Prevalence and associations of diabetic retinopathy in a large cohort of prediabetic subjects: the Gutenberg Health Study

J Diabetes Complications. 2014 Jul-Aug;28(4):482-7. doi: 10.1016/j.jdiacomp.2014.02.008. Epub 2014 Feb 26.


Aims: To evaluate the prevalence of diabetic retinopathy/maculopathy (DR/DMac) and its associations with cardiovascular risk factors (CRF) in participants with prediabetes (PwPD) in a large European cohort within the population-based Gutenberg Health Study (GHS).

Methods: The study was based on a sub-cohort of the GHS (n=5,000, age: 35-74 y). Prediabetes was diagnosed according to HbA1c levels (5.7-6.4%). DR/DMac was graded from fundus photographs. Blood samples and comprehensive questionnaires served for evaluation of laboratory results and CRF.

Results: The prevalence of prediabetes was 22.4%, and of DR/DMac 8.1%/0.2%, respectively. The majority of participants had mild DR (7.2%). A percentage of 0.5 of PwPD presented with moderate and 0.3% with severe non-proliferative disease. None of the subjects had proliferative DR. No independent association was found between any of the analyzed CRF [hypertension, smoking, (family) history of myocardial infarction, congestive heart failure, coronary heart disease, stroke, obesity, dyslipidemia, chronic obstructive pulmonary disease, peripheral artery disease and chronic kidney disease] and DR.

Conclusions: Although prevalences of prediabetes and DR in this Caucasian cohort are considerable, retinopathy findings are mainly mild, and no association was found for DR/DMac and CRF.

Keywords: Cardiovascular risk factors; Diabetic maculopathy; Diabetic retinopathy; Prediabetes; Screening.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / epidemiology
  • Cohort Studies
  • Diabetic Angiopathies / complications
  • Diabetic Angiopathies / epidemiology
  • Diabetic Cardiomyopathies / complications
  • Diabetic Cardiomyopathies / epidemiology
  • Diabetic Retinopathy / epidemiology*
  • Diabetic Retinopathy / physiopathology
  • Female
  • Germany / epidemiology
  • Glycated Hemoglobin A / analysis
  • Humans
  • Macular Degeneration / complications
  • Macular Degeneration / epidemiology
  • Macular Degeneration / physiopathology
  • Male
  • Middle Aged
  • Prediabetic State / blood
  • Prediabetic State / complications*
  • Prediabetic State / epidemiology
  • Prediabetic State / pathology
  • Prevalence
  • Retina / pathology*
  • Risk Factors
  • Severity of Illness Index
  • Surveys and Questionnaires


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human