Factors associated with non-proliferative diabetic retinopathy in patients with type 1 and type 2 diabetes: the Japan Diabetes Complication and its Prevention prospective study (JDCP study 4)
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This study aims to identify associations of non-proliferative diabetic retinopathy (NPDR) in the Japan Diabetes Complication and its Prevention prospective (JDCP) study, a nation-wide study capturing real-world practice for diabetes in Japan.
We recruited patients with type 1 and type 2 diabetes mellitus aged between 40 and 75 years from 464 hospitals and clinics. Seven thousand and seven hundred patients fulfilled the inclusion criteria, and 5852 patients were included for this specific analysis. Multiple logistic regression models were used to identify associated factors of NPDR.
Of the 363 patients with type 1 diabetes, 83 patients (22.8%) had NPDR; there were significant associations of duration of diabetes and high-density lipoprotein cholesterol with the presence of NPDR. Of the 5489 patients with type 2 diabetes, 1515 (27.6%) had NPDR. Female, duration of diabetes, lifetime maximum body weight, treatment types, systolic blood pressure, and the number of oral hypoglycemic agents (OHA) and antihypertensive drug were associated with increased odds of having NPDR. Diastolic BP, body mass index, alcohol intake, and the number of lipid-lowering drugs were associated with lower odds of having NPDR. Statin and fibrate use was associated with lower odds of having NPDR; this association was confirmed in the model adjusting for the propensity score for taking fibrate or statin (odds ratio 0.80, 95% confidence interval 0.70–0.92; p = 0.002).
There was a potential protective association of lipid-lowering medication (statin or fibrate) and statin use and the presence of NPDR in patients with type 2 diabetes in the JDCP study.
KeywordsDiabetic retinopathy Type 1 diabetes Type 2 diabetes Risk factor Epidemiology
We thank all the participating hospitals and clinics and participants of this study.
1: Study design: TN, RN, YS, SK, YH; data analysis: RK, KS, RN; interpretation of data: RK, SK, YS, YH, RN, TN. 2: Drafting the article: RK, SK, RN; revising the article: RK, SK, YS, YH, RN, TN. 3: final approval: RK, SK, YS, YH, RN, TN
The JDCP study is a Japan Diabetes Society (JDS)-initiated research project. The study was supported by a Ministry of Health, Labour and Welfare grant-in-aid during the 2009–2010 period and then by JDS grants-in-aid from 2011 onward. The project also has received research grants from the Manpei Suzuki Diabetes Foundation since 2006 to provide support in registry configuration that had to do with the data collection.
Compliance with ethical standards
Human rights statement and informed consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study. The study protocol was reviewed and approved by the Research Ethics Review Board of the Japan Diabetes Society (approved on July 2, 2013; study title “Japan Diabetes Complication and its Prevention Prospective study (JDCP study); approval number: not applicable).
Conflict of interest
Research funding: Pfizer (RK), Rohto (RK), Novartis (RK, KS, HY, RN), Bayer (RK, KS), Santen (KS, HY), Senju (RK, KS), Alcon Japan (KS, HY), Funayama Hospital (HY), Trust Medical (HY), Sanofi (RN), Japan Medtronic (RN), Japan Boehringer-Ingelheim (RN, TN), Takeda (RN, TN), Kissei (RN, TN), Eli Lily (RN), Novo Nordisk (RN, TN), Astellas (RN, TN), Abbott Japan (TN), and MSD (TN). Endowed department: Topcon (RK).
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