https://orcid.org/0000-0003-4413-9752
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ABSTRACT
Purpose
This study investigates the relationship between diabetic retinopathy (DR) and birth weight (BW) in diabetic subjects sampled from the general population.
Methods
The Gutenberg Health Study (GHS) is a population-based, observational cohort study in participants aged from 35 to 74 years. Criteria for diabetes diagnosis were HbA1c ≥6.5% at study entry, a doctor-diagnosis of diabetes, or diabetes medication. The presence of DR was determined by evaluating fundus photographs. BW was assessed by self-reports. GHS participants were divided into three different BW groups (low: <2500 g; normal: 2500–4000 g; high:>4000 g). Logistic regression analysis was conducted as uni- and multivariable analysis with adjustment for age and sex. Effect mediators were separately investigated.
Results
A total of 1,124 GHS participants (7.5% of the cohort) had diabetes at study entry. Of these, 402 subjects (35.8%) had gradable fundus photographs, reported BW data and were included into this study. Overall, 91/402 subjects (23%) had DR. With regard to BW groups, DR was descriptively more frequent in subjects with low (28.1% [95%-CI: 14.4–47.0%; n = 32]) and high BW (30.8% [95%-CI: 19.1–45.3%; n = 52]) compared to normal BW (20.8% [95%-CI: 16.5–25.7%; n = 318]). Both high and low BW were associated with DR in multivariable analysis (high: OR = 1.68, p = .037; low: OR = 1.81, p = .05). The BW effect was mediated by duration of diabetes in both BW groups and by arterial hypertension in the low BW group.
Conclusion
Low and high BW in persons with diabetes is related to higher risk of diabetic retinopathy. Longer duration of diabetes and higher prevalence of arterial hypertension are factors in these subjects explaining the elevated risk.
Acknowledgments
We thank all study participants for their willingness to provide data for this research project, and we are indebted to all co-workers for their enthusiastic commitment.
Authors’ contributions
AF, JL, PR, TP, SN, MEB, TM, PSW, KL, NP, and AKS conceived and designed the study; AF, SN, and AKS analyzed and interpreted the data; AF wrote the paper; AF, JL, PR, TP, KP, SN, TM, PSW, MEB, MU, KJL, NP, and AKS critically revised the manuscript; and all authors read and approved the final manuscript.
Access to data, responsibility and analysis
AKS and PSW had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Statistical analyses were performed by AKS and SN.
The analysis presents clinical data of a large-scale population-based cohort with ongoing follow-up examinations. This project constitutes a major scientific effort in which high methodological standards and detailed guidelines for analysis and publication are applied to ensure that scientific analysis is conducted at the highest level. Therefore, the data are not made available to the scientific community outside the established and controlled workflows and algorithms.
To meet the need for the verification and reproducibility of our scientific findings, we offer access to data at the local database in accordance with the ethics vote upon request at any time. The GHS steering committee, which comprises a member of each involved department and the head of the Gutenberg Health Study (PSW), convenes once each month. The steering committee makes decisions regarding internal and external access by researchers and use of the data and biomaterials based on research proposals supplied by the researchers. Interested researchers should submit their requests to the head of the Gutenberg Health Study (Philipp S. Wild; [email protected]). More detailed contact information is available at the homepages of the GHS (www.gutenberghealthstudy.org) and the ophthalmic branch of the GHS (www.unimedizin-mainz.de/augenklinik/forschung/gutenberg-gesundheitsstudie.html).
Consent for publication
Not applicable
Competing interests
The authors declare that they have no competing interests.
Ethics approval and consent to participate
The study protocol and study documents were approved by the local ethics committee of the Medical Chamber of Rhineland-Palatinate, Germany (reference no. 837.020.07; original vote: 22.3.2007, latest update: 20.10.2015). According to the tenets of the Declaration of Helsinki, written informed consent was obtained from all participants prior to entering the study.
Financial disclosure
Pfeiffer N receives financial support and grants from Novartis, Ivantis, Santen, Thea, Boehringer Ingelheim Deutschland GmbH & Co. KG, Alcon, and Sanoculis. Beutel ME received speaker honorarium from Pfizer Deutschland GmbH, Shire Deutschland GmbH and currently receives research grants from the governments of Rhineland-Palatinate and Nordrhein-Westfalen, the German Association of Psychoanalysis and Psychotherapy (DGPT), the German Research Foundation, the German Ministry of Research, the German Cancer Aid, and the European Union. Schuster AK holds the professorship for ophthalmic healthcare research endowed by “Stiftung Auge“ and financed by “Deutsche Ophthalmologische Gesellschaft“ and “Berufsverband der Augenärzte Deutschland e.V.“ He received research funding from Bayer Vital, Allergan, Plusoptix, Novartis, and Heidelberg Engineering. Nickels S received reimbursement of travel expenses from Heidelberg Engineering. Ponto KA previously received grants from Bayer Vital, the Federal Ministry of Education and Research (BMBF 01EO1503), Grimmke Stiftung, and Dr. Gertraud-Maria-Rzehulka-Stiftung
Fieß A., Lamparter J., Raum P., Peto T., Münzel T., Urschitz M., Lackner KJ: none.