Management of Diabetes and Risk Factors of Retinopathy

Abstract

The incidence of retinopathy among diabetic workers in the gas industry was studied. 281 workers with diabetes mellitus were followed up from the onset of disease to retirement. Of them, 106 developed retinopathy. The relation between the incidence of retinopathy and the following 12 factors pertaining to diabetic workers was analysed: l) classification according to Keith-Wagener criteria of fundus oculi, 2) classification according to control of the cardiovascular system, 3) classification according to control of diabetes mellitus, 4) weight control, 5) total cholesterol levels, 6) triglyceride levels, 7) HbA1C, 8) urinary protein, 9) age at present, 10) age at diagnosis, 11) duration of diabetes, 12) family history of diabetes. Hayashi's Quantification II Analysis was used for calculation of risk factors. The major results were as follows: 1. The factor most closely associated with the development of retinopathy was the classification according to Keith-Wagener criteria. 2. Factors closely associated with the development of retinopathy in order were: Keith-Wagener classification> control of diabetes (insulin therapy) > HbAlc (greater than 8.1%)= low weight > urinary protein positive = the age at diagnosis (younger than 29) = Age at present (40 to 49). 3. Controllable parameters such as weight, hyperlipidemia, and blood glucose level are factors less closely associated with the development of retinopathy. 4. Although Keith-Wagener classification, age, and duration of diabetes are uncontrollable, these factors are associated with the development of retinopathy. 5. The risk score for each risk factor was calculated as follows:Risk factor Risk scoreKeith-Wagener classification 3 ---------10Insulin (less than 40 U per day)--------- 5Keith-Wagener classification 2 --------- 4HbAlc>8.1%--------------------------------- 2Low weight <95% --------------------------- 2Keith-Wagener classification 1 --------- 1Urinary protein positive ------------------ 1Age at diagnosis (younger than 29) --- 1Age at present (40 to 49) ------------------ 16. Based on the total risk score for each individual, the probability values of development of retinopathy were estimated as follows:Risk score Probability0 0.171.0 0.302.05.0 0.526.09.0 0.8610 1.00 These findings demonstrate difficulties in management of diabetes and suggest that assessment of individuals and long-term care is important for diabetic patients.