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Microaneurysm count as a predictor of long-term progression in diabetic retinopathy in young patients with type 1 diabetes: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987)

  • Retinal Disorders
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Abstract

Purpose

To investigate microaneurysm (MA) count as a predictor of long-term progression of diabetic retinopathy (DR) in young patients with type 1 diabetes mellitus (T1DM).

Methods

We examined 185 patients with T1DM at baseline (1995) and at follow-up (2011). At baseline, mean age and duration of diabetes were 20.6 and 12.9 years, respectively. Two-field (1995) and seven-field (2011) fundus photographs were taken in accordance with the European Diabetes Study Group (EURODIAB) and the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol, respectively. DR was graded in accordance to the ETDRS protocol, allowing for non-standard photography at baseline. Baseline MAs were counted; patients without DR and those with MAs only were included. Multivariable logistic regressions were performed to investigate MA-count as a predictor of two-step progression, progression to proliferative DR (PDR), and incident diabetic macula edema (DME).

Results

We included 138 patients (138 eyes). Of these, 58 had no retinopathy and 80 had MAs only. At follow-up, rates of two-step progression of DR, progression to PDR and incident DME were 52.9, 21.7, and 10.1 %, respectively.

In logistic regression models, MA count was able to predict progression to PDR (OR: 1.51 per MA; 95 % CI: [1.04–2.20]) and DME (OR: 1.69 per MA; 95 % CI: [1.05–2.77]), but not two-step progression (OR 0.91 per MA, 95 % CI: [0.64–1.31]).

Conclusions

In younger patients with T1DM, MA count predicts long-term incidence of PDR and DME. This demonstrates that early DR is a warning sign of late retinopathy complications and that the number of MAs is an important factor for long-term outcome.

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Funding

This work was supported by grants from Fight for Sight, Denmark, Merchant Christian Andersen and Wife Ingeborg Ovidia Signe Andersen, born Schmidt’s grant, the Foundation of AJ Andersen and Wife, the Foundation of Carl and Nicoline Larsen, the Memorial-Grant of Alice Rasmussen, the Foundation of Teacher Karen Svankjaer Yde, the Memorial-Grant of Else Poulsen, the Foundation of Goldsmith AL & D Rasmussen, Lykfeldt’s Grant, the Foundation of June 15th, the Foundation of the Kjaersgaard, Sunds Family, the Region of Southern Denmark, and the Institute of Clinical Research at the University of Southern Denmark.

TP is funded by the NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, and UCL Institute of Ophthalmology, London, United Kingdom.

None of the funders were involved in any decisions regarding this study.

Conflict of interest

The authors declare that there is no duality of interest associated with this manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark

    M. L. Rasmussen, R. Broe, U. Frydkjaer-Olsen & J. Grauslund

  2. The Clinical Research Institute, University of Southern Denmark, Odense, Denmark

    M. L. Rasmussen, R. Broe, U. Frydkjaer-Olsen, T. Peto & J. Grauslund

  3. OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark

    R. Broe

  4. Department of Pediatrics E, Herlev Hospital, Turkisvej 14, 2730, Herlev, Denmark

    B. S. Olsen & H. B. Mortensen

  5. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    B. S. Olsen & H. B. Mortensen

  6. The NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Rd, London, EC1V 2PD, UK

    T. Peto

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  1. M. L. Rasmussen
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Correspondence to M. L. Rasmussen.

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Rasmussen, M.L., Broe, R., Frydkjaer-Olsen, U. et al. Microaneurysm count as a predictor of long-term progression in diabetic retinopathy in young patients with type 1 diabetes: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). Graefes Arch Clin Exp Ophthalmol 253, 199–205 (2015). https://doi.org/10.1007/s00417-014-2682-7

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  • DOI: https://doi.org/10.1007/s00417-014-2682-7

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