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Master Thesis

Relation entre la sévérité de la rétinopathie diabétique et le risque de développer une artériopathie oblitérante des membres inférieurs majeure chez les patients diabétiques de type 2

Abstract : Introduction: previous studies reported an association between diabetic retinopathy (DR) and lower-extremity arterial disease (LEAD), but the role of traditional risk factors that may mediate this association remains uncertain. We evaluated the association between DR stages and LEAD, its prognostic value, and the influence of potential contributors to this relationship in a prospective cohort of patients with type 2 diabetes, SURDIAGENE (SURvival, type 2 DIAbetes and GENEtics). Methods: DR was staged at baseline as absent, non-proliferative, or proliferative. A Cox regression model was fitted in order to compute the hazard ratio (95% CI) for major LEAD (lower-limb amputation or revascularization) during follow-up by baseline retinopathy stages. Results: among 1320 participants without a history of LEAD at baseline, 94 persons (7.1%) developed a major LEAD during a 7.1 (4.4-10.7) year median follow-up (incidence rate 9.6 per 1000 person-years). The LEAD incidence rate (per 1000 person-years) increased as retinopathy worsened (p<0.0001; log-rank test). The risk of LEAD was significantly higher for non-proliferative DR (adjusted HR 2.31 95% CI (1.43-3.81); p=0.0006) and proliferative DR (3.14 (1.40-6.15); p=0.007) versus no DR. No heterogeneity was observed across subgroups. DR enhanced the C statistic (+0.023 [95% CI 0.003–0.044]; p=0.02), IDI (+0.209 [0.130-0.321]; p<0.001), and NRI (+0.562 [0.382-0.799]; p<0.001) values for risk of LEAD, beyond traditional risk factors. Conclusions: an independent dose-response relationship was identified between DR stages and major LEAD. Retinopathy yielded incremental prognostic information for stratifying risk of LEAD, suggesting its usefulness as a predictor of LEAD.
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https://dumas.ccsd.cnrs.fr/dumas-03202237
Contributor : Médecine Ub <>
Submitted on : Monday, April 19, 2021 - 4:18:46 PM
Last modification on : Thursday, May 13, 2021 - 3:18:15 AM

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Ninon Foussard. Relation entre la sévérité de la rétinopathie diabétique et le risque de développer une artériopathie oblitérante des membres inférieurs majeure chez les patients diabétiques de type 2. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03202237⟩

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