Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study

PLoS One. 2015 Jun 15;10(6):e0127188. doi: 10.1371/journal.pone.0127188. eCollection 2015.

Abstract

Objective: Diabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and maculopathy (DMac) in Germany.

Research design and methods: The Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases.

Results: Overall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio [95% confidence interval]: 0.97 [0.955-0.992]; p = 0.006) arterial hypertension (1.90 [1.190-3.044]; p = 0.0072) and vision-threatening DR with obesity (3.29 [1.504-7.206]; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 [1.068-1.114]; p<0.0001 and 1.18 [1.137-1.222]; p<0.0001, respectively).

Conclusions: Our calculations suggest that approximately 142 000 persons aged between 35 and 74 years have vision threatening diabetic retinal disease in Germany [corrected].Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus.

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / complications*
  • Cohort Studies
  • Comorbidity
  • Diabetic Retinopathy / diagnosis
  • Diabetic Retinopathy / epidemiology*
  • Diabetic Retinopathy / etiology*
  • Female
  • Germany / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Retinal Diseases / diagnosis
  • Retinal Diseases / epidemiology*
  • Retinal Diseases / etiology*
  • Risk Factors

Grant support

The Gutenberg Health Study is funded through the government of Rhineland- Palatinate („Stiftung Rheinland-Pfalz für Innovation“, contract AZ 961-386261/733), the research programs “Wissen schafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” as well as the Center for Thrombosis and Haemostasis (CTH) of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim, PHILIPS Medical Systems and Novartis including an unrestricted grant for the Gutenberg Health Study. Philipp Wild and Katharina Ponto are funded by the Federal Ministry of Education and Research (BMBF 01EO1003). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.