Epidemiology of Diabetic Retinopathy

描述（由申请人提供）：本流行病学研究旨在：(1)确定1型糖尿病患者糖尿病视网膜病变的累积15年进展和增殖性视网膜病变、黄斑水肿、视力损害、其他微血管（糖尿病肾病）和大血管（心肌梗死、下肢截肢）并发症的发生率，并量化这些结果的风险，包括炎症标志物、内皮功能障碍、细胞粘连和估计的胰岛素抵抗；(2)检验10年以上1型糖尿病患者视力变化与自评健康和自评视力目标生活质量的关系；(3)研究1型糖尿病患者视觉障碍与抑郁的横断面关联。该研究建立在以人群为基础的威斯康辛糖尿病视网膜病变流行病学研究（WESDR, NEIR01 03083）的基础上，该研究包括了1979-1980年在威斯康辛州西南部11个县接受初级医疗保健的所有胰岛素摄入1型糖尿病患者。分别于1980-82年、1984-86年、1990-92年、1995-96年和2000-01年进行检查。

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.