AIMS: Baseline diabetic retinopathy (DR) and risk of development of microalbuminuria, kidney function decline, and cardiovascular events (CVEs) in type 2 diabetes. METHODS: Post-hoc analysis of the PRIORITY study including 1758 persons with type 2 diabetes and normoalbuminuria followed for a median of 2.5 (IQR: 2.0-3.0) years. DR diagnosis included non-proliferative and proliferative abnormalities, macular oedema, or prior laser treatment. Cox models were fitted to investigate baseline DR presence with development of persistent microalbuminuria (urinary albumin-creatinine ratio > 30 mg/g); chronic kidney disease (CKD) G3 (eGFR <60 ml/min/1.73m2); and CVE. Models were adjusted for relevant risk factors. RESULTS: At baseline, 304 (17.3 %) had DR. Compared to persons without DR, they were older (mean ± SD: 62.7 ± 7.7 vs 61.4 ± 8.3 years, p = 0.019), had longer diabetes duration (17.9 ± 8.4 vs. 10.6 ± 7.0 years, p < 0.001), and higher HbA1c (62 ± 13 vs. 56 ± 12 mmol/mol, p < 0.001). The adjusted hazard ratios of DR at baseline for development of microalbuminuria (n = 197), CKD (n = 166), and CVE (n = 64) were: 1.50 (95%CI: 1.07, 2.11), 0.87 (95%CI: 0.56, 1.34), and 2.61 (95%CI: 1.44, 4.72), compared to without DR. CONCLUSIONS: Presence of DR in normoalbuminuric type 2 diabetes was associated with an increased risk of developing microalbuminuria and CVE, but not with kidney function decline.

Amsterdam UMC location Vrije Universiteit Amsterdam Department of Epidemiology and Data Science Amsterdam the Netherlands; Amsterdam Cardiovascular Sciences Amsterdam the Netherlands; Amsterdam Public Health Amsterdam the Netherlands; Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands

Amsterdam UMC location Vrije Universiteit Amsterdam Department of Epidemiology and Data Science Amsterdam the Netherlands; Amsterdam Public Health Amsterdam the Netherlands

Bethesda Diabetes Research Center Hoogeveen the Netherlands

Department General Practice and Elderly Care Amsterdam the Netherlands

Department of Internal Medicine 4 Division of Endocrinology Diabetology and Nephrology University Hospital Tübingen Tübingen Germany

Department of Internal Medicine Charles University 3rd Faculty of Medicine Prague Czech Republic

Department of Internal Medicine Charles University 3rd Faculty of Medicine Prague Czech Republic; Faculty Hospital Královské Vinohrady Prague Czech Republic

Department of Internal Medicine Nephrology Ziekenhuisgroep Twente Hospital Almelo the Netherlands

Department of Nephrology Cyril and Methodius University in Skopje Skopje Macedonia

Department of Nephrology Ghent University Hospital Ghent Belgium

Department of Renal Medicine Clinical Research Centre for Rare Diseases Aldo e Cele Daccò Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica Bergamo Italy

Diabetes Center 2nd Department of Internal Medicine National and Kapodistrian University of Athens Medical School Hippokratio General Hospital Athens Greece

Diabetes Center Institute for Clinical and Experimental Medicine Prague Czech Republic

Diabetespraxis Leipzig Germany

Diabetologische Schwerpunktpraxis Diabetologen Hessen Marburg Germany

Division of Nephrology and KfH Renal Unit Hospital St Georg Leipzig Germany; Martin Luther University Halle Wittenberg Germany

Division of Nephrology Department of Internal Medicine University Medical Center Groningen University of Groningen Groningen the Netherlands

Instituto de Investigacion Sanitaria de la Fundacion Jiménez Díaz UAM Madrid Spain

Mosaiques Diagnostics GmbH Hannover Germany

Orgenesis Germany GmbH Munich Germany

School of Cardiovascular and Metabolic Health University of Glasgow Glasgow UK

School of Health and Wellbeing University of Glasgow Glasgow UK

Steno Diabetes Center Copenhagen Herlev Denmark

Steno Diabetes Center Copenhagen Herlev Denmark; Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Steno Diabetes Center Copenhagen Herlev Denmark; Department of Medicine Copenhagen University Hospital Holbæk Holbæk Denmark; Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

University Clinic of Endocrinology Diabetes and Metabolic Disorders Skopje Macedonia

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ClinicalTrials.gov
NCT02040441

EudraCT
20120-004523-4