American Diabetes Association
DC22-2118 Supplement_DC_Retinopathy_paper.docx (23.83 kB)

People with type 1 diabetes of African-Caribbean ethnicity are at increased risk of developing sight-threatening diabetic retinopathy

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posted on 2023-04-16, 00:10 authored by Anastasios Mangelis, Piyumi Wijewickrama, Abbeyramei Nirmalakumaran, Nikolaos Fountoulakis, Prashanth Vas, Laura Webster, Samantha Mann, Julianne Collins, DAVID HOPKINSDAVID HOPKINS, Stephen ThomasStephen Thomas, Salma Ayis, Janaka Karalliedde



There is limited information on the effect of ethnicity on the development of referable sight-threatening diabetic retinopathy (STDR) in people with type 1 diabetes. To describe the risk-factors for STDR in a diverse cohort of people with type 1 diabetes attending a regional diabetes eye screening service 

Research design and methods

Clinical and digital retinal imaging data from 1876 people with type 1 diabetes (50% female, 72.1% Caucasian, 17.3% African-Caribbean, 2.9 % Asian and 7.6% other) with no retinopathy at baseline, attending surveillance eye screening were reviewed. Referable STDR was defined as presence of any moderate to severe non-proliferative or pre-proliferative diabetic retinopathy or proliferative diabetic retinopathy or maculopathy in either eye as per United Kingdom National Diabetic Eye Screening criteria. Median follow-up was 6 years.


The median (interquartile range) age of the cohort was 29 (21, 41) years. Of the cohort of 1876 people, 359 (19%) developed STDR. People who developed STDR had higher baseline HbA1c, raised systolic blood pressure (SBP), longer diabetes duration and were more often of African-Caribbean origin (24% vs 15.6%), p<0.05 for all. In multivariable cox regression analyses, hazard ratio (95% confidence intervals), African-Caribbean ethnicity (HR 1.39, CI 1.09-1.78, P=0.009), baseline SBP (HR 1.01 CI 1.00-1.01, p=0.033) and baseline HbA1c (HR 1.01 CI 1.00-1.01, p=0.0001) emerged as independent risk-factors for STDR.


We observed that people with type 1 diabetes of African-Caribbean ethnicity are at significantly greater risk of STDR. Further research is required to understand the mechanisms that explain this novel observation. 


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