THE DETECT-2 COLLABORATION WRITING

OBJECTIVE — To re-evaluate the relationship between glycemia and diabetic retinopathy. RESEARCH DESIGN AND METHODS — We conducted a data-pooling analysis of nine studies from five countries with 44,623 participants aged 20–79 years with gradable retinal photographs. The relationship between diabetes-specific retinopathy (defined as moderate or more severe retinopathy) and three glycemic measures (fasting plasma glucose [FPG; n 41,411], 2-h post oral glucose load plasma glucose [2-h PG; n 21,334], and A1C [n 28,010]) was examined. RESULTS — When diabetes-specific retinopathy was plotted against continuous glycemic measures, a curvilinear relationship was observed for FPG and A1C. Diabetes-specific retinop-athy prevalence was low for FPG6.0 mmol/l and A1C6.0 % but increased above these levels. Based on vigintile (20 groups with equal numbers) distributions, glycemic thresholds for dia-betes-specific retinopathy were observed over the range of 6.4–6.8 mmol/l for FPG, 9.8–10.6 mmol/l for 2-h PG, and 6.3–6.7 % for A1C. Thresholds for diabetes-specific retinopathy from receiver-operating characteristic curve analyses were 6.6 mmol/l for FPG, 13.0 mmol/l for 2-h PG, and 6.4 % for A1C