This epidemiological study aims to: (1) determine the cumulative 15-year progression of diabetic retinopathy and incidence of proliferative retinopathy, macular edema, visual impairment, other microvascular (diabetic nephropathy) and macrovascular (myocardial infarction, lower extremity amputation) complications in persons with type I diabetes and quantify the risk of these outcomes with regard to markers of inflammation, endothelial dysfunction, cellular adhesion and of estimated insulin resistance; (2) examine the association of change in visual acuity and changes in self-rated health and self-reported visual-targeted quality of life in type 1 persons with long term diabetes over a ten year period; and (3) examine the cross-sectional association of visual impairment and depression in persons with type 1 diabetes. The study builds upon the population-based Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR, NEIR01 03083) which included all insulin-taking persons with type 1 diabetes and who were receiving primary medical care in an 11-county area of southwestern Wisconsin in 1979-1980. Exams were performed in 1980-82, 1984-86, 1990-92, 1995-96, and 2000-01. These persons will be examined in their communities in a mobile examining van. Refraction, visual acuity, intraocular pressure, blood pressure and other measurements will be obtained according to standardized protocols. Objective recording of retinopathy from stereoscopic fundus photography combined with a standardized grading will be used. Standardized questionnaires including the SF-36, the NEI-VFQ 25, and the Center for Epidemiologic Studies Depression Scale (CES-D) will be administered. C-reactive protein, interleukin-6, tumor necrosis factor-""""""""c, and other markers of inflammation, endothelial dysfunction, and cellular adhesion will be measured. New data from this study will provide a unique opportunity to evaluate the relationship of new factors to the presence and severity of retinopathy and to the progression of retinopathy and incidence of other micro- vascular (e.g., diabetic nephropathy) and macrovascular (e.g., lower extremity amputation, myocardial infarction) complications and will provide needed information regarding the associations of retinopathy and visual impairment to self-reported visual-targeted quality of life and depression in persons with long duration of type 1 diabetes. These data will be useful to patients and their physicians involved in the management of diabetes and to public health practitioners designing and delivering preventive care services. Conversely, the new data to be collected in this study may provide insights into the relative protective value of low levels of markers of inflammatory, cell adhesion, and endothelial dysfunction on vascular complications of diabetes mellitus.

Agency
National Institute of Health (NIH)
Institute
National Eye Institute (NEI)
Type
Research Project (R01)
Project #
5R01EY016379-04
Application #
7483591
Study Section
Special Emphasis Panel (ZRG1-HOP-N (90))
Program Officer
Kurinij, Natalie
Project Start
2005-09-01
Project End
2010-07-31
Budget Start
2008-08-01
Budget End
2010-07-31
Support Year
4
Fiscal Year
2008
Total Cost
$390,852
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
Klein, Ronald; Lee, Kristine E; Danforth, Lorraine et al. (2018) The Relationship of Retinal Vessel Geometric Characteristics to the Incidence and Progression of Diabetic Retinopathy. Ophthalmology 125:1784-1792
Klein, Ronald; Horak, Kayla; Lee, Kristine E et al. (2017) The Relationship of Serum Soluble Receptor for Advanced Glycation End Products (sRAGE) and Carboxymethyl Lysine (CML) to the Incidence of Diabetic Nephropathy in Persons With Type 1 Diabetes. Diabetes Care 40:e117-e119
Klein, Barbara E K; Horak, Kayla L; Maynard, John D et al. (2017) Association of Skin Intrinsic Fluorescence with Retinal Microvascular Complications of Long Term Type 1 Diabetes in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Ophthalmic Epidemiol 24:211-216
O'Neal, Wesley T; Lee, Kristine E; Soliman, Elsayed Z et al. (2017) Predictors of electrocardiographic abnormalities in type 1 Diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. J Endocrinol Invest 40:313-318
Ryan, Christopher M; Klein, Barbara E K; Lee, Kristine E et al. (2016) Associations between recent severe hypoglycemia, retinal vessel diameters, and cognition in adults with type 1 diabetes. J Diabetes Complications 30:1513-1518
Fan, Qiao; Guo, Xiaobo; Tideman, J Willem L et al. (2016) Childhood gene-environment interactions and age-dependent effects of genetic variants associated with refractive error and myopia: The CREAM Consortium. Sci Rep 6:25853
Roshandel, Delnaz; Klein, Ronald; Klein, Barbara E K et al. (2016) New Locus for Skin Intrinsic Fluorescence in Type 1 Diabetes Also Associated With Blood and Skin Glycated Proteins. Diabetes 65:2060-71
Sohn, Elliott H; van Dijk, Hille W; Jiao, Chunhua et al. (2016) Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus. Proc Natl Acad Sci U S A 113:E2655-64
Porta, Massimo; Toppila, Iiro; Sandholm, Niina et al. (2016) Variation in SLC19A3 and Protection From Microvascular Damage in Type 1 Diabetes. Diabetes 65:1022-30
Klein, Barbara E K; Klein, Ronald (2015) Further insight on the limits of success of glycemic control in type 1 diabetes. Diabetes 64:341-3

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