FoU-centrum Primärvård och Tandvård i Skaraborg

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

1258

(305 dead)

381 ≥70 yrs at baseline

(187 dead)

877 < 70 yrs at baseline

(118 dead)

6 undefined

2type 1

403type 2

8 undefined

104type 1

765type 2

Population 2007-2010

SDR=Skaraborgs diabetesregister

FoU-centrum Primärvård och Tandvård i Skaraborg

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

Results I aDiabetic retinopathy in all patients (type 1+2+0)

*Before 01/01/99, ** Before 01/01/03, *** Before 10/08/09, § last examination

Number of patients

Examination 1996-1998

Examination 2000-2002

Examination 2003- 2009§

Examined 362 630 649

Any retinopathy 26 88 168

Maculopathy 5 19 38

Proliferative retinopathy

0 5 12

Laser treatmentA maculopathyB scatter

330

10103

232210 (1 BRVO)

Visual acuity>0.5<0.3

3313245

6186075

6376169

Mortality 22* 57** 117***

FoU-centrum Primärvård och Tandvård i Skaraborg

Results I Diabetic retinopathy in patients type 0+2 <70 years at baseline

*Before 01/01/99, ** Before 01/01/03, *** Before 10/08/09, § last examination

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 treatmentA maculopathyB scatter

330

771

19 (3.4%)186 (1 BRVO)

Visual acuity>0.5<0.3

2642593

5415145

5485279

Mortality 20* 53** 114***

FoU-centrum Primärvård och Tandvård i Skaraborg

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

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

Results IIaHbA1C in 1996-1998

FoU-centrum Primärvård och Tandvård i Skaraborg

Results IIbHbA1C and time to retinopathy

FoU-centrum Primärvård och Tandvård i Skaraborg

Results IIcHbA1C 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 IIeBMI in 96-98 and maculopathy

FoU-centrum Primärvård och Tandvård i Skaraborg

Results IIIaBlood 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 IIIbAntihypertensive treatment and retinopathy

FoU-centrum Primärvård och Tandvård i Skaraborg

Results IIIcAntihypertensive 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!

Questions or comments?

FoU-centrum Primärvård och Tandvård i Skaraborg

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