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Published online January 9, 2008
Diabetes Care 31:708-713, 2008
DOI: 10.2337/dc07-1657
© 2008 by the American Diabetes Association
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Epidemiology/Health Services Research
Original Research

Retinal Vascular Lesions in Patients of Caucasian and Asian Origin With Type 2 Diabetes

Baseline results from the ADVANCE Retinal Measurements (AdRem) study

Ronald P. Stolk, MD1,2, Mary J. van Schooneveld, MD2, J. Kennedy Cruickshank, MD3, Alun D. Hughes, PHD4, Alice Stanton, MD5, Juming Lu, MD6, Anushka Patel, MD7, Simon A. McG. Thom, MD4, Diederick E. Grobbee, MD2, Johannes R. Vingerling, MD8 on behalf of the AdRem Project Team and ADVANCE Management Committee*

1 Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands
2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
3 Cardiovascular Sciences Research Group, University of Manchester and Royal Infirmary, Manchester, U.K.
4 International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, U.K.
5 Molecular and Cellular Therapeutics and RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland
6 Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
7 The George Institute for International Health, University of Sydney, Sydney, Australia
8 Departments of Ophthalmology and Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands

Address correspondence and reprint requests to Prof. R.P. Stolk, Department of Epidemiology, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, Netherlands. E-mail: r.p.stolk{at}epi.umcg.nl

OBJECTIVE—The objective of this study was to describe prevalent vascular retinal lesions among patients with type 2 diabetes enrolled in the ADVANCE Retinal Measurements (AdRem) study, a substudy of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial.

RESEARCH DESIGN AND METHODS—Seven-field stereoscopic photographs of both eyes were obtained at the baseline assessment of the ADVANCE trial. All photographs were graded in a central reading center. Gradable retinal images were received from 1,605 patients.

RESULTS—The number of patients with any retinopathy (Early Treatment of Diabetic Retinopathy Study [ETDRS] score ≥20) was 645 (40.2% [95% CI 37.8–42.6]); of these, 35 (2.2% [1.6–3.0]) had severe diabetic retinopathy (ETDRS score ≥50). Focal arterial narrowing, venous beading, and arteriovenous nicking were present in 3.8, 5.1, and 9.8% of participants, respectively. Among participants included in this study, Chinese and South-Asian patients had more retinopathy than Caucasians, as defined both by ETDRS score (49.4, 46.0, and 31.3%, respectively; P < 0.001, adjusted for age, sex, A1C, systolic blood pressure, and duration of diabetes) and specific vascular lesions (e.g., arteriovenous nicking 12.3, 8.5, and 7.5%, respectively; adjusted P < 0.005). A1C, duration of diabetes, and systolic blood pressure were similarly associated with increased retinal lesions in Chinese, South-Asian, and Caucasian patients.

CONCLUSIONS—Using a sensitive diagnostic procedure, more than one-third of patients with type 2 diabetes enrolled in the AdRem study had retinal lesions at baseline. Despite differences in prevalence and severity of retinopathy among Chinese, South-Asian, and Caucasian patients included in this study, the cross-sectional associations among established risk factors for retinopathy and retinal lesions were similar across ethnic groups.

Abbreviations: AdRem, Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation Retinal Measurements • ADVANCE, Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation • ETDRS, Early Treatment of Diabetic Retinopathy Study • UKPDS, United Kingdom Prospective Diabetes Study


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