A Population-Based Study of the Risk of Diabetic Retinopathy in Patients With Type 1 Diabetes and Celiac Disease
Diabetes Care, 09/17/2012
Clinical Article
Mollazadegan K et al. – Having a diagnosis of Celiac disease (CD) for >10 years is a risk factor for the development of diabetic retinopathy (DRP) in type 1 diabetes (T1D). Long–standing CD in patients with T1D merits intense monitoring of DRP.
Methods
- This was a population–based cohort study.
- Through the Swedish National Patient Register, the authors identified 41,566 patients diagnosed with diabetes in 1964–2009 and who were ≤30 years of age at diagnosis.
- CD was defined as having villous atrophy (Marsh stage 3) according to small intestinal biopsies performed between 1969 and 2008, with biopsy reports obtained from Sweden’s 28 pathology departments.
- During follow–up, 947 T1D patients had a diagnosis of CD.
- They used Cox regression analysis with CD as a time–dependent covariate to estimate adjusted hazard ratios (aHRs) for DRP in patients with T1D and CD and compared them with patients with T1D but no CD.
Results
- Duration of CD correlated with the risk of DRP.
- When results were stratified by time since CD diagnosis, individuals with T1D and CD were at a lower risk of DRP in the first 5 years after CD diagnosis (aHR 0.57 [95% CI 0.36–0.91]), followed by a neutral risk in years 5 to <10 (1.03 [0.68–1.57]).
- With longer follow–up, coexisting CD was a risk factor for DRP (10 to <15 years of follow–up, aHR 2.83 [95% CI 1.95–4.11]; ≥15 years of follow–up, 3.01 [1.43–6.32]).