FoU-centrum Primärvård och Tandvård i Skaraborg
Does treatment for hypertension protect against retinopathy?
Skaraborgs Diabetesregister (SDR) ten years follow up
Grete Garberg, MD Skaraborg Hospital
FoU-centrum Primärvård och Tandvård i Skaraborg
Background I
Diabetic retinopathy • main reason for visual impairment in working ages,
patients fear ”blindness”Important to preventType 2 diabetes • retinopathy not unusual at diagnosisScreening is effective to detect retinopathy• makes treatment possible before symptoms evolve
FoU-centrum Primärvård och Tandvård i Skaraborg
Background II
Screening in Skaraborg from late 1980• patients in ages < 70 years
Skaraborgs Diabetes Register (SDR)• 1991-2004 • clinical data and data on morbidity and mortality
Patients type 2 (+0=undefined)diagnosed 1996-1998• the basis of this study
FoU-centrum Primärvård och Tandvård i Skaraborg
SDR cohort 1996-1998
1258
(305 dead)
381 ≥70 yrs at baseline
(187 dead)
877 < 70 yrs at baseline
(118 dead)
6 undefined
2type 1
403type 2
8 undefined
104type 1
765type 2
Population 2007-2010
SDR=Skaraborgs diabetesregister
FoU-centrum Primärvård och Tandvård i Skaraborg
Methods
Data from retinal screening • close to diagnosis and after 5 and 10 years From screening records • retinopathy, maculopathy, laser treatment, visual acuity
and other reasons for visual impairment From Skaraborgs Diabetes Register • HbA1c, body mass index (BMI), blood pressure (BP) and
antihypertensive treatment
FoU-centrum Primärvård och Tandvård i Skaraborg
Results I aDiabetic retinopathy in all patients (type 1+2+0)
*Before 01/01/99, ** Before 01/01/03, *** Before 10/08/09, § last examination
Number of patients
Examination 1996-1998
Examination 2000-2002
Examination 2003- 2009§
Examined 362 630 649
Any retinopathy 26 88 168
Maculopathy 5 19 38
Proliferative retinopathy
0 5 12
Laser treatmentA maculopathyB scatter
330
10103
232210 (1 BRVO)
Visual acuity>0.5<0.3
3313245
6186075
6376169
Mortality 22* 57** 117***
FoU-centrum Primärvård och Tandvård i Skaraborg
Results I Diabetic retinopathy in patients type 0+2 <70 years at baseline
*Before 01/01/99, ** Before 01/01/03, *** Before 10/08/09, § last examination
Number of patients
Examination 1996-1998
Examination 2000-2002
Examination 2003- 2009§
Examined 288 540 559
Any retinopathy 21 76 144 (25,6%)
Maculopathy 3 15 32(5,7%)
Proliferative retinopathy
0 2 7 (1.4%)
Laser treatmentA maculopathyB scatter
330
771
19 (3.4%)186 (1 BRVO)
Visual acuity>0.5<0.3
2642593
5415145
5485279
Mortality 20* 53** 114***
FoU-centrum Primärvård och Tandvård i Skaraborg
Results summary IFrequency of screening• 83% (639/773) of patients <70 years at diagnosis
screened some time during follow-up
HbA1C at diagnosis• Mean value 6,66% Visual acuity • 96% (527/548) >0.5 at the last recorded examination
FoU-centrum Primärvård och Tandvård i Skaraborg
HbA1C at diagnosis
FoU-centrum Primärvård och Tandvård i Skaraborg
HbA1c < 7.0 % ≥7.0 % pRetinopathy 88 (22.4%) 71 (38.6%) < 0.001
Maculopathy 15 (4.0%) 18 (9.8%) 0.006
HbA1c < 8.0 % ≥8.0 % pRetinopathy 114 (24.4%) 45 (41.7%) < 0.001
Maculopathy 20 (4.4%) 13 (11.9%) 0.003
Results IIaHbA1C in 1996-1998
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IIbHbA1C and time to retinopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IIcHbA1C and time to maculopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IId BMI in 96-98 and retinopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IIeBMI in 96-98 and maculopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IIIaBlood pressure and hypertension
Systolic blood pressure <130 mmHg • Associated with less retinopathy
Systolic blood pressure >130 mmHg • Further increase in systolic blood pressure not associated with more
retinopathy.
Blood pressure at baseline • Not associated with retinopathy or maculopathy
Hypertension treatment at baseline• Associated with less retinopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IIIbAntihypertensive treatment and retinopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IIIcAntihypertensive treatment and maculoopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Conclusions I
Relatively few patients with visual impairment
Retinopathy increases rapidly after 10 years duration
FoU-centrum Primärvård och Tandvård i Skaraborg
Conclusions II
HbA1C level at diagnosis seems to predict risk for retinopathy and maculopathy
BMI at diagnosis does not affect development of retinopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Conclusions III
Antihypertensive treatment regardless of BP level associated with
•lower frequency of retinopathy
•lower frequency of maculopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Thank you for your attention!
Questions or comments?
FoU-centrum Primärvård och Tandvård i Skaraborg
Thanks for contribution from
• R&D Centre, Skaraborg Hospital, financing
• Bo Berger, PhD
• Kristina A Boström, Supervisor; PhD, R&D Centre Skaraborg Primary Care
• Monica Lövestam Adrian, Suprervisor; PhD, Eye Clinic, Lund University Hospital
• Salmir Nasic, Statistician, Skaraborg Hospital
• Ann Segerblom, Research Assistent, R&D Centre Skaraborg Primary Care
