Epidemiology of Diabetic Retinopathy

描述（申请人提供）：本流行病学研究旨在：（1）确定糖尿病视网膜病变15年的累积进展和增殖性视网膜病变、黄斑水肿、视力损害、其他微血管病变的发生率。（糖尿病肾病）和大血管（心肌梗塞，下肢截肢）并发症，并量化这些结果与炎症标志物有关的风险，内皮功能障碍、细胞粘附和估计的胰岛素抵抗;（2）检查在10年期间患有长期糖尿病的1型患者中视力变化与自我评定的健康和自我报告的视觉目标生活质量的变化的关联;和（3）检查患有1型糖尿病的患者中视觉损害和抑郁的横截面关联。这项研究建立在威斯康星州糖尿病视网膜病流行病学研究（WESDR，NEIR 01 03083）的基础上，该研究包括1979-1980年在威斯康星州西南部11个县接受初级医疗保健的所有1型糖尿病胰岛素服用者。考试在1980-82年，1984-86年，1990-92年，1995-96年和2000-01年进行。 这些人将在其社区内由移动的检查货车进行检查。将根据标准化方案获得屈光、视力、眼内压、血压和其他测量结果。将使用立体眼底照相结合标准化分级的视网膜病变客观记录。将进行标准化问卷调查，包括SF-36、NEI-VFQ 25和流行病学研究中心抑郁量表（CES-D）。将测量C-反应蛋白、白细胞介素-6、肿瘤坏死因子-C和炎症、内皮功能障碍和细胞粘附的其他标志物。 这项研究的新数据将提供一个独特的机会来评估新因素与视网膜病变的存在和严重程度以及视网膜病变的进展和其他微血管病变（例如，糖尿病肾病）和大血管（例如，下肢截肢、心肌梗死）并发症，并将提供关于视网膜病变和视力损害与长期1型糖尿病患者自我报告的视觉目标生活质量和抑郁症之间的相关性的所需信息。这些数据将有助于参与糖尿病管理的患者及其医生以及设计和提供预防保健服务的公共卫生从业人员。相反，本研究中收集的新数据可能会深入了解低水平炎症、细胞粘附和内皮功能障碍标志物对糖尿病血管并发症的相对保护价值。

DESCRIPTION (provided by applicant): This epidemiological study aims to: (1) determine the cumulative 15-year progression of diabetic retinopathy and incidence of proliferative retinopathy, macular edema, visual impairment, other microvascular (diabetic nephropathy) and macrovascular (myocardial infarction, lower extremity amputation) complications in persons with type I diabetes and quantify the risk of these outcomes with regard to markers of inflammation, endothelial dysfunction, cellular adhesion and of estimated insulin resistance; (2) examine the association of change in visual acuity and changes in self-rated health and self-reported visual-targeted quality of life in type 1 persons with long term diabetes over a ten year period; and (3) examine the cross-sectional association of visual impairment and depression in persons with type 1 diabetes. The study builds upon the population-based Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR, NEIR01 03083) which included all insulin-taking persons with type 1 diabetes and who were receiving primary medical care in an 11-county area of southwestern Wisconsin in 1979-1980. Exams were performed in 1980-82, 1984-86, 1990-92, 1995-96, and 2000-01. These persons will be examined in their communities in a mobile examining van. Refraction, visual acuity, intraocular pressure, blood pressure and other measurements will be obtained according to standardized protocols. Objective recording of retinopathy from stereoscopic fundus photography combined with a standardized grading will be used. Standardized questionnaires including the SF-36, the NEI-VFQ 25, and the Center for Epidemiologic Studies Depression Scale (CES-D) will be administered. C-reactive protein, interleukin-6, tumor necrosis factor-"c, and other markers of inflammation, endothelial dysfunction, and cellular adhesion will be measured. New data from this study will provide a unique opportunity to evaluate the relationship of new factors to the presence and severity of retinopathy and to the progression of retinopathy and incidence of other micro- vascular (e.g., diabetic nephropathy) and macrovascular (e.g., lower extremity amputation, myocardial infarction) complications and will provide needed information regarding the associations of retinopathy and visual impairment to self-reported visual-targeted quality of life and depression in persons with long duration of type 1 diabetes. These data will be useful to patients and their physicians involved in the management of diabetes and to public health practitioners designing and delivering preventive care services. Conversely, the new data to be collected in this study may provide insights into the relative protective value of low levels of markers of inflammatory, cell adhesion, and endothelial dysfunction on vascular complications of diabetes mellitus.