Key result
The ACE DD genotype was associated with a significantly higher risk of proliferative retinopathy in type 1 diabetes compared with the II genotype (RR 6.6; 95% CI 2.2-19.5; P=0.0026).
Why the study?
Is the ACE gene DD genotype associated with an increased risk of proliferative retinopathy in patients with type 1 diabetes?
Case-Control (n=176)
Is the ACE gene DD genotype associated with an increased risk of proliferative retinopathy in patients with type 1 diabetes?
Relative Risk: 6.6 (95% CI 2.2–19.5)
p-value: p=0.0026
The ACE gene DD genotype is associated with a significantly increased susceptibility to proliferative retinopathy in patients with long-standing type 1 diabetes, independent of diabetic nephropathy.
May support ACE genotyping for retinopathy risk stratification in type 1 diabetes; leaves open causal role and need for prospective validation.
OBJECTIVE: To evaluate the relationship between the ACE insertion/deletion polymorphism and proliferative diabetic retinopathy in patients with type 1 diabetes of long duration. Based on epidemiological and pathophysiological findings, risk factors apart from glycemic control and duration of disease are likely to be involved in the development of proliferative retinopathy. RESEARCH DESIGN AND METHODS: In this case-control study, we compared 81 patients with longstanding (> or =20 years) type 1 diabetes who had nonproliferative (mild or moderate background) retinopathy with 95 patients with diabetes of similar duration and HbA1c who had proliferative retinopathy. To avoid the confounding effect of nephropathy, patients with overt nephropathy were excluded, and microalbuminuria was introduced into the multiple logistical regression model. The polymorphic region in intron 16 of the ACE gene (17q23) was analyzed using the polymerase chain reaction. RESULTS: The ACE genotype distribution in patients with proliferative retinopathy (DD 39.4%, ID 48.9%, II 11.7%) was significantly different (P < 0.001) from that of patients with nonproliferative retinopathy (DD 17.3%, ID 54.3%, II 28.4%). In a multiple logistical regression analysis, the adjusted relative risk for proliferative retinopathy in a patient with a DD genotype compared with a patient with an II genotype was 6.6 (95% CI 2.2-19.5), P = 0.0026. In addition to genotype, systolic blood pressure (odds ratio 1.027 [95% CI 1.0-1.1], P = 0.0093) but not microalbuminuria (< or =20 vs. > or =20 microg/min) reached statistical significance in the multiple regression model. Because subjects were matched regarding diabetes duration and HbA1c, we did not interpret the respective parameter estimates. CONCLUSIONS: These data provide evidence that deletion in the ACE gene is associated with the prevalence of proliferative retinopathy in type 1 diabetes and suggest that the DD genotype confers susceptibility to proliferative retinopathy independent of diabetic nephropathy
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Rabensteiner et al. (1999) conducted a case-control in Type 1 diabetes (n=176). ACE gene DD genotype vs. ACE gene II genotype was evaluated on Proliferative retinopathy (RR 6.6, 95% CI 2.2-19.5, p=0.0026). The ACE DD genotype was associated with a significantly higher risk of proliferative retinopathy in type 1 diabetes compared with the II genotype (RR 6.6; 95% CI 2.2-19.5; P=0.0026).
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