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    Glycemic thresholds for diabetes-specific retinopathy: Implications for diagnostic criteria for diabetes

    Access Status
    Open access via publisher
    Authors
    Colagiuri, S.
    Lee, Crystal
    Wong, T.
    Balkau, B.
    Shaw, J.
    Borch-Johnsen, K.
    Date
    2011
    Type
    Journal Article
    
    Metadata
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    Citation
    Colagiuri, S. and Lee, C. and Wong, T. and Balkau, B. and Shaw, J. and Borch-Johnsen, K. 2011. Glycemic thresholds for diabetes-specific retinopathy: Implications for diagnostic criteria for diabetes. Diabetes Care. 34 (1): pp. 145-150.
    Source Title
    Diabetes Care
    DOI
    10.2337/dc10-1206
    ISSN
    0149-5992
    School
    School of Public Health
    URI
    http://hdl.handle.net/20.500.11937/5863
    Collection
    • Curtin Research Publications
    Abstract

    OBJECTIVE :To re-evaluate the relationship between glycemia and diabetic retinopathy. RESEARCH DESIGN AND METHODS: We conducted a data-pooling analysis of nine studies from five countries with 44,623 participants aged 20-79 years with gradable retinal photographs. The relationship between diabetes-specific retinopathy (defined as moderate or more severe retinopathy) and three glycemic measures (fasting plasma glucose [FPG; n = 41,411], 2-h post oral glucose load plasma glucose [2-h PG; n=21,334], and A1C [n=28,010]) was examined. RESULTS: When diabetes-specific retinopathy was plotted against continuous glycemic measures, a curvilinear relationship was observed for FPG and A1C. Diabetes-specific retinopathy prevalence was low for FPG <6.0 mmol/l and A1C <6.0% but increased above these levels. Based on vigintile (20 groups with equal numbers) distributions, glycemic thresholds for diabetes-specific retinopathy were observed over the range of 6.4-6.8 mmol/l for FPG, 9.8 -10.6 mmol/l for 2-h PG, and 6.3-6.7% for A1C. Thresholds for diabetes-specific retinopathy from receiver-operating characteristic curve analyses were 6.6 mmol/l for FPG, 13.0 mmol/l for 2-h PG, and 6.4% for A1C. CONCLUSIONS: This study broadens the evidence based on diabetes diagnostic criteria. A narrow threshold range for diabetes-specific retinopathy was identified for FPG and A1C but not for 2-h PG. The combined analyses suggest that the current diabetes diagnostic level for FPG could be lowered to 6.5 mmol/l and that an A1C of 6.5% is a suitable alternative diagnostic criterion.

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