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2005, Number 2

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Cir Cir 2005; 73 (2)

Diabetic retinopathy: twelve-year incidence and progression

Rodríguez-Villalobos E, Cervantes-Aguayo F, Vargas-Salado E, Ávalos-Muñoz ME, Juárez-Becerril DM, Ramírez-Barba EJ

Language: Spanish
References: 44
Page: 79-84
PDF size: 67.78 Kb.


ABSTRACT

Introduction: diabetic retinopathy (DR) it is the main cause of preventable blindness in productive-age adults. The rate of progression to blindness from DR differs among countries and populations.
Material and methods: in order to report the incidence and progression of DR after 12 years of follow-up in a cohort (n = 100) of adult patients with diabetes mellitus type 2 (DM2) in Leon, Guanajuato, Mexico, we designed an open population cohort study from April 1992 to July 2004. Main variables studied longitudinally were incidence and progression of DR, fasting blood glucose, glycated hemoglobin and associated clinical parameters.
Results: mean age was 54 ± (SD) 9.2 years and the time since DM2 diagnosis was 9 ± 6 years. Incidence rates at 3, 6 and 12 years were 23, 48 and 71 % , respectively; and for progression were 56, 70 and 74 % , respectively. The 12-year proliferative DR incidence and progression were 14.3 and 32 % , respectively. Mean fasting blood glucose levels were 193 mg/dL and for glycated hemoglobin 11 % . Mortality was 45 % , half attributable to acute myocardial infarction.
Discussion: diabetic retinopathy in our population has a high incidence that doubled in 3 years, and has an accelerated progression toward more severe forms. Incidence and progression are higher than that reported in white non-Hispanics. It should be high priority in our country to (a) prevent diabetes mellitus, (b) improve its metabolic control, (c) establish RD diagnostic programs and (d) give appropriate treatment.


REFERENCES

  1. SSA. Encuesta Nacional de Enfermedades Crónicas. México, D.F.: Secretaría de Salud. Dirección General de Epidemiología;1993.

  2. 2. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025. Diabetes Care 1998;21:1414-1431.

  3. 3. SSA. Programa de Acción: Diabetes Mellitus. 1ra ed. México, D.F.: Secretaría de Salud;2001.

  4. 4. INSP. Diabetes Mellitus. Capítulo 16. En: Sepúlveda J, ed. Encuesta Nacional de Salud (ENSA) 2000 Tomo II: la salud de los adultos. 1ra. ed. México: Instituto Nacional de Salud Pública;2003:140.

  5. 5. Klein R, Klein BE, Moss SE. The relation of socioeconomic factors of incidence of proliferative diabetic retinopathy and loss of vision. Ophthalmology 1994;101:68-76.

  6. 6. Salazar S, Garduño E, Rodríguez R, Martínez G. Características de los pacientes con diagnóstico de invalidez por diabetes mellitus: un análisis en trabajadores del área de la salud. Rev Med IMSS 1991;29:49.

  7. 7. Aiello LM. Perspectives on diabetic retinopathy. Am J Ophthalmol 2003;136:122-135.

  8. 8. Arun CS, Ngugi N, Lovelock L, Taylor R. Effectiveness of screening in preventing blindness due to diabetic retinopathy. Diabet Med 2003;20:186-190.

  9. 9. Rodríguez-Villalobos E, Ramírez-Barba EJ, Cervantes-Aguayo FC, Vargas-Salado E. The incidence and opportunity for the diagnosis of diabetic retinopathy. Salud Publica Mex 1994;36:275-280.

  10. 10. Gonzalez-Villalpando ME, Gonzalez-Villalpando C, Arredondo-Perez B, Stern MP. Diabetic retinopathy in Mexico. Prevalence and clinical characteristics. Arch Med Res 1994;25:355-360.

  11. 11. Harris MI, Kelin R, Cowie CC, Rowland M, Byrd-Holt DD. Is the risk of diabetic retinopathy greater in non-hispanic blacks and Mexican Americans than in non-hispanic whites with type 2 diabetes? A U.S. population study. Diabetes Care 1998;21:1230-1235.

  12. 12. Gonzalez-Villalpando C, Gonzalez-Villalpando ME, Rivera-Martinez D, Stern MP. Incidence and progression of diabetic retinopathy in low income population of Mexico City. Rev Invest Clin 1999;51:141-150.

  13. 13. Rodríguez-Villalobos E, Ramírez-Barba EJ, Cervantes-Aguayo F, Vargas-Salado E, Ávalos-Muñoz ME. Incidencia y progresión de la retinopatía diabética en diabetes mellitus 2, a seis años. Diabet Hoy Med Sal 2004;5:1262-1273.

  14. 14. Rodriguez-Villalobos E, Ramirez-Barba EJ, Cervantes-Aguayo FC, Vargas-Salado E. Diabetic retinopathy and risk of blindness in Mexico. Are we doing enough? Diabetes Care 1999;22:1905.

  15. 15. Lwanga S, Lemeshow S. Determinación del tamaño de muestras en los estudios sanitarios. Ginebra: Organización Mundial de la Salud (OMS/WHO);1991.

  16. 16. IMSS. Diagnóstico situacional de atención al paciente diabético en la delegación Guanajuato. León, Gto.: Instituto Mexicano del Seguro Social, Delegación Guanajuato;1987.

  17. 17. ETDRS-10. Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98(5 Suppl):786-806.

  18. 18. DRS-7. A modification of the Airlie House Clasification of Diabetic Retinopathy. Invest Ophthalmol Vis Sci 1981;21:210-226.

  19. 19. ETDRS-12. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Early treatment diabetic retinopathy study research group. Ophthalmology 1991;98 (5 Suppl):823-833.

  20. 20. SSA. Norma Oficial Mexicana NOM-015-SSA2-1994. Para la Prevención, Tratamiento y Control de la Diabetes. Secretaría de Salud. En: Normas Oficiales Mexicanas. México, D.F.;1999.

  21. 21. Hintze J. Number Cruncher Statistical System for Windows (NCSS) 2000. Released April 28, 2004. www.ncss.com. In Utah: Jerry Hintze;2004.

  22. 22. Klein R, Klein BE, Moss SE, Cruickshanks KJ. Ten-year incidence and progression of diabetic retinopathy. Arch Ophthalmol 1994;112:1217-1228.

  23. 23. Klein R, Klein BE, Moss SE. How many steps of progression of diabetic retinopathy are meaningful? The Wisconsin epidemiologic study of diabetic retinopathy. Arch Ophthalmol 2001;119:547-553.

  24. 24. West SK, Klein R, Rodriguez J, et al. Diabetes and diabetic retinopathy in a Mexican-American population: Proyecto VER. Diabetes Care 2001;24:1204-1209.

  25. 25. Quiroz-Mercado H, Granados-Melo EA, Roig-Melo E, et al. Preva-lencia y gravedad de la retinopatía diabética en una población del Estado de Durango. Rev Mex Oftalmol 2000;74:263-266.

  26. 26. Ferris F. Early photocoagulation in patients with either type I or type II diabetes. Trans Am Ophthalmol Soc 1996;94:505-537.

  27. 27. ETDRS-9. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98(5 Suppl):766-785.

  28. 28. DRS-14. Indications for photocoagulation treatment of diabetic retinopathy: Diabetic Retinopathy Study Report no. 14. The Diabetic Retinopathy Study Research Group. Int Ophthalmol Clin 1987; 27:239-253.

  29. 29. Aiello LM, Cavallerano JD. Diabetic retinopathy. Curr Ther Endocri-nol Metab 1997;6:475-485.

  30. 30. Ohkubo Y, Kishikawa H, Araki A. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomised prospective 6 year study. Diabetes Res Clin Pract 1995;28:103-117.

  31. 31. DCCT. The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes 1995;44:968-983.

  32. 32. UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837-853.

  33. 33. Rajala U, Laakso M, Qiao Q, Keinanen-Kiukaanniemi S. Prevalence of retinopathy in people with diabetes, impaired glucose tolerance, and normal glucose tolerance. Diabetes Care 1998;21:1664-1669.

  34. 34. Alder V, Su E, Yu D, Cringle S, Yu P. Diabetic retinopathy: early functional changes. Clin Exp Pharmacol Physiol 1997;24:785-788.

  35. 35. Davis M, Fisher M, Gangnon R, et al. Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: ETDRS #18. Early Treatment Diabetic Retinopathy Study Report #18. Invest Ophthalmol Vis Sci 1998;39:233-252.

  36. 36. DPP. The Diabetes Prevention Program. Design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care 1999;22:623-634.

  37. 37. DCCT. Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complication Trial. Ophthalmology 1995;102:647-655.

  38. 38. Quiroz-Mercado H, Suarez-Licona A, Fromow-Guerra J, et al. Human lymphocyte antigen DR7 protects against proliferative retino-

  39. pathy with type II diabetes mellitus. Arch Med Res 2002;33:123-127.

  40. 39. West SK, Munoz B, Klein R, et al. Risk factors for type II diabetes and diabetic retinopathy in a Mexican-American population: Proyecto VER. Am J Ophthalmol 2002;134:390-398.

  41. 40. Santos A, Salguero ML. The epsilon 4 allele of apolipoprotein E gene is a potential risk factor for the severity of macular edema in type 2 diabetic Mexican patients. Ophthalmic Genet 2002;23:13-19.

  42. 41. Diabetes Prevention Program Research Group. Effects of withdrawal from metformin on the development of diabetes in the diabetes prevention program. Diabetes Care 2003;26:977-980.

  43. 42. Molitch ME, Fujimoto W, Hamman RF, Knowler WC. The diabetes prevention program and its global implications. J Am Soc Nephrol 2003;14(7 Suppl 2):S103-S107.

  44. 43. Murphy D, Chapel T, Clark C. Moving diabetes care from science to practice: the evolution of the National Diabetes Prevention and Control Program. Ann Intern Med 2004;140:978-984.




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