Glycosylated Hemoglobin Predicts the Incidence and Progression of Diabetic Retinopathy
Abstract
The relationship between hyperglycemia, measured by glycosylated hemoglobin at the initial examination, and the four-year incidence and progression of diabetic retinopathy was examined in a population-based study in Wisconsin. Younger- (n = 891) and older-onset (n = 987) persons participating in baseline and follow-up examinations were included. Glycosylated hemoglobin was measured by microcolumn. Retinopathy was determined from stereoscopic fundus photographs. In the younger-onset group, comparing the highest with the lowest quartile of glycosylated hemoglobin, the relative risk for developing any diabetic retinopathy was 1.9; for proliferative retinopathy, 21.8; and for progression, 4.0. Among older-onset persons taking insulin, the corresponding relative risks were 1.9, 4.0, and 2.1. Among older-onset persons not taking insulin, relative risks were 4.0 for any retinopathy and 6.2 for progression. A positive relationship between incidence and progression of retinopathy and glycosylated hemoglobin remained after controlling for duration of diabetes, age, sex, and baseline retinopathy. These data suggest a strong and consistent relationship between hyperglycemia and incidence and progression of retinopathy. (JAMA1988;260:2864-2871)
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Clinical trials, in concert with epidemiological data, support decreasing glycemia as an effective means of reducing long-term microvascular and neuropathic complications.
“The clinical trials, in concert with epidemiological data (18,19), support decreasing glycemia as an effective means of reducing long-term microvascular and neuropathic complications.”
From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [18]
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- Authors
- Klein, R.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- Klein, Ronald
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1988-11-18
- Volume
- 260
- Issue
- 19
- Pages
- 2864
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2034900477
- Cited by
- 528
- References
- 0
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 3 · 2023: 6 · 2022: 5 · 2021: 8 · 2020: 7 · 2019: 7 · 2018: 8 · 2017: 7 · 2016: 6 · 2015: 12 · 2014: 13 · 2013: 7 · 2012: 19
- FWCI
- 19.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (P30-AM AG-26659)
- National Eye Institute (EY0-3083)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- HbA1c, diabetic retinopathy, hyperglycemia, retinopathy incidence, retinopathy progression, proliferative diabetic retinopathy, insulin therapy, diabetes duration
- MeSH terms
- Adult, Age Factors, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hyperglycemia, Male, Physical Examination, Prognosis, Models, Statistical, Cohort Studies
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