Influence of serum lipids on the incidence and progression of diabetic retinopathy and macular oedema: Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular genetics Study-II.
IMPORTANCE
The importance of lipids on incidence and progression of diabetic retinopathy has not been studied in the Indian population.


BACKGROUND
To elucidate the influence of serum lipid control on the incidence and progression of diabetic retinopathy and diabetic macular oedema in subjects with type 2 diabetes.


DESIGN
Population-based longitudinal observational study in a hospital setting.


PARTICIPANTS
Eight hundred ninety subjects were examined at baseline and follow-up.


METHODS
Diabetic retinopathy was graded per Modified Early Treatment Diabetic Retinopathy Study scales; 45°, 4-field dilated stereoscopic digital photography was performed with an additional 30°, 7-field for those who had retinopathy. Macular oedema was evaluated per Proposed International Clinical Diabetic Retinopathy and Diabetic Macular Oedema Disease Severity Scales.


MAIN OUTCOME MEASURES
Association of serum lipids and incidence and progression of diabetic retinopathy.


RESULTS
Poor control of total cholesterol was associated with the incidence of sight-threatening retinopathy (odds ratio = 7.2 [95% confidence interval: 1.5-34.3], P = 0.012) and macular oedema (odds ratio = 5.5 [95% confidence interval: 1.4-27.4], P = 0.037) after adjusting for potential confounders. Poor control of triglycerides was associated with progression to proliferative diabetic retinopathy (odds ratio = 3.2 [95% confidence interval: 1.1-10.5], P = 0.048). Risk for incident macular oedema (P = 0.041) and progression to proliferative diabetic retinopathy (P = 0.028) was greater when all lipid types were abnormal.


CONCLUSIONS AND RELEVANCE
Poor control of lipids is a risk factor for incidence of and progression to late stages of retinopathy. Abnormal levels of all lipid types are associated with risk of incident macular oedema and progression to proliferative diabetic retinopathy.
['Srinivasan|Sangeetha|S|', 'Raman|Rajiv|R|0000-0001-5842-0233', 'Kulothungan|Vaitheeswaran|V|', 'Swaminathan|Gayathri|G|', 'Sharma|Tarun|T|']
D000328:Adult D000368:Aged D015415:Biomarkers D003924:Diabetes Mellitus, Type 2 D003930:Diabetic Retinopathy D018450:Disease Progression D005260:Female D005500:Follow-Up Studies D006801:Humans D015994:Incidence D007194:India D008055:Lipids D008269:Macular Edema D008297:Male D008875:Middle Aged D008967:Molecular Biology D016017:Odds Ratio D012189:Retrospective Studies D012307:Risk Factors D013997:Time Factors
diabetic retinopathy diabetic macular oedema cholesterol triglyceride risk factor