Microvascular - Macrovascular Disease in Type 2 Diabetes

描述（申请人提供）：该提案描述了一项以人群为基础的队列研究，旨在确定视网膜血管特征之间的关系，（如全身性和局灶性视网膜小动脉狭窄、小静脉扩张和动静脉（AN）切口）以及糖尿病视网膜病变、缺血性心脏病和中风死亡率的发病率和进展，以及2型糖尿病患者下肢截肢和糖尿病肾病的发病率。 在这项流行病学研究中，受试者包括所有符合以下条件的人：（1）在诊断时年龄在30岁或以上;（2）在威斯康星州中南部的11个县接受过初级医疗保健;（3）从1979-80年的医生记录中确定。在基线以及4年和10年的随访检查中采用了标准化的检查和面谈程序。拒绝率一直很低。 糖尿病视网膜病变研究的彩色立体眼底照片在基线和随访检查时对每只眼睛拍摄7个标准视野。通过使用Aiflie House分类系统对这些照片进行分级来确定视网膜病变的严重程度。此外，标准化方案用于测量血压、身高和体重;抽取血液样本以测定糖化血红蛋白和血糖;并抽取尿液样本用于蛋白质分析。病史包括吸烟状况、高血压、心脏病、中风、下肢截肢、药物等项目。获得死亡证明信息。 我们计划扫描基线检查和4年随访时拍摄的眼底照片，并对该队列中的视网膜血管直径进行计算机辅助分级，并对局灶性小动脉狭窄和AN切口进行灯箱分级。这将使我们能够检查局灶性和全身性视网膜小动脉狭窄和AN切口与视网膜病变、缺血性心脏病和中风死亡率的发病率和进展以及下肢截肢和糖尿病肾病的发病率的相关性，并控制其他危险因素。 关于这些关联的发现将有助于了解这些并发症的发病机制，制定预防策略，以及其他研究这些关系的人， 2型糖尿病

DESCRIPTION (provided by applicant): This proposal describes a population-based cohort study aimed at determining the relationship between retinal vascular characteristics (such as generalized and focal retinal arteriolar narrowing, venular dilation, and arterio-venous (AN) nicking) and the incidence and progression of diabetic retinopathy, ischemic heart disease and stroke mortality, and the incidence of lower extremity amputation and diabetic nephropathy in people with Type 2 diabetes. For this epidemiologic study, subjects include all persons who: (1) were 30 years of age or older at the time of their diagnosis; (2) had received primary medical care in an 11-county area of south central Wisconsin; and (3) were identified from doctors' records in 1979-80. Standardized protocols for examinations and interviews have been employed during the baseline, and 4- and 10-year follow-up examinations. Refusal rates have been low. Color stereoscopic fundus photographs of the Diabetic Retinopathy Study 7 standard fields were taken of each eye at the baseline and follow-up examinations. Retinopathy severity was determined by grading these photographs using the Aiflie House classification system. In addition, standardized protocols were used to measure blood pressure, height and weight; a blood specimen was drawn to determine glycosylated hemoglobin and blood glucose; and a urine specimen for analysis for protein. A medical history included items on smoking status, hypertension, heart disease, stroke, lower extremity amputation, medications, etc. Death certificate information was obtained. We plan to scan the fundus photographs taken at the baseline examination and the 4-year follow-up and do computer-assisted grading for retinal vessel diameter and light box grading for focal arteriolar narrowing and AN nicking in this cohort. This will permit us to examine the associations of focal and generalized retinal arteriolar narrowing and AN nicking with the incidence and progression of retinopathy, ischemic heart disease and stroke mortality, and the incidence of lower extremity amputation and diabetic nephropathy controlling for other risk factors. Findings regarding these associations will be useful for understanding the pathogenesis of these complications, for developing preventive strategies for them, and for other research investigating these relationships in people with Type 2 diabetes.