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Retinal Arteriolar Narrowing Predicts Incidence of Diabetes

The Australian Diabetes, Obesity and Lifestyle (AusDiab) Study

¹ Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
² Centre for Vision Research, University of Sydney, Sydney, Australia
³ International Diabetes Institute, Melbourne, Australia
⁴ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
⁵ Singapore Eye Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Address correspondence and reprint requests to Tien Y. Wong, MD, PhD, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne St., East Melbourne 3002, Australia. E-mail: twong{at}unimelb.edu.au

Abbreviations: 2hPG, 2-h plasma glucose; AusDiab, Australian Diabetes, Obesity and Lifestyle; FPG, fasting plasma glucose; IFG, impaired fasting glucose; IGT, impaired fasting glucose; NGT, normal glucose tolerance; OGTT, oral glucose tolerance test

OBJECTIVE—To examine the relationship of retinal vascular caliber to incident diabetes in a population-based cohort.

RESEARCH DESIGN AND METHODS—The Australian Diabetes, Obesity and Lifestyle (AusDiab) Study recruited adults aged 25+ years across Australia in 1999–2000, with a follow-up 5 years later in 2004–2005. Participants' glycemic status was classified using fasting plasma glucose (FPG) and 2-h oral glucose tolerance (2-h plasma glucose [2hPG]) tests. Diabetes was diagnosed if FPG was 7.0 mmol/l or 2hPG was 11.1 mmol/l. Retinal vascular caliber was measured from baseline retinal photographs using a computer-assisted program.

RESULTS—Of the 803 participants without diabetes at baseline, 108 (13.4%) developed diabetes at follow-up: 7 (2.8%) of 246 participants with normal glucose tolerance, 9 (13.6%) of 66 participants with impaired fasting glucose, and 92 (18.7%) of 491 participants with impaired glucose tolerance. After multivariate analysis, participants with narrower retinal arteriolar caliber had a higher risk of diabetes (odds ratio 2.21 [95% CI 1.02–4.80], comparing smallest versus highest arteriolar caliber tertiles, P = 0.04 for trend). There was no association between retinal venular caliber and incident diabetes.

CONCLUSIONS—Narrower retinal arteriolar caliber predicted risk of diabetes. These data provide further evidence that microvascular changes may contribute to the pathogenesis of diabetes.

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