This epidemiologic study has three Components: (1) to re-examine a large geographically-defined, well-characterized cohort of younger-onset diabetic persons in southwestern Wisconsin in order to determine the 15- year progression of diabetic retinopathy, and incidences of proliferative retinopathy, macular edema, loss of vision, diabetic renal disease, and amputation; to evaluate these conditions with respect to risk factors measured at previous examinations (e.g., glycosylated hemoglobin and blood pressure); and to investigate possible effects of medications which have become more widely used since the first examination (e.g., angiotensin converting enzyme inhibitors and humulin, etc.); (2) to compare the prevalence and incidence of diabetic retinopathy in diabetic persons studied in Wisconsin with those of other ethnic and racial groups using gradings of fundus photographs (all graded in Wisconsin) and risk factor or data from population-based studies in different communities in the U.S.; and (3) to quantitate the relationships of glycemia, blood pressure, and markers of """"""""severity of diabetes"""""""" (e.g., proliferative retinopathy and visual impairment) to cause-specific mortality in the younger- and older- onset Wisconsin population. Younger-onset persons will be examined in their communities in a mobile examining van. Refraction, visual acuity, intraocular pressure and blood pressure measurements will be obtained according to standardized protocols. Determination of proteinuria, creatinine, and glycosylated hemoglobin will be performed. Objective recording of retinopathy from stereoscopic fundus photography combined with a standardized grading of retinopathy will be used as in the previous examinations of the population. Grading of the stereoscopic photographs provides a sensitive and reproducible method for detection of the progression of retinopathy. The incidence and causes of visual impairment will be determined. The progression of retinopathy and incidence of renal disease and amputation will be evaluated with respect to duration and age at diagnosis of diabetes, changes in glycosylated hemoglobin level, blood pressure, use of angiotensin converting enzyme inhibitors, use of humulin, insulin-like growth factor, serum uric acid, and other systemic and ocular conditions as ascertained at the previous examination(s) in the younger-onset group. The vital status of all participants with regard to the severity of retinopathy and other risk factors or risk indicators will be determined. Differences in frequencies and in risk factors for diabetic retinopathy among ethnic groups may have implications for prevention. In this grant, we will compare rates of diabetic retinopathy, among Hispanics, American Indians, African-Americans, and non-Hispanic Whites in Wisconsin. We will analyze data to determine if differences among these groups are related to differences in levels of covariates. Data from this study will continue to be used for estimating the need for medical counseling and rehabilitative services, projecting medical care costs, measuring temporal trends, developing causal inferences, developing preventive strategies, and designing clinical trials related to diabetes and diabetic retinopathy.

Agency
National Institute of Health (NIH)
Institute
National Eye Institute (NEI)
Type
Research Project (R01)
Project #
2R01EY003083-16
Application #
2158622
Study Section
Vision Research and Training Committee (VSN)
Project Start
1979-07-01
Project End
1998-06-30
Budget Start
1994-07-01
Budget End
1995-06-30
Support Year
16
Fiscal Year
1994
Total Cost
Indirect Cost
Name
University of Wisconsin Madison
Department
Ophthalmology
Type
Schools of Medicine
DUNS #
161202122
City
Madison
State
WI
Country
United States
Zip Code
53715
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Verhoeven, Virginie J M; Hysi, Pirro G; Wojciechowski, Robert et al. (2013) Genome-wide meta-analyses of multiancestry cohorts identify multiple new susceptibility loci for refractive error and myopia. Nat Genet 45:314-8
Grassi, Michael A; Tikhomirov, Anna; Ramalingam, Sudha et al. (2012) Replication analysis for severe diabetic retinopathy. Invest Ophthalmol Vis Sci 53:2377-81
Klein, Barbara E K; Lee, Kristine E; Klein, Ronald (2011) Refraction in adults with diabetes. Arch Ophthalmol 129:56-62
Klein, Ronald; Klein, Barbara E K (2010) Are individuals with diabetes seeing better?: a long-term epidemiological perspective. Diabetes 59:1853-60
Cooper, Rachel; Kuh, Diana; Hardy, Rebecca et al. (2010) Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ 341:c4467
Klein, Ronald; Lee, Kristine E; Gangnon, Ronald E et al. (2010) The 25-year incidence of visual impairment in type 1 diabetes mellitus the wisconsin epidemiologic study of diabetic retinopathy. Ophthalmology 117:63-70
Klein, Ronald; Knudtson, Michael D; Lee, Kristine E et al. (2009) The Wisconsin Epidemiologic Study of Diabetic Retinopathy XXIII: the twenty-five-year incidence of macular edema in persons with type 1 diabetes. Ophthalmology 116:497-503
Klein, Ronald; Lee, Kristine E; Knudtson, Michael D et al. (2009) Changes in visual impairment prevalence by period of diagnosis of diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Ophthalmology 116:1937-42
Grassi, Michael A; Mazzulla, D Anthony; Knudtson, Michael D et al. (2009) Patient self-report of prior laser treatment reliably indicates presence of severe diabetic retinopathy. Am J Ophthalmol 147:501-4

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