What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type 1 and Type 2 diabetes mellitus (n=191). Intervention: Systolic blood pressure. Primary outcome: Presence of diabetic retinopathy in type 1 diabetes (OR 1.05, 95% CI 0.99-1.10, p=0.045).

January 1, 2022Open Access

Blood pressure is associated with diabetic retinopathy in type 1 but not in type 2 diabetes

Q: What does this research mean for the field?

Systolic blood pressure is significantly associated with the presence of diabetic retinopathy in patients with type 1 diabetes, but not in those with type 2 diabetes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Systolic blood pressure was significantly associated with the presence of diabetic retinopathy in patients with type 1 diabetes (OR 1.05), but not in those with type 2 diabetes.

Study Design

Type

Cross-Sectional (n=191)

Multicenter

Structured PICO

Population

191 patients (84 with type 1 diabetes and 107 with type 2 diabetes) from a single center in Croatia. Exclusions: illnesses affecting eye function and blood pressure, corticosteroid or cytostatic therapy, immunological and acute infectious inflammatory diseases, pregnancy, other eye diseases, active proliferative diabetic retinopathy, and active diabetic macular edema.

Outcome

Presence of diabetic retinopathy assessed by indirect slit-lamp fundoscopy, color fundus photography, and optical coherence tomographysurrogate

Systolic blood pressure is independently associated with the presence of diabetic retinopathy in patients with type 1 diabetes, but not in those with type 2 diabetes.

Main Result

Effect estimate: OR 1.05 (95% CI 0.99-1.10)

p-value: p=0.045

Limitations

Cross-sectional design limits the ability to infer a causal relation between diabetic retinopathy and blood pressure
Small sample size in subgroups
Analyses were based on a single measurement of blood pressure (office blood pressure) rather than 24-hour ambulatory monitoring
Cohort had little racial/ethnic diversity, primarily relevant to a white European population

Abstract

The aim of this study was to investigate the role of systolic blood pressure (SBP) and diastolic blood pressure (dBP) in the development of diabetic retinopathy (dr) in type 1 and type 2 diabetes and to determine the differences between these two types of diabetes. This cross-sectional study included 84 patients with type 1 diabetes (t1dM) and 107 patients with type 2 diabetes (t2dM). Ophthalmologic retinal examination included indirect slit-lamp fundoscopy, color fundus photography according to eurOdiAB (eurOpe and diABetes) protocol and optical coherence tomography. Blood pressure was measured with a mercury sphygmomanometer after a 10-minute rest period. in t1dM, dr was positively associated with SBP (p = 0.035), hbA1c median (p < 0.001) and hypertensive retinopathy (p < 0.001), while in t2dM dr was positively related only to hbA1c median (p = 0.021). Binary logistic regression analysis (no dr/dr) showed that diabetes duration and hbA1c median were the main predictors of dr in both types of diabetes. in contrast, SBP (Or = 1.05, p = 0.045) and hypertensive retinopathy (Or = 3.75, p < 0.001) were the main predictors/indicators of dr only in t1dM. in conclusion, blood pressure is associated with dr in type 1 but not in type 2 diabetes.

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