High prevalence of advanced retinopathy in patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study

Aims: The natural history of diabetic complications, including diabetic retinopathy (DR), is changing due to improved care. This study aimed at assessing prevalence of advanced DR and its correlation with risk factors and complications in subjects with type 2 diabetes from the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study. Methods: This study enrolled 15,773 patients visiting consecutively 19 Diabetes Clinics in years 2007-2008. DR was assessed by dilated fundoscopy and classified according to the Global Diabetic Retinopathy Project Group. Results: Advanced DR was observed in 9.8% of patients (4.2% pre-proliferative, 4.2% proliferative, 1.3% maculopathy, 0.1% blindness). Advanced DR was independently associated with hemoglobin (Hb) A(1c), diabetes duration and treatment, particularly with insulin, hypertension, previous cardiovascular disease (CVD), albuminuria and, inversely, age, age at diabetes diagnosis, smoking and estimated glomerular filtration rate. Maculopathy alone was associated with female gender, but not HbA(1c), hypertension and age. Conclusions: We found an alarming high prevalence of advanced DR in subjects with type 2 diabetes from the RIACE cohort, suggesting that the expected favorable effect of improved diabetes management has not emerged yet. Independent correlates of advanced DR were indexes of glycemic exposure, hypertension, CVD, albuminuria and, inversely, age at diagnosis and smoking. (C) 2012 Elsevier Ireland Ltd. All rights reserved.