Examination of Exacerbating Factors in Diabetic Retinopathy

To examine exacerbating factors in diabetic retinopathy, we retrospectively evaluated clinical findings on long-term follow up of 183 patients with non-insulin dependent diabetes mellitus (NIDDM)(93 males, 90 females). I) Diabetic retinopathy was classified as no retinopathy, simple, preproliferative and proliferative retinopathy. The patients were divided into 3 groups: an exacerbated group with at least 1 stage of progression, a stable group without progression, and an improved group with at least 1 stage of improvement over the past 5 years. The mean value of hemoglobin A1c (HbA1c) and mean blood pressure during the past 5 years were examined among 3 groups. II) 45 patients with simple retinopathy (22 males, 23 females) were divided into 2 groups, an exacerbated group or a stable/improved group, and were studied as described in I). III) 23 patients (8 males, 15 females) with NIDDM in whom the onset of simple retinopathy could be specified, were divided into 2 groups, Group S with simple retinopathy without progression or Group P with progression from simple retinopathy to either preproliferative or proliferative retinopathy. The following items were retrospectively compared: 1. duration of simple retinopathy (prior to study), 2. HbA1c, 3. systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP), and 4. serum total cholesterol (TC). The results are as follows: I There were 23 patients in the improvement group, 106 patients in the no change group, and 54 patients in the exacerbation group. In both the improvement group and the no change group, levels of HbA1c and mean blood pressure were significantly lower than those in the exacerbation group (p<0.001). II There were 24 patients in the improvement/no change group, and 21 patients in the exacerbation group. In the improvement/no change group, levels of HbA1c and mean blood pressure were significantly lower than those in the exacerbation group (p<0.01, p