Document Detail

Prospective study of inflammatory biomarkers and risk of diabetic retinopathy in the diabetes control and complications trial.
MedLine Citation:
PMID:  23392399     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: This study demonstrates that increasing quintiles of baseline high-sensitivity C-reactive protein (hsCRP) level may be associated with higher risk of incident clinically significant macular edema, the leading cause of vision loss in working-aged individuals in North America.
OBJECTIVE: To determine whether baseline levels of hsCRP and intercellular adhesion molecule 1 (ICAM-1) predict development and progression of diabetic retinopathy (DR), clinically significant macular edema (CSME), retinal hard exudates, and proliferative DR in the Diabetes Control and Complications Trial (DCCT) cohort.
DESIGN: The DCCT was a large multicenter randomized controlled clinical trial.
SETTING: Twenty-nine medical centers in the United States and Canada.
PARTICIPANTS: The DCCT population consisted of 1441 subjects with type 1 diabetes mellitus aged 13 to 39 years at study entry.
INTERVENTION: We measured levels of hsCRP, ICAM-1, vascular cell adhesion molecule 1, and tumor necrosis factor α receptor 1 in stored baseline blood samples.
MAIN OUTCOME MEASURES: We assessed the association of levels of hsCRP, ICAM-1, vascular cell adhesion molecule 1, and tumor necrosis factor α receptor 1 with incident DR end points ascertained from grading of standardized 7-field stereoscopic retinal color photographs taken at baseline and every 6 months during follow-up.
RESULTS: After adjustment for randomized treatment assignment and other factors, we observed a statistically significant association between hsCRP and risk of CSME, with a relative risk (RR) for the top vs bottom quintile of 1.83 (95% CI, 0.94-3.55; P for trend = .01). Similarly, for the development of retinal hard exudates, the RR for the top vs bottom quintile of hsCRP level was 1.78 (95% CI, 0.98-3.25; P for trend = .004), whereas for ICAM-1 level, the RR comparing the top vs bottom quintiles was 1.50 (95% CI, 0.84-2.68; P for trend = .05). There were no statistically significant associations between baseline VCAM-1 or tumor necrosis factor α receptor 1 levels and risk of any of the DR end points.
CONCLUSIONS AND RELEVANCE: After adjusting for known risk factors, increasing quintiles of baseline hsCRP level may be associated with higher risk of incident CSME and macular hard exudate in the DCCT cohort. Circulating levels of ICAM-1 may also be associated with the development of retinal hard exudates.
Rajeev H Muni; Radha P Kohly; Eudocia Q Lee; JoAnn E Manson; Richard D Semba; Debra A Schaumberg
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA ophthalmology     Volume:  131     ISSN:  2168-6173     ISO Abbreviation:  JAMA Ophthalmol     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-12     Completed Date:  2013-06-05     Revised Date:  2014-04-02    
Medline Journal Info:
Nlm Unique ID:  101589539     Medline TA:  JAMA Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  514-21     Citation Subset:  AIM; IM    
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MeSH Terms
Biological Markers / blood*
C-Reactive Protein / metabolism*
Chromatography, High Pressure Liquid
Diabetes Mellitus, Type 1 / complications
Diabetic Retinopathy / blood,  diagnosis*
Enzyme-Linked Immunosorbent Assay
Hemoglobin A, Glycosylated / metabolism
Intercellular Adhesion Molecule-1 / blood*
Macular Edema / blood,  diagnosis
Nephelometry and Turbidimetry
Prospective Studies
Receptors, Tumor Necrosis Factor, Type I / blood*
Risk Assessment
Risk Factors
Vascular Cell Adhesion Molecule-1 / blood*
Young Adult
Grant Support
R01 AG027012/AG/NIA NIH HHS; R01 EY013834/EY/NEI NIH HHS
Reg. No./Substance:
0/Biological Markers; 0/Hemoglobin A, Glycosylated; 0/Receptors, Tumor Necrosis Factor, Type I; 0/Vascular Cell Adhesion Molecule-1; 0/hemoglobin A1c protein, human; 126547-89-5/Intercellular Adhesion Molecule-1; 9007-41-4/C-Reactive Protein

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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