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The presence of generalized or focal retinal arteriolar narrowing in patients with type 1 diabetes is associated with an increased risk of lower extremity amputations, independent of glycosylated hemoglobin levels and blood pressure.
Changes in retinal arterioles are believed to reflect microvascular damage occurring elsewhere in the body, says Scot E. Moss, of the University of Wisconsin Medical School in Madison.
To further explore these issues, they analyzed 20-year follow-up data for nearly 1000 subjects with diabetes onset before age 30 who required insulin. The cohort had undergone baseline examinations between 1980 and 1982. Retinal vessel caliber was measured on digitized fundus photographs.
The 79 lower extremity amputations that occurred during the ensuing 20 years translated to a cumulative 20-year incidence of 9.9%. After adjusting for age and sex, the odds ratio for amputation was 2.73 for those in the lowest quartile of arteriolar/venular ratio compared with those in the upper three quartiles. The odds ratio for risk associated with focal narrowing was even higher at 3.48.
Multivariate analysis revealed that the odds ratios for focal and generalized narrowing and diabetic retinopathy remained elevated after adjusting for glycosylated hemoglobin levels, blood pressure, and history of foot ulcers.
It seems that all these complications of diabetes tend to go together in a package, If you see one complication, it seems to put the patient at risk for other complications."
Similar analyses for type 2 diabetics have yet to be completed, he noted, so it impossible to draw conclusions for these patients. However, "we certainly have type 2 patients who have had diabetes as long patients with type 1," so those with microvascular retinal changes are probably also at increased risk for amputation. Arch Intern Med 2003;163:2505-2510
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