You are here

Home » Content

Tip 2 diyabetli hastalarda retinopati, hipertansiyon ve hastalık süresi arasındaki ilişki: 6 yıllık deneyim

THE ASSOCIATION BETWEEN RETINOPATHY, HYPERTENSION, AND DIABETES DURATION IN TYPE 2 DIABETICS: 6-YEARS OF EXPERIENCE

Journal Name:

  • İnönü Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2000

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Background: Morbidity and mortality in diabetes are caused mainly by its vascular complications, both in the microcirculation and in the large vessels with accelerated atherosclerosis. Diabetic retinopathy is the clinical hallmark of microangiopathy which may lead to blindness. Materials and method: This study was designed in type 2 diabetic patients who were on regular control and treatment in the diabetes clinic of Turgut Ozal Medical Center between June 1994 and February 2000. Six hundred and forty-seven type 2 diabetic patients (274 males and 373 females), aged 53.50 ± 11.02 years were evaluated. The mean diabetes duration was 7.90 ± 6.27 years. Patients were categorized according to the presence of retinopathy. Results: Retinopathy was encountered in 181 patients (27.97%) (79 males and 102 females), aged 57.63 ± 10.18 years. Their mean diabetes duration were 12.98 ± 6.41 years. Four hundred and sixty-six patients (195 males and 271 females), aged 51.90 ± 10.93 years formed the non-retinopathy group. The mean diabetes duration were 5.93 ± 4.98 years. Hypertension was present in 210 of patients (45.06%) without retinopathy and in 130 patients (71.82%) with retinopathy. In terms of grading of retinopathy, background retinopathy was encountered in 93 (51.4%) patients, preproliferative retinopathy was encountered in 46 (25.4%) patients, and proliferative retinopathy was encountered in 42 (23.2%) patients. When retinopathy was compared with diabetes duration, background retinopathy was highly encountered in patients with a duration of 6-10 years, preproliferative retinopathy was seen the most in 11-15 years, and proliferative retinopathy was found to be higher in >15 years. When presence of hypertension was investigated in these patients, we found out that 52.4% of patients in group 1 (patients with diabetes duration of 0-5 years), 75.4% of patients in group 2 (6-10 years), 64% of patients in group 3 (11-15 years), and 85.3% of patients in group 4 (>15 years) were hypertensive. Conclusion: The presence of hypertension should be investigated in patients with diabetic retinopathy and if present, should be treated aggressively. We need further studies in diabetic patients to consider the frequency and stage of retinopathy in normotensive, hypertensive, and aggresively treated hypertensive groups.
Bookmark/Search this post with
Abstract (Original Language): 
Amaç: Artmış ateroskleroz ile birlikte hem mikrosirkülasyonda, hem de büyük damarlardaki vasküler komplikasyonlar diyabet morbidite ve mortalitesine neden olmaktadır. Körlüğe neden olabilen diyabetik retinopati, mikroanjiyopatinin de klinik bir göstergesidir. Materyal ve Metod: Çalışmamızda, Turgut Özal Tıp Merkezi Diyabet Kliniğinde, Haziran 1994 ile Şubat 2000 tarihleri arasında takip edilen, ortalama yaşları 53.50 ± 11.02 yıl olan 647 diyabetik hasta (274 erkek ve 373 bayan) değerlendirildi. Ortalama hastalık süreleri 7.90 ± 6.27 yıl idi. Hastalar, retinopati varlığına göre grup/andırıldı. Bulgular: Retinopati saptanan 181 hastanın (%27.97) (79 erkek ve 102 bayan) ortalama yaşları 57.63 ± 10.18 yıl ve ortalama diyabet süreleri 12.98 ± 6.41 yıl idi. Retinopati saptanmayan 466 hastanın (195 erkek ve 271 bayan) ortalama yaşları 51.90 ± 10.93 yıl ve ortalama hastalık süreleri 5.93 ± 4.98 yıl idi. Hipertansiyon, retinopati saptanmayan hastaların 210'unda (%45,06) ve retinopati saptanan hastaların 130'unda (%71.82) tesbit edildi. Retinopati sınıflaması yapıldığında, hastaların 93'ünde (%51,4) background retinopati, 46'sında preproliferatif retinopati (%25,4) ve 42'sinde (%23,2) proliferatif retinopati saptandı. Retinopati, diyabet süresi ile karşılaştırıldığında, background retinopati özellikle hastalık süresi 6-10 yıl arası olan hastalarda en fazla görülürken, preproliferatif retinopati 11-15 yıl ve proliferatif retinopati >15 yıldan fazla hastalık süresi olan gruplarda en fazla görüldü. Aynı hasta gruplarında hipertansiyon araştırıldığında, grup l'de (diyabet süresi 0-5 yıl olan hastalar) %52,4, grup 2'de (6-10 yıl) %75,4, grup 3'de (11-15 yıl) %64 ve grup 4'de (>15 yıl) %85,3 olarak bulundu. Sonuç: Diyabetik retinopatili hastalarda, hipertansiyon varlığı araştırılmalı ve saptandığında yoğun bir şekilde tedavi edilmelidir. Normotansif, hipertansif ve yoğun tedavi edilen hipertansif gruplarda, diyabetik retinopati sıklığı ve evrelendirilmesi çalışmaları yapılmalıdır.
FULL TEXT (PDF): 
PDF icon arastirmax-tip-2-diyabetli-hastalarda-retinopati-hipertansiyon-hastalik-suresi-arasindaki-iliski-6-yillik-deneyim.pdf
  • 2
99-104
  • Turkish

REFERENCES

References: 

1. Parving H-H, 0sterby R, Anderson PW, Hsueh WA. Diabetic nephropathy. In: Brenner BM, ed. The Kidney. WB Saunders Co, Philadelphia, Saunders, 1996, p. 1864-1892.
2. American Academy of Ophthalmology. Basic and Clinical Science Course, Section 4: Retina and Vitreous, San Francisco, California, 1990, 14-23.
3. Federman JL, Gouras P, Schubert H, Slusher MM, Vrabec TR. Retina and Vitreous. In: Podos SM, Yanoff M (eds). Textbook of Ophthalmology, volume 9, 1991; 12: 7-24.
4. Wilson JD, Foster DW, Kronenberg HM, Larsen PR. In: Linger RH, Foster DW. Diabetes Mellitus. Williams Textbook of Endocrinology, WB Saunders Company, 1998, p 1022-4.
5. Williams G, Pickup JC. Handbook of Diabetes. Blackwell Science, Oxford 1999, p 116-22.
6. Walker WG, Hermann J, Murphy R, et al. Elevated blood pressure and angiotensin II are associated with accelerated loss of renal function in diabetic nephropathy. Trans Am Clin Climatol Assoc 1985; 97: 94-104.
7. Knowler WC, Bennet PH, Ballintine EJ. Increased incidence of retinopathy in diabetics with elevated blood pressure. N Engl J Med 1980; 302: 645-50.
8. Ishihara M, Yukimura Y, Aizawa T, et al. High blood pressure as a risk factor in diabetic retinopathy development in NIDDM patients. Diabetes Care 1987; 10: 20-5.
9. Janka H, Dirschedl P. Systolic blood pressure as a predictor for cardiovascular disease in diabetes: a five year longitudinal study. Hypertension 1985; 7 [Suppl 2]: II90-II94.
10. Factor SM, Minase T, Sonnenblick EH. Clinical and morphological features of human hypertensive-diabetic cardiomyopathy. Am Heart J 1980; 99: 446-58.
11. Küller LH, Dorman JS, Wolf PA. Cerebrovascular disease and diabetes. In: diabetes in America. Washington DC, US Department of Health and Human Services 1985, Publication 85-1468, pp 1-8.
12. Tuck ML. Diabetes and hypertension. Postgrad Med J 1988; 64 [Suppl 3]: 76-83.
13. Maser R, Steenkisste A, Dorman J, et al. Epidemiological correlates of diabetic neuropathy. Diabetes 1989; 38: 1456¬61.
14. Dupree EA, Meyer MB. Role of risk factors in complications of diabetes mellitus. Am J Epidemiol 1980; 112: 100-12.
15. Nelson RG, Newman JM, Knowler WC, et al. Incidence of end-stage renal disease in type II diabetes mellitus in Pima Indians. Diabetologia 1988; 31: 730-46.
16. Klein R, Klein BE, Moss SE, Cruickshanks KJ. Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy. Arch Intern Med 1994; 154: 2169-78.
17. The Diabetes Control and Complication Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977-86.
18. Chase HP, Garg SK, Jackson WE, et al. Blood pressure and retinopathy in type I diabetes. Ophthalmology 1990; 97: 155¬9.
19. Knuimann MW, Welborn TA, McCann VJ, Stanton KG, Constable IJ. Prevalance of diabetic complications in relation to risk factors. Diabetes 1986; 35: 1332-9.
20. Burditt AF, Caird FI, Drapen GJ. The natural history of diabetic retinopathy. Q J Med 1968; 37: 303-17.
21. Klein R, Klein BEK, Moss SE, et al. The Wisconsin Epidemiologic Study of Diabetic Retinopathy II: prevalance and risk factors of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984; 102: 520-6.
22. Güliter S, Ergin A, Emir M, Bayraktar Z. Prevalence of retinopathy in patients with newly diagnosed diabetes mellitus. Ret-vit 1999; 7: 203-7.
23. Marks JB, Raskin P. Prevention and treatment of diabetes and its complications: nephropathy and hypertension in diabetes. Med Clin North Am 1998; 82(4): 877-907.
24. Schrier RW, Estacio RO, Jeffers B. Appropriate blood pressure control in NIDDM (ABCD) Trial. Diabetologia 1996; 39: 1646¬54.
25. Schrier RW, Savage S. Appropriate blood pressure control in diabetes (ABCD) Trial: Implications for complications. Am J Kidney Dis 1992; 6: 653-7.
26. Hilborne LH, Lin PC, Higgins SA, Rodgerson DO. Evaluation of the Behring nephelometer for detection of low level urinary albumin. Am J Clin Pathol 1990; 93: 405-10.
27. Mogensen CE. Microalbuminuria in diabetic renal disease. In: Mogensen CE, Standi E (eds). Prevention and treatment of diabetic late complications, Gruyter, New York.
28. Poulsen PL, Bek T, Ebbehoj E, Hansen KW, Mogensen CE. 24-h ambulatory blood pressure and retinopathy in normoalbuminuric IDDM patients. Diabetologia 1998, 41: 105-110.
29. Patel V, Rassam S, Newsom R, Wiek J, Kohner EM. Retinal blood flow in diabetic retinopathy. BMJ 1992, 305: 678-683
30. Rassam SMB, Patel V, Kohner EM. The effect of experimental hypertension on retinal autoregulation in humans: a mechanism for the progression of diabetic retinopathy. Exp Physiol 1995, 80: 53-68.
31. Kohner EM, Aldington SJ, Stratton IM, Manley SE, Holman RR, Matthews DR, Turner RC. United Kingdom Prospective Diabetes Study, 30. Diabetic retinopathy at diagnosis of non-insulin dependent diabetes mellitus and associated risk factors. Arch Ophthalmol 1998, 116: 297-303.
32. Norgaard K, Feldt Rasmussen B, Deckert T. Is hypertension a major independent risk factor for retinopathy in type 1 diabetes? Diabet Med 1991, 8: 334-337.

Thank you for copying data from http://www.arastirmax.com