To identify risk factors for diabetic retinopathy in insulin-dependent diabetes mellitus (IDDM), we studied the relationships among residual β-cell function, human leukocyte antigen (HLA), long-term glycemic control, and development of diabetic retinopathy in 128 IDDM patients. Residual β-cell function was assessed by serum C-peptide immunoreactivity (CPR) response to a 100-g oral glucose load (ΔCPR). The patients were stratified into three groups: those with ΔCPR of <0.033 nmol/1 (group 1, n = 50), those with ΔCPR of 0.033–0.1 nmol/1 (group 2, n = 38), and those with ΔCPR of > 0.1 nmol/1 (group 3, n = 40). The cumulative incidence rate of background retinopathy was higher in the order of groups 1, 2, and 3 (P = 0.032). Group 1 progressed to preproliferative retinopathy at an earlier stage than did groups 2 and 3 combined (P = 0.028). Further progression to proliferative retinopathy tended to be earlier in group 1 than in groups 2 and 3 combined (P = 0.083). The mean HbA1c value rose from 9.01 ± 1.06% (mean ± SD) in group 3 to 9.75 ± 0.79% in group 2 to 10.48 ± 1.12% in group 1 (P <0.0001). In group 1, 89.6% of the patients had HLA-A24, whereas 50 and 43.6% of the patients had this antigen in groups 2 and 3 respectively (P <0.0001). In Cox's proportional hazards model, both serum CPR response and mean HbA1c value were identified as independent risk factors for development of diabetic retinopathy after adjusting for other potential risk factors. These results indicate that complete loss of β-cell function, which is associated with HLA-A24, predicts earlier occurrence of diabetic retinopathy through metabolic control.
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November 01 1995
Residual β-Cell Function and HLA-A24 in IDDM: Markers of Glycemic Control and Subsequent Development of Diabetic Retinopathy
Koji Nakanishi;
Koji Nakanishi
Department of Endocrinology and Metabolism Okinaka Memorial Institute for Medical Research
Tokyo
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Tetsuro Kobayashi;
Tetsuro Kobayashi
Department of Endocrinology and Metabolism Okinaka Memorial Institute for Medical Research
Tokyo
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Hidetoshi Inoko;
Hidetoshi Inoko
Departments of Molecular Life Science, Tokai University School of Medicine
Bohseidai, Isehara, Kanagawa, Japan
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Kimiyoshi Tsuji;
Kimiyoshi Tsuji
Transplantation, Tokai University School of Medicine
Bohseidai, Isehara, Kanagawa, Japan
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Toshio Murase;
Toshio Murase
Department of Endocrinology and Metabolism Okinaka Memorial Institute for Medical Research
Tokyo
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Kinori Kosaka
Kinori Kosaka
Department of Endocrinology and Metabolism Okinaka Memorial Institute for Medical Research
Tokyo
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Address correspondence and reprint requests to Dr. Koji Nakanishi, Department of Endocrinology and Metabolism, Toranomon Hospital, 2–2–2 Toranomon, Minatoku, Tokyo 105, Japan.
1
BMI, body mass index; CPR, C-peptide immunoreactivity; ΔCPR, serum CPR response to a 100-g oral glucose load; FBG, fasting blood glucose; HLA, human leukocyte antigen; ICA, islet cell antibodies; IDDM, insulin-dependent diabetes mellitus; OGTT, oral glucose tolerance test.
Diabetes 1995;44(11):1334–1339
Article history
Received:
September 27 1994
Revision Received:
July 27 1995
Accepted:
July 27 1995
PubMed:
7589833
Citation
Koji Nakanishi, Tetsuro Kobayashi, Hidetoshi Inoko, Kimiyoshi Tsuji, Toshio Murase, Kinori Kosaka; Residual β-Cell Function and HLA-A24 in IDDM: Markers of Glycemic Control and Subsequent Development of Diabetic Retinopathy. Diabetes 1 November 1995; 44 (11): 1334–1339. https://doi.org/10.2337/diab.44.11.1334
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