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FoU-centrum Primärvård och Tandvård i Skaraborg Does treatment for hypertension protect against retinopathy? Skaraborgs Diabetesregister (SDR) ten years.

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En presentation över ämnet: "FoU-centrum Primärvård och Tandvård i Skaraborg Does treatment for hypertension protect against retinopathy? Skaraborgs Diabetesregister (SDR) ten years."— Presentationens avskrift:

1 FoU-centrum Primärvård och Tandvård i Skaraborg Does treatment for hypertension protect against retinopathy? Skaraborgs Diabetesregister (SDR) ten years follow up Grete Garberg, MD Skaraborg Hospital

2 FoU-centrum Primärvård och Tandvård i Skaraborg Background I Diabetic retinopathy main reason for visual impairment in working ages, patients fear ”blindness” Important to prevent Type 2 diabetes retinopathy not unusual at diagnosis Screening is effective to detect retinopathy makes treatment possible before symptoms evolve

3 FoU-centrum Primärvård och Tandvård i Skaraborg Background II Screening in Skaraborg from late 1980 patients in ages < 70 years Skaraborgs Diabetes Register (SDR) 1991-2004 clinical data and data on morbidity and mortality Patients type 2 (+0=undefined)diagnosed 1996-1998 the basis of this study

4 FoU-centrum Primärvård och Tandvård i Skaraborg SDR cohort 1996-1998 1258 (305dead) 381≥70yrs at baseline (187dead) 877 < 70yrs at baseline (118dead) 6 undefined 2 type1 403 type2 8 undefined 104 type1 765 type2 Population 2007-2010 SDR=Skaraborgs diabetesregister

5 FoU-centrum Primärvård och Tandvård i Skaraborg Methods Data from retinal screening close to diagnosis and after 5 and 10 years From screening records retinopathy, maculopathy, laser treatment, visual acuity and other reasons for visual impairment From Skaraborgs Diabetes Register HbA1c, body mass index (BMI), blood pressure (BP) and antihypertensive treatment

6 FoU-centrum Primärvård och Tandvård i Skaraborg Results I a Diabetic retinopathy in all patients (type 1+2+0) *Before 01/01/99, ** Before 01/01/03, *** Before 10/08/09, § last examination Number of patients Examination 1996-1998 Examination 2000-2002 Examination 2003- 2009§ Examined362630649 Any retinopathy2688168 Maculopathy51938 Proliferative retinopathy 0512 Laser treatment A maculopathy B scatter 330330 10 3 23 22 10 (1 BRVO) Visual acuity  >0.5  <0.3 331 324 5 618 607 5 637 616 9 Mortality22*57**117***

7 FoU-centrum Primärvård och Tandvård i Skaraborg Results I Diabetic retinopathy in patients type 0+2 <70 years at baseline *Before 01/01/99, ** Before 01/01/03, *** Before 10/08/09, § last examination Number of patients Examination 1996-1998 Examination 2000-2002 Examination 2003- 2009§ Examined288540559 Any retinopathy2176144 (25,6%) Maculopathy31532(5,7%) Proliferative retinopathy 027 (1.4%) Laser treatment A maculopathy B scatter 330330 771771 19 (3.4%) 18 6 (1 BRVO) Visual acuity  >0.5  <0.3 264 259 3 541 514 5 548 527 9 Mortality20*53**114***

8 FoU-centrum Primärvård och Tandvård i Skaraborg Results summary I Frequency of screening 83% (639/773) of patients <70 years at diagnosis screened some time during follow-up HbA1C at diagnosis Mean value 6,66% Visual acuity 96% (527/548) >0.5 at the last recorded examination

9 FoU-centrum Primärvård och Tandvård i Skaraborg HbA1C at diagnosis

10 FoU-centrum Primärvård och Tandvård i Skaraborg HbA1c< 7.0 %≥7.0 %p Retinopathy88 (22.4%)71 (38.6%)< 0.001 Maculopathy15 (4.0%)18 (9.8%)0.006 HbA1c< 8.0 %≥8.0 %p Retinopathy114 (24.4%)45 (41.7%)< 0.001 Maculopathy20 (4.4%)13 (11.9%)0.003 Results IIa HbA1C in 1996-1998

11 FoU-centrum Primärvård och Tandvård i Skaraborg Results IIb HbA1C and time to retinopathy

12 FoU-centrum Primärvård och Tandvård i Skaraborg Results IIc HbA1C and time to maculopathy

13 FoU-centrum Primärvård och Tandvård i Skaraborg Results IId BMI in 96-98 and retinopathy

14 FoU-centrum Primärvård och Tandvård i Skaraborg Results IIe BMI in 96-98 and maculopathy

15 FoU-centrum Primärvård och Tandvård i Skaraborg Results IIIa Blood pressure and hypertension Systolic blood pressure <130 mmHg Associated with less retinopathy Systolic blood pressure >130 mmHg Further increase in systolic blood pressure not associated with more retinopathy. Blood pressure at baseline Not associated with retinopathy or maculopathy Hypertension treatment at baseline Associated with less retinopathy

16 FoU-centrum Primärvård och Tandvård i Skaraborg Results IIIb Antihypertensive treatment and retinopathy

17 FoU-centrum Primärvård och Tandvård i Skaraborg Results IIIc Antihypertensive treatment and maculoopathy

18 FoU-centrum Primärvård och Tandvård i Skaraborg Conclusions I Relatively few patients with visual impairment Retinopathy increases rapidly after 10 years duration

19 FoU-centrum Primärvård och Tandvård i Skaraborg Conclusions II HbA 1 C level at diagnosis seems to predict risk for retinopathy and maculopathy BMI at diagnosis does not affect development of retinopathy

20 FoU-centrum Primärvård och Tandvård i Skaraborg Conclusions III Antihypertensive treatment regardless of BP level associated with lower frequency of retinopathy lower frequency of maculopathy

21 FoU-centrum Primärvård och Tandvård i Skaraborg Thank you for your attention! Questions or comments?

22 FoU-centrum Primärvård och Tandvård i Skaraborg Thanks for contribution from R&D Centre, Skaraborg Hospital, financing Bo Berger, PhD Kristina A Boström, Supervisor; PhD, R&D Centre Skaraborg Primary Care Monica Lövestam Adrian, Suprervisor; PhD, Eye Clinic, Lund University Hospital Salmir Nasic, Statistician, Skaraborg Hospital Ann Segerblom, Research Assistent, R&D Centre Skaraborg Primary Care


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