Risk Factors for Development of Retinopathy in Elderly Japanese Patients With Diabetes Mellitus

OBJECTIVE To define the risk factors for the development of diabetic retinopathy in elderly patients with diabetes mellitus. RESEARCH DESIGN AND METHODS We studied 110 diabetic outpatients > 60 yr of age who were free of diabetic retinopathy at the first visit and were followed for at least 5 yr to examine the relationships between the initial findings and the subsequent development of retinopathy. RESULTS A total of 49 of the subjects developed diabetic retinopathy during the follow-up period; of these, 4 patients progressed to preproliferative and 3 to proliferative retinopathy. Univariate analysis showed that the initial fasting plasma glucose levels, the HbA 1 values, the 2-h postload plasma glucose levels, the estimated duration of diabetes, and the presence of persistent proteinuria were all associated with the development of diabetic retinopathy. However, age at the initial examination, estimated age at diabetes onset, sex, body mass index, type of therapy, and hypertension had little impact on the development of retinopathy. Stepwise multiple Cox regression analysis revealed that the initial HbA1 or fasting plasma glucose, the diabetes duration, and the presence of persistent proteinuria are significant independent predictors for the development of retinopathy. CONCLUSIONS Initial fasting plasma glucose, diabetes duration, and proteinuria are important risk factors for the development of retinopathy in elderly patients with diabetes mellitus.