Microvascular - Macrovascular Disease in Type 2 Diabetes

描述(申请人提供)：这项建议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(如全身性和局灶性视网膜小动脉狭窄、静脉扩张和动静脉划痕)与2型糖尿病患者糖尿病视网膜病变、缺血性心脏病和中风死亡的发生率和进展以及下肢截肢和糖尿病肾病的发生率之间的关系。在这项流行病学研究中，受试者包括以下所有人：(1)确诊时年龄在30岁或以上；(2)在威斯康星州中南部的11个县地区接受过初级医疗护理；(3)从1979-80年的医生记录中确定。在基线以及4年和10年的后续考试中，采用了标准化的考试和面谈方案。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拍摄每只眼的7个标准视野。视网膜病变的严重程度通过使用Aiflie House分类系统对这些照片进行分级来确定。此外，还使用标准化方案测量血压、身高和体重；抽取血液样本以测定糖化血红蛋白和血糖；并抽取尿样进行蛋白质分析。病史包括吸烟状况、高血压、心脏病、中风、截肢、用药等。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，并对视网膜血管直径进行计算机辅助分级，对局灶性小动脉狭窄和划痕进行灯箱分级。这将使我们能够检查局限性和全身性视网膜小动脉狭窄和划痕与视网膜病变、缺血性心脏病和中风死亡率的发生率和进展的关系，以及控制其他危险因素的下肢截肢和糖尿病肾病的发生率。有关这些关联的发现将有助于了解这些并发症的发病机制，为它们制定预防策略，并有助于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.