Retinal Arteriolar Narrowing and Risk of Diabetes Mellitus in Middle-aged Persons

• Published in: JAMA : the journal of the American Medical Association Vol. 287; no. 19; pp. 2528 - 2533
• Main Authors: Wong, Tien Yin, Klein, Ronald, Sharrett, A. Richey, Schmidt, Maria I, Pankow, James S, Couper, David J, Klein, Barbara E. K, Hubbard, Larry D, Duncan, Bruce B, for the ARIC Investigators
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 15.05.2002
• Subjects: Aged; Aging; Aging - physiology; Biological and medical sciences; Blood vessels; Diabetes; Diabetes Mellitus - epidemiology; Diabetes Mellitus - etiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Eyes & eyesight; Female; Humans; Hypertension - physiopathology; Inflammation; Logistic Models; Male; Medical sciences; Microcirculation - physiology; Middle age; Middle Aged; Photography; Prospective Studies; Retinal Artery Occlusion - etiology; Retinal Artery Occlusion - physiopathology; Retinal Vessels - physiology; Risk Factors; United States; North America; America; Endocrinopathy; Human; Pathogenesis; Cardiovascular disease; Retina; Narrowing; Marker; Non insulin dependent diabetes; Epidemiology; Vascular disease; Microangiopathy; Risk factor; Technique
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.287.19.2528

CONTEXT Microvascular processes have been hypothesized to play a role in the pathogenesis of type 2 diabetes mellitus, but prospective clinical data regarding this hypothesis are unavailable. OBJECTIVE To examine the relation of retinal arteriolar narrowing, a marker of microvascular damage from aging, hypertension, and inflammation, to incident diabetes in healthy middle-aged persons. DESIGN, SETTING, AND PARTICIPANTS The Atherosclerosis Risk in Communities Study, an ongoing population-based, prospective cohort study in 4 US communities that began in 1987-1989. Included in this analysis were 7993 persons aged 49 to 73 years without diabetes, of whom retinal photographs were taken during the third examination (1993-1995). MAIN OUTCOME MEASURES Incident diabetes (defined as fasting glucose levels of ≥126 mg/dL [7.0 mmol/L], casual levels of ≥200 mg/dL [11.1 mmol/L], diabetic medications use, or physician diagnosis of diabetes at the fourth examination) by quartile of retinal arteriole-to-venule ratio (AVR). RESULTS After a median follow-up of 3.5 years, 291 persons (3.6%) had incident diabetes. The incidence of diabetes was higher in persons with lower AVR at baseline (2.4%, 3.1%, 4.0%, and 5.2%, from highest to lowest AVR quartile; P for trend<.001). After controlling for fasting glucose and insulin levels, family history of diabetes, adiposity, physical activity, blood pressure, and other factors, persons in the lowest quartile of AVR were 71% more likely to develop diabetes than those in the highest quartile (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.13-2.57; P for trend = .002). This association persisted with different diagnostic criteria (OR, 1.92; 95% CI, 1.10-3.36; P for trend = .01, using a fasting glucose level of ≥141 mg/dL [7.8 mmol/L] as a cutoff), and was seen even in people at lower risk of diabetes, including those without a family history of diabetes, without impaired fasting glucose, and with lower measures of adiposity. CONCLUSIONS Retinal arteriolar narrowing is independently associated with risk of diabetes, supporting a microvascular role in the development of clinical diabetes.