Female Preponderance in the Discordant Association between Retinopathy and Nephropathy in Patients with Type 2 Diabetes Mellitus
- 1
- 2
- 3
- 4
- 5
- 6
Abstract
Aim: To elucidate clinical features in patients with type 2 diabetes with advanced retinopathy but without nephropathy. Methods: This study examined 1324 patients (784 males and 540 females) with type 2 diabetes mellitus. Diabetic reti-nopathy was graded according to the International Clinical Classification of Diabetic Retinopathy as no diabetic reti-nopathy, mild or moderate non-proliferative diabetic retinopathy, severe non-proliferative diabetic retinopathy, and proliferative diabetic retinopathy. Diabetic nephropathy was classified into four stages of severity according to the Guideline Committee of the Japan Diabetes Society. Each patient was examined for retinopathy grade and nephropathy stage. Clinical features of patients with proliferative diabetic retinopathy were compared with regard to the four grades of diabetic nephropathy. Results: Fifty-two patients with type 2 diabetes (3.9% of the whole series of 1324 patients with type 2 diabetes and 25.7% of patients with proliferative diabetic retinopathy) had proliferative diabetic retinopathy without the presence of nephropathy. Multiple statistical analysis using a proportional odds model revealed that pa-tients with proliferative diabetic retinopathy without nephropathy had a significantly lower systolic blood pressure (p < 0.001) than those who did and were preponderantly female (p < 0.05). Conclusions: A possible susceptibility of dia-betic females to proliferative advanced retinopathy without nephropathy encourages further studies on the role of hor-mones and blood coagulation in the pathogensis of proliferative diabetic retinopathy.
- The Diabetic Control and Complications Trial Research Group, “The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus,” New England Journal of Medicine, Vol. 329, No. 14, 1993, pp. 977-987.
- UK Prospective Diabetes Group, “Intensive Blood-Glucose Control with Sulphonylurea or Insulin Compared with Conventional Treatment and Risk of Complications in Patients with Type 2 Diabetes (UKPDS33),” Lancet, Vol. 352, No. 9131, 1998, pp. 837-853.
- UK Prospective Diabetes Group, “Tight Blood Pressure Control and Risk of Macrovascular and Microvascular Complications in Type 2 Daibetes (UKPDS38),” British Medical Journal, Vol. 317, No. 7160, 1998, pp. 703-713.
- R. Klein, B. E. Klein, S. E. Moss, M. D. Davis and D. L. DeMets, “The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Prevalence and Risk of Diabetic Retinopathy When Age at Diagnosis Is Less Than 30 Years,” Archives of Ophthalmology, Vol. 102, No. 4, 1984, pp. 520-526.
- E. A. Friedman and F. A. L’Esperance, “Diabetic Ren Al-Retinal Syndrome,” Archives of Internal Medicine, Vol. 140, No. 9, 1980, pp. 1149-1150.
- E. Agardh, G. Tallroth, B. Bauer, U. Cavallin-Sj?berg and C. D. Agardh, “Retinopathy and Nephropathy in Insulin-Dependent Diabetics: An Inconsistent Relationship?” Diabetic Medicine, Vol. 4, No. 3, 1987, pp. 248-250.
- B. M. Chavers, S. M. Mauer, R. C. Ramsay and M.W. Steffes, “Relationship between Retinal and Glomerular Lesions in IDDM Patients,” Diabetes, Vol. 43, No. 3, 1994, pp. 441-446.
- M. Kanauchi, T. Kawano, H. Uyama, H. Shiiki and K. Dohi, “Discordance between Retinopathy and Nephropathy in Type 2 Diabetes,” Nephron, Vol. 80, No. 1, 1998, pp. 71-75.
- C. P. Wilkison, F. L. Ferris, R. E. Klein, P. P. Lee, C. D. Agardh, M. Davis, D. Dills, A. Kampik, R. Pararajasegaram, J. T. Verdaguer, “Proposed International Clinical Diabetic Retinopathy and Diabetic Macular Edema Disease Severity Scales,” Ophthalmology, Vol. 110, No. 9, 2003, pp. 1677-1682.
- The Japan Diabetes Society, “Evidence-based Practice Guideline for the Treatment of Diabetes in Japan, 2nd Edition,” Nankodo, Tokyo, 2007.
- A. Sessa, G. Batini, M. Meroni, F. Aqneli, F. Giordano and L. T. Tarelli, “Renal-Ritinal Diabetic Syndrome,” Nephron, Vol. 83, No. 3, 1999, pp. 285-286.
- G. Wolf, N. Muller, A. Mandecka and U. A. Müler, “Association of diabetic retinopathy and renal function in patients with types 1 and 2 diabetes mellitus,” Clinical Nephrology, Vol. 68, No. 2, 2007, pp. 81-86.