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 prevent
Type 2 diabetes
• retinopathy not unusual at diagnosis
Screening 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
Population 2007-2010
1258
(305 dead)
765
type 2
877 < 70 yrs at baseline
381 ≥70 yrs at baseline
(118 dead)
(187 dead)
104
type 1
8
undefined
SDR=Skaraborgs diabetesregister
FoU-centrum Primärvård och Tandvård i Skaraborg
403
type 2
2
type 1
6
undefined
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
FoU-centrum Primärvård och Tandvård i Skaraborg
Results I a
Diabetic retinopathy in all patients (type 1+2+0)
Number of
patients
Examination Examination Examination
2003- 2009§
1996-1998
2000-2002
Examined
362
630
649
Any retinopathy
26
88
168
Maculopathy
5
19
38
Proliferative
retinopathy
0
5
12
Laser treatment
A maculopathy
B scatter
3
3
0
10
10
3
23
22
10 (1 BRVO)
Visual acuity
>0.5
<0.3
331
324
5
618
607
5
637
616
9
Mortality
22*
57**
117***
*Before 01/01/99, ** Before 01/01/03, *** Before 10/08/09, § last examination
FoU-centrum Primärvård och Tandvård i Skaraborg
Results I
Diabetic retinopathy in patients type 0+2 <70 years at baseline
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 treatment
A maculopathy
B scatter
3
3
0
7
7
1
19 (3.4%)
18
6 (1 BRVO)
Visual acuity
>0.5
<0.3
264
259
3
541
514
5
548
527
9
Mortality
20*
53**
114***
*Before 01/01/99, ** Before 01/01/03, *** Before 10/08/09, § last examination
Results summary I
Frequency 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
Results IIa
HbA1C in 1996-1998
HbA1c
< 7.0 %
≥7.0 %
p
Retinopathy
88 (22.4%)
71 (38.6%)
< 0.001
Maculopathy
15 (4.0%)
18 (9.8%)
0.006
HbA1c
< 8.0 %
≥8.0 %
p
Retinopathy
114 (24.4%)
45 (41.7%)
< 0.001
Maculopathy
20 (4.4%)
13 (11.9%)
0.003
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IIb
HbA1C and time to retinopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IIc
HbA1C 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 IIe
BMI in 96-98 and maculopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IIIa
Blood 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 IIIb
Antihypertensive treatment and retinopathy
FoU-centrum Primärvård och Tandvård i Skaraborg
Results IIIc
Antihypertensive 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!
FoU-centrum Primärvård och Tandvård i Skaraborg
Questions or comments?
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
FoU-centrum Primärvård och Tandvård i Skaraborg
