function and insulin resistance in a cluster analysis, five distinct diabetes clusters were identified. The four clusters representing T2D patients differed in incidence of DR, nephropathy and non-alcoholic fatty liver disease. This was replicated with similar results in three geographically separate populations.

By studying socioeconomic background and factors present at the time of diagnosis we can better predict prognosis for chronic diabetes complications. These findings may facilitate better-targeted diabetes screening programs and more individually tailored treatment regimes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 87 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1361
Keyword
New-onset Diabetes Mellitus, socioeconomic position, epidemiology, diabetes complications, diabetic retinopathy, cellular immunology, diabetes classification, type 2 diabetes, latent autoimmune diabetes in adults (LADA), type 1 diabetes
National Category
General Practice
Research subject
Family Medicine; Endocrinology and Diabetology
Identifiers
urn:nbn:se:uu:diva-328382 (URN)978-91-513-0047-4 (ISBN)
Public defence
2017-10-13, Auditorium Minus, Gustavianum, Akademigatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Funder
EXODIAB - Excellence of Diabetes Research in Sweden, 2009-1039
Available from: 2017-09-21 Created: 2017-08-22 Last updated: 2018-01-13

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Martinell, MatsStålhammar, Jan

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