The Incidence of Retinopathy 10 Years After Diagnosis in Young Adult People With Diabetes

The Incidence of Retinopathy 10 Years After Diagnosis in Young Adult People With Diabetes Results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS) Marianne Henricsson , MD, PHD 1 , Lennarth Nyström , MSC, PHD 2 , Göran Blohmé , MD, PHD 3 , Jan Östman , MD, PHD 4 , Carin Kullberg , MSC, PHD 5 , Maria Svensson , MD 2 , Anna Schölin , MD 6 , Hans J. Arnqvist , MD, PHD 5 , Elisabeth Björk , MD, PHD 6 , Jan Bolinder , MD, PHD 4 , Jan W. Eriksson , MD, PHD 2 and Göran Sundkvist , MD, PHD 7 1 Department of Ophthalmology, Helsingborg Hospital, Helsingborg, Sweden 2 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden 3 Department of Medicine, South Hospital, Stockholm, Sweden 4 Department of Medicine, Huddinge Hospital, Stockholm, Sweden 5 Department of Medicine, Linköping University Hospital, Linköping, Sweden 6 Department of Medicine, Uppsala University Hospital, Uppsala, Sweden 7 Department of Endocrinology, Malmö University Hospital, Malmö, Sweden Abstract OBJECTIVE —To estimate the prevalence and severity of diabetic retinopathy (DR) 10 years after diagnosis in a nationwide population-based cohort study of young adult diabetic patients in Sweden. RESEARCH DESIGN AND METHODS —The Diabetes Incidence Study in Sweden (DISS) aims to register all incident cases of diabetes aged 15–34 years in Sweden. In 1987–1988, 806 cases were reported, and 627 (78%) of them were followed up with regard to retinopathy 8–10 years later. The assessment was based on retinal photographs in most cases (86%). RESULTS —Ten years after diagnosis, retinopathy was found in 247 patients (39%). The retinopathy was mild in 206 (33%), whereas 30 (4.8%) patients had moderate nonproliferative DR (NPDR) and 11 (1.8%) had proliferative DR (PDR). Patients with retinopathy had worse glycemic control during the years than patients without (HbA 1c 8.1 ± 1.5% and 6.8 ± 1.2%, respectively; P < 0.001). In a Cox regression analysis, time to retinopathy was related to high HbA 1c ( P < 0.001) and high BMI ( P = 0.001). Patients with type 2 diabetes had an increased prevalence of severe retinopathy (NPDR or PDR) compared with those with type 1 diabetes (14 of 93 [15%] versus no or mild 24 of 471 [5%], respectively; P < 0.001). CONCLUSIONS —Despite modern diabetes management, 39% of young adult diabetic patients developed retinopathy within the first 10 years of the disease. Nevertheless, compared with the prevalence of retinopathy (63%), after a simi