Timing Is Everything: Age of Onset Influences Long-Term Retinopathy Risk in Type 2 Diabetes, Independent of Traditional Risk Factors

• Published in: Diabetes care Vol. 31; no. 10; pp. 1985 - 1990
• Main Authors: Wong, Jencia, Molyneaux, Lynda, Constantino, Maria, Twigg, Stephen M, Yue, Dennis K
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.10.2008
• Subjects: Adult; Age of Onset; Aged; Biological and medical sciences; Blood pressure; Body Mass Index; Data collection; Development and progression; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetes therapy; Diabetes. Impaired glucose tolerance; Diabetic retinopathy; Diabetic Retinopathy - epidemiology; Diabetics; Disease Susceptibility; Endocrine pancreas. Apud cells (diseases); Endocrinology; Endocrinopathies; Epidemiology/Health Services Research; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin A - metabolism; Humans; Hyperglycemia; Lipids - blood; Macular Edema - epidemiology; Male; Medical sciences; Metabolic diseases; Metabolic syndrome; Middle Aged; Miscellaneous; Mortality; New South Wales - epidemiology; Ophthalmology; Organizational structure; Patients; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Factors; Studies; Type 2 diabetes; Variables; Endocrinopathy; Type 2 diabetes; Human; Retinopathy; Nutrition; Independence; Metabolic diseases; Risk; Long term; Eye disease; Age of onset; Statistical model; Risk factor; Temporal study; Timing; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc08-0580

OBJECTIVE:--To test the hypothesis that age of type 2 diabetes onset influences inherent susceptibility to diabetic retinopathy, independent of disease duration and degree of hyperglycemia. RESEARCH DESIGN AND METHODS--Retinopathy data from 624 patients with a type 2 diabetes duration of 20-30 years (group A) were analyzed by stratifying patients according to age of onset of diabetes and glycemic control. Retinopathy status was scored clinically as per a modified Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. To obviate possible bias due to a higher attrition from comorbidities in those with later-onset diabetes and retinopathy, 852 patients with type 2 diabetes of shorter duration (10-12 years, group B) were similarly studied. RESULTS:--Prevalence and severity of retinopathy was significantly higher in the younger-onset, group A patients. When further stratified according to mean A1C, retinopathy risk remained increased in younger-onset patients. The greatest impact was seen in those with a mean A1C >9% (odds ratio [OR] for retinopathy 16.6, 7.5, and 2.7 for age of diagnosis <45, 45-55, and >55 years, respectively, P = 0.003). By logistic regression, earlier type 2 diabetes onset is associated with increased retinopathy risk, independent of traditional risk factors (OR of retinopathy 1.9, 1.1, and 1 for age of onset <45, 45-55, and >55 years, respectively). Similar results were found in group B patients. CONCLUSIONS:-- These data suggest an increased inherent susceptibility to diabetic retinopathy with earlier-onset type 2 diabetes. This further supports the importance of delaying development of diabetes and also implies a need for more stringent metabolic targets for younger individuals.