Progression and regression: distinct developmental patterns of diabetic retinopathy in patients with type 2 diabetes treated in the diabetes care system west-friesland, the Netherlands

Hata Zavrelova, T. Hoekstra, Marjan Alssema, Laura M C Welschen, Giel Nijpels, Annette C Moll, Henrica C W de Vet, Bettine C P Polak, Jacqueline M Dekker

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OBJECTIVE: To identify distinct developmental patterns of diabetic retinopathy (DR) and assess the risk factor levels of patients in these clusters.

RESEARCH DESIGN AND METHODS: A cohort of 3,343 patients with type 2 diabetes mellitus (T2DM) monitored and treated in the Diabetes Care System West-Friesland, the Netherlands, was followed from 2 to 6 years. Risk factors were measured, and two-field fundus photographs were taken annually and graded according to the EURODIAB study group. Latent class growth modeling was used to identify distinct developmental patterns of DR over time.

RESULTS: Five clusters of patients with distinct developmental patterns of DR were identified: A, patients without any signs of DR (88.9%); B, patients with a slow regression from minimal background to no DR (4.9%); C, patients with a slow progression from minimal background to moderate nonproliferative DR (4.0%); D, patients with a fast progression from minimal or moderate nonproliferative to (pre)proliferative or treated DR (1.4%); and E, patients with persistent proliferative DR (0.8%). Patients in clusters A and B were characterized by lower risk factor levels, such as diabetes duration, HbA(1c), and systolic blood pressure compared with patients in progressive clusters (C-E).

CONCLUSIONS: Clusters of patients with T2DM with markedly different patterns of DR development were identified, including a cluster with regression of DR. These clusters enable a more detailed examination of the influence of various risk factors on DR.

Original languageEnglish
Pages (from-to)867-872
Number of pages6
JournalDiabetes Care
Issue number4
Publication statusPublished - Apr 2011


  • Aged
  • Diabetes Mellitus, Type 2
  • Diabetic Retinopathy
  • Female
  • Hemoglobin A, Glycosylated
  • Humans
  • Journal Article
  • Male
  • Middle Aged
  • Netherlands
  • Risk Factors

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