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13-09-2009 | Diabetes | Article

Macular edema prevalence varies by ethnicity

Abstract

Free abstract

MedWire News: Subanalysis of the Veterans Affairs Diabetes Trial (VADT) shows that clinically significant macular edema (CSME) in patients with Type 2 diabetes and cardiovascular disease is more common in Hispanic and African–American patients than in non-Hispanic Whites.

The VADT trial was primarily aimed at determining whether intensive glycemic control prevents macrovascular events in Type 2 diabetes, and included significant numbers of all three major ethnic groups in the USA.

“Because more than one-seventh of the individuals in our cohort were African–American and another one-seventh Hispanic, we had an excellent opportunity to assess the impact of ethnicity/race on the prevalence of CSME,” write Carlos Abraira (Miami Veterans Affairs Medical Center, USA) and colleagues in the journal Diabetes Research and Clinical Practice.

In previous analyses of the VADT cohort, the authors found that participants with a Hispanic or African–American background had more severe retinopathy than non-Hispanic Whites, independent of other risk factors.

To determine whether this association also exists for macular edema, they analyzed data from the 1268 participants in VADT who had baseline 7-field stereo fundus photographs available for both eyes.

CSME was defined as the presence of thickening of the retina at or within 500 mm of the center of the macula; hard exudates at or within 500 mm of the center of the macula; and/or a zone of retinal thickening, 1 disc area or larger, within 1 disc diameter of the center of the macula.

The study population comprised 222 (17.5%) Hispanics, 225 (17.7%) African–Americans, and 821 (64.7%) non-Hispanic Whites. CSME was present in 10% (127 of 1268) of the cohort overall but the prevalence varied by race, at 6.3% in non-Hispanic Whites, 15.6% in African–Americans, and 18% in Hispanics.

In univariate analysis, the prevalence of CSME was associated with younger onset and longer duration of diabetes, retinopathy severity, high levels of glycated hemoglobin, blood pressure, urine albumin/creatinine, and amputation.

In multivariate regression analysis, CSME remained associated with ethnicity/race, with a 2.3-fold higher prevalence in both Hispanics and African–Americans compared with non-Hispanic Whites.

Diastolic blood pressure, a history of amputation, and severity of retinopathy were also independently associated with the presence of CSME in multivariate logistic regression analyses.

“These findings may have very important implications for tailored targeting of clinical care,” conclude the authors.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Jenny Grice