What question did this study set out to answer?

To assess the relationship between diabetic retinopathy stages and the risk of major lower-extremity arterial disease (LEAD), as well as evaluate its incremental prognostic utility in patients with type 2 diabetes.

September 2, 2020Diabetes CareOpen Access

Relationship Between Diabetic Retinopathy Stages and Risk of Major Lower-Extremity Arterial Disease in Patients With Type 2 Diabetes

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To assess the relationship between diabetic retinopathy stages and the risk of major lower-extremity arterial disease (LEAD), as well as evaluate its incremental prognostic utility in patients with type 2 diabetes.
Prospective cohort study evaluating 1,320 participants with type 2 diabetes and no baseline history of LEAD, followed for a median duration of 7.1 years.
Diabetic retinopathy was graded at baseline as absent, nonproliferative, or proliferative, and major LEAD was defined as lower-limb amputation or revascularization.
Cox proportional hazards models and risk discrimination metrics (C statistic, integrated discrimination improvement, and net reclassification improvement) were utilized.
Major LEAD occurred in 94 participants (7.1%), with incidence rates of 5.5 (95% CI 3.9–7.8), 14.6 (95% CI 11.1–19.3), and 20.1 (95% CI 11.1–36.3) per 1,000 person-years across absent, nonproliferative, and proliferative retinopathy groups, respectively.
Baseline nonproliferative retinopathy (adjusted HR 2.31 [95% CI 1.43–3.81], P = 0.0006) and proliferative retinopathy (adjusted HR 3.14 [95% CI 1.40–6.15], P = 0.007) independently predicted major LEAD without subgroup heterogeneity.
Adding retinopathy stage to conventional risk factors improved risk prediction, increasing the C statistic (+0.023 [95% CI 0.003–0.044], P = 0.02), IDI (0.209 [95% CI 0.130–0.321], P < 0.001), and NRI (0.562 [95% CI 0.382–0.799], P < 0.001).

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Implication

Prospective cohort study finds diabetic retinopathy severity predicts major lower-extremity arterial disease in type 2 diabetes, highlighting its value for peripheral vascular risk stratification.

Cite This Study

Foussard et al. (2020) studied this question.

synapsesocial.com/papers/6a77b9df1400807f0f1ec55e https://doi.org/10.2337/dc20-1085

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Implication

Prospective cohort study finds diabetic retinopathy severity predicts major lower-extremity arterial disease in type 2 diabetes, highlighting its value for peripheral vascular risk stratification.

Relationship Between Diabetic Retinopathy Stages and Risk of Major Lower-Extremity Arterial Disease in Patients With Type 2 Diabetes

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Discussion

Implication

Cite This Study

Relationship Between Diabetic Retinopathy Stages and Risk of Major Lower-Extremity Arterial Disease in Patients With Type 2 Diabetes

Key Points

Discussion

Implication

Cite This Study

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