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Risk factors for development and progression of retinopathy in normoalbuminutic type 1 diabetic patients

Purpose: The onset of diabetic retinopathy (DR) is insufficiently understood, but supposed to occur simultaneously and with equal severity as diabetic renal disease. The aim of this study was to assess the prevalence of retinopathy in normoalbuminuric type 1 diabetics and evaluate the risk factors for its development and progression in these patients. Methods: 223 normoalbuminuric type 1 diabetics with normal renal function (glomerular filtration rate ≥60 ml/min/1.73m2) were included in this prospective study and followed for 48 months. Complete diabetologic, nephrologic, cardiologic and ophthalmologic examination was done. Risk factors for the development and progression of DR were examined in backward stepwise Cox's multiple regression analysis. Results: At baseline, 156 (70%) patients had no retinopathy and 67 (30%) had NPDR. After 48 months, 24 patients (10.7%) developed NPDR or progressed to PDR. From the 156 patients with no retinopathy at the beginning of the study 15 (9.6%) progressed to NPDR, while from the 67 patients with NPDR at the beginning of the study 9 (13.4%) progressed to PDR. Male sex, systolic blood pressure, urinary albumin excretion (UAE) and resting heart rate were significantly associated with the development and progression of retinopathy. Conclusion: This study showed that retinopathy may develop and progress in type 1 diabetics even without a coexisting renal disease. This points to the need for even closer monitoring of normoalbuminuric type 1 diabetics aimed at early detecting, preventing or limiting the progression of retinopathy, especially in men with higher UAE, systolic blood pressure and higher resting heart rate.

normoalbuminuric type 1 diabetic patients, diabetic retinopathy, risk factors

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