People With Type 1 Diabetes of African Caribbean Ethnicity Are at Increased Risk of Developing Sight-Threatening Diabetic Retinopathy

TY - JOUR

T1 - People With Type 1 Diabetes of African Caribbean Ethnicity Are at Increased Risk of Developing Sight-Threatening Diabetic Retinopathy

AU - Mangelis, Anastasios

AU - Wijewickrama, Piyumi

AU - Nirmalakumaran, Abbeyramei

AU - Fountoulakis, Nikolaos

AU - Vas, Prashanth

AU - Webster, Laura

AU - Mann, Samantha

AU - Collins, Julian

AU - Hopkins, David

AU - Thomas, Stephen

AU - Ayis, Salma

AU - Karalliedde, Janaka

N1 - Funding Information: This work was funded by a research grant from Guy’s and St Thomas’ Charity. S.A. was funded/supported by the National Institute for Health Research Biomedical Research Centre based at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. Funding Information: Funding. This work was funded by a research grant from Guy’s and St Thomas’ Charity. S.A. was funded/supported by the National Institute for Health Research Biomedical Research Centre based at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. Publisher Copyright: © 2023 by the American Diabetes Association.

PY - 2023/5

Y1 - 2023/5

N2 - There is limited information on the effect of ethnicity on the development of re-ferable sight-threatening diabetic retinopathy (STDR) in people with type 1 diabe-tes. This study describes the risk factors for STDR in a diverse cohort of people with type 1 diabetes attending a regional diabetes eye screening service. RESEARCH DESIGN AND METHODS Clinical and digital retinal imaging data from 1,876 people with type 1 diabetes (50% women, 72.1% Caucasian, 17.3% African Caribbean, 2.9% Asian, and 7.6% other) with no retinopathy at baseline, attending surveillance eye screening were reviewed. Referable STDR was defined as the presence of any moderate to severe nonproliferative or preproliferative diabetic retinopathy or proliferative diabetic retinopathy or maculopathy in either eye as per U.K. National Diabetic Eye Screening criteria. Median follow-up was 6 years. RESULTS The median (interquartile range) age of the cohort was 29 (21, 41) years. Of the cohort of 1,876 people, 359 (19%) developed STDR. People who developed STDR had higher baseline HbA1c, raised systolic blood pressure (SBP), longer diabetes duration, and were more often of African Caribbean origin (24% vs. 15.6%; P < 0.05 for all). In multivariable Cox regression analyses, African Caribbean ethnicity (hazard ratio [HR] 1.39, 95% CI 1.09–1.78, P = 0.009), baseline SBP (HR 1.01, 95% CI 1.00–1.01, P = 0.033), and baseline HbA1c (HR 1.01, 95% CI 1.00–1.01, P = 0.0001) emerged as independent risk factors for STDR. CONCLUSIONS We observed that people with type 1 diabetes of African Caribbean ethnicity are at significantly greater risk of STDR. Further research is required to understand the mechanisms that explain this novel observation.

AB - There is limited information on the effect of ethnicity on the development of re-ferable sight-threatening diabetic retinopathy (STDR) in people with type 1 diabe-tes. This study describes the risk factors for STDR in a diverse cohort of people with type 1 diabetes attending a regional diabetes eye screening service. RESEARCH DESIGN AND METHODS Clinical and digital retinal imaging data from 1,876 people with type 1 diabetes (50% women, 72.1% Caucasian, 17.3% African Caribbean, 2.9% Asian, and 7.6% other) with no retinopathy at baseline, attending surveillance eye screening were reviewed. Referable STDR was defined as the presence of any moderate to severe nonproliferative or preproliferative diabetic retinopathy or proliferative diabetic retinopathy or maculopathy in either eye as per U.K. National Diabetic Eye Screening criteria. Median follow-up was 6 years. RESULTS The median (interquartile range) age of the cohort was 29 (21, 41) years. Of the cohort of 1,876 people, 359 (19%) developed STDR. People who developed STDR had higher baseline HbA1c, raised systolic blood pressure (SBP), longer diabetes duration, and were more often of African Caribbean origin (24% vs. 15.6%; P < 0.05 for all). In multivariable Cox regression analyses, African Caribbean ethnicity (hazard ratio [HR] 1.39, 95% CI 1.09–1.78, P = 0.009), baseline SBP (HR 1.01, 95% CI 1.00–1.01, P = 0.033), and baseline HbA1c (HR 1.01, 95% CI 1.00–1.01, P = 0.0001) emerged as independent risk factors for STDR. CONCLUSIONS We observed that people with type 1 diabetes of African Caribbean ethnicity are at significantly greater risk of STDR. Further research is required to understand the mechanisms that explain this novel observation.

UR - https://www.scopus.com/pages/publications/85159448599

U2 - 10.2337/dc22-2118

DO - 10.2337/dc22-2118

M3 - Article

C2 - 37062044

AN - SCOPUS:85159448599

SN - 0149-5992

VL - 46

SP - 1091

EP - 1097

JO - Diabetes Care

JF - Diabetes Care

IS - 5

ER -