Diabetic retinopathy in type 1 diabetes patients in Western Norway and its impact on health related quality of life

Session Details

Session Title: Free Paper Session 7: Vascular Diseases & Diabetic Retinopathy II

Session Date/Time: Thursday 07/09/2017 | 14:30-16:00

Paper Time: 15:36

Venue: Room 117

First Author: : R.Jansson NORWAY

Co Author(s): :    K. Hufthammer   J. Krohn                          

Abstract Details

Purpose:

To describe the prevalence of diabetic retinopathy (DR) and diabetic macular oedema (DME), clinical and sociodemographic characteristics, associated risk factors, and health-related quality of life (HRQoL) among patients with type 1 diabetes mellitus (DM1) in Western Norway.

Setting:

From a population-based cohort of 350 DM1 patients in Western Norway, a total of 237 patients (68%) agreed to participate in the study and were examined between 2010-2014.

Methods:

The medical history was gathered through a structured interview and review of the patients’ medical records. All patients underwent a complete ophthalmic examination including best corrected visual acuity (BCVA) and stereo fundus photography of the seven ETDRS standard fields for grading of DR and DME according to the International Clinical Diabetic Retinopathy Disease Severity Scale. A general examination included among others height, weight, blood pressure, monofilament test, HbA1c, creatinine, cholesterol status, and urine albumin-to-creatinine ratio. Uni- and multivariate regression models were used to assess possible associations between risk factors and DR. Kaplan-Meier survival analyses were performed to evaluate disease progression in relation to diabetes duration and pre-/postpubertal age at diabetes debut. In order to assess the participants' HRQoL, all patients aged 16 years or older were asked to fill out the Medical Outcomes Study Short Form 36 (SF-36, Norwegian version 1.2). Age- and gender-adjusted analyses of the association between the SF-36 scores and the level of DR were performed.

Results:

The mean age at inclusion was 34 years (4-75 years) and the mean diabetes duration was 19 years (5 months-63 years). Forty-nine percent of the patients were females and mean HbA1c was 8% (5-14%). A total of 145 patients (61%) had DR, 62 (26%) mild, 39 (16%) moderate, and 13 (5%) severe non-proliferative retinopathy, while 31 (13%) had proliferative retinopathy. The prevalence of DME was 8%. The most important risk factors predicting DR in the multivariate analyses were diabetes duration (p<0.0001) and self-reported HbA1 (p<0.0001). Neuropathy (p=0.01), nephropathy (p=0.01), and male gender (p=0.04) were also significant predictors of DR. The proportion of patients with any retinopathy at 10, 20, and 30 years diabetes duration was 20%, 68%, and 90%, respectively. Similar figures for proliferative retinopathy were 1%, 13%, and 30%. Compared to normative age- and gender matched SF-36 data, the study group scored significantly lower in the general health domain (p=0.0004). There was a linear trend of decreasing scores with increasing severity of retinopathy that was statistically significant for all the physical dimension scores. After adjustment for other diabetes-related complications and BCVA, DR severity remained a significant predictor only for the bodily pain score (p=0.005).

Conclusions:

The prevalence of DR in DM1 patients was somewhat higher than earlier reported in Norway. Diabetes duration, increased HbA1c, male gender, and the presence of neuropathy and nephropathy were significant predictors of diabetic retinopathy. Regarding the HRQoL of DM1 patients, the scores of the general health and bodily pain domains were significantly and negatively associated with the severity of DR.

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