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Which of the following is not a Risk Factor for Diabetic
Retinopathy:
1. Hyperglycemia
2. Body Mass Index (BMI)
3. Elevated C-Peptides
4. Dyslipidemia
5. Hypertension
6. Pregnancy
The onset and progression of diabetic eye disease is influenced by many
factors. Diabetes duration, age at diagnosis, and blood glucose control
are well-established risk factors for diabetic retinopathy. The Diabetes
Control and Complications Trial (DCCT) has shown that intensive blood
glucose control can delay onset and slow progression of diabetic retinopathy.
In addition, other factors, such as hypertension, dyslipidemia, hypercholesterolemia,
renal disease, and pregnancy, also have been shown to contribute to
the risk of diabetic retinopathy progression.
The higher the BMI, the greater the risk of developing health problems.
A person with a BMI of 25-29 is approximately 20% overweight and is
generally considered to be vulnerable to moderate health risks, while
a BMI of >/= 30 is considered obese and increases the risk of death
from any cause by 50% to 150%. Heart disease, diabetes, and high blood
pressure are all associated with being overweight.
In the recent population-based cross-sectional Hoorn Study, van Leiden
and colleagues[1] evaluated the risk factors affecting the prevalence
of retinopathy in Dutch type 2 diabetic and nondiabetic patients using
a logistic regression analysis for glycosylated hemoglobin (A1C), age,
sex, hypertension, BMI, waist-hip ratio, serum lipids, and smoking.
They found that the prevalence of retinopathy was positively associated
with BMI as well as hyperglycemia, elevated blood pressure, serum cholesterol,
and serum triglyceride in patients with normal glucose metabolism, impaired
glucose metabolism, or newly diagnosed diabetes mellitus.
In a longitudinal study, Dorchy and colleagues[3] found BMI to have
a significant predictive value for a risk of progression from early
nonproliferative diabetic retinopathy to proliferative diabetic retinopathy
in patients with type 1 diabetes. Higher BMI levels were associated
with progression to proliferative diabetic retinopathy (BMI 27 vs 22
kg/m2, P= .035).
Similarly, Zhang and colleagues[4] performed a logistic regression
analysis on the DCCT group to evaluate the risk of developing retinopathy
in type 1 diabetes patients with good (mean A1C </= 6.87%) or poor
(mean A1C </= 9.49%) metabolic control. They reported a 9.8% 3-step
worsening of retinopathy in the good-control group compared with 43%
in the poor-control group. Although the occurrence of diabetic retinopathy
was primarily related to metabolic control and duration of diabetes
(P < .0001), an increase in BMI possibly contributed to the early
progression of diabetic retinopathy in these type 1 diabetes patients
(odds ratio 1.11, P < .05).
In conclusion, BMI is an important risk factor for cardiovascular diseases
and is an important consideration in optimizing the systemic status
of patients with diabetes. It elicits major health concerns in individuals
exceeding 25 kg/m2. Studies to date also suggest that it may be a risk
factor for increased prevalence of diabetic retinopathy and for progression
of diabetic retinopathy, especially in patients with type 1 diabetes.
References
1. van Leidein HA, Dekker JM, Moll AC, et al. Blood pressure, lipids,
and obesity are associated with retinopathy: the hoorn study. Diabetes
Care. 2002;25:1320-1325. Abstract
2. van Leiden HA, Dekker JM, Moll AC, et al. Risk factors for incident
retinopathy in a diabetic and nondiabetic population: the Hoorn study.
Arch Ophthalmol. 2003;121:245-251. Abstract
3. Dorchy H, Claes C, Verougstraete C. Risk factors of developing proliferative
retinopathy in type 1 diabetic patients: role of BMI. Diabetes Care.
2003:25:798-799.
4. Zhang L, Krzentowski G, Albert A, Lefebvre PJ. Risk of developing
retinopathy in Diabetes Control and Complications trial type 1 diabetic
patients with good or poor metabolic control. Diabetes Care. 2001;24:1275-1279.
Abstract
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