Epidemiology of Diabetic Retinopathy

描述(申请人提供)：这项流行病学研究的目的是：(1)确定I型糖尿病患者15年来糖尿病视网膜病变的累积进展和增殖性视网膜病变、黄斑水肿、视力障碍、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、内皮功能障碍、细胞黏附和估计胰岛素抵抗的标记物；(2)研究长期患有1型糖尿病的患者在10年内视力变化与自我健康和自我报告的视觉目标生活质量变化的关系；以及(3)研究1型糖尿病患者视力损害和抑郁之间的横断面关联。这项研究建立在以人群为基础的威斯康星州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1979年至1980年在威斯康星州西南部11个县地区接受初级医疗护理的所有1型糖尿病患者。考试在1980-82年、1984-86年、1990-92年、1995-96年和2000-01年进行。 这些人将在他们所在社区的一辆流动检查车上接受检查。屈光度、视力、眼压、血压和其他测量将按标准化方案获得。目的采用立体眼底照相结合标准化分级的方法记录视网膜病变。标准问卷包括SF-36、NEI-VFQ 25和流行病学研究中心抑郁量表(CES-D)。C反应蛋白、白介素6、肿瘤坏死因子c和其他炎症、内皮功能障碍和细胞黏附的标记物将被检测。 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的关系，以及与视网膜病变的进展和其他微血管(例如糖尿病肾病)和大血管(例如下肢截肢、心肌梗死)并发症的发生率的关系，并将提供有关视网膜病变和视力损害与长期患有1型糖尿病的患者自我报告的视觉目标生活质量和抑郁之间的关系的必要信息。这些数据将对参与糖尿病管理的患者和他们的医生以及设计和提供预防保健服务的公共卫生从业人员有用。相反，这项研究中将要收集的新数据可能会为低水平的炎症、细胞黏附和内皮功能障碍的标记物对糖尿病血管并发症的相对保护价值提供洞察力。

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.