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The Use of the Markov Process in Describing the Natural Course of Diabetic Retinopathy
Satish K. Garg, MD;
Guillermo Marshall;
H. Peter Chase, MD;
William E. Jackson, MD;
Philip Archer, ScD;
Michael J. Crews
Arch Ophthalmol. 1990;108(9):1245-1247.
Abstract
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• The natural course of early diabetic retinopathy in young subjects with insulin-dependent diabetes mellitus was evaluated during 693 patient visits for 259 subjects during a mean of 2.4 years. Diabetic retinopathy is considered a progressive disease among people with insulin-dependent diabetes mellitus (type I). Improvement of early retinopathy has not been recognized as a part of the natural course. In our experience, 25% of observations in subjects with early diabetic retinopathy (grades 2 and 3) showed improvement. Thus, 28 of 174 observations of diabetic retinopathy improved from grade 2 to grade 1, and 34 of 79 observations improved from grade 3 to grades 2 or 1. Markov chains indicate that 25% of observations of diabetic retinopathy will change from grade 1 to grade 5 or 6 in 17.0 years and 25% will change from grade 2 to grade 5 or 6 in 16.0 years. Future studies of diabetic retinopathy should consider a matrix of estimated transition probabilities, depending on the population, to judge probabilities of transition between states of retinopathy.
Author Affiliations
From the Departments of Pediatrics (Drs Garg and Chase and Mr Crews), Ophthalmology (Dr Jackson), and Preventive Medicine and Biometrics (Dr Archer and Mr Marshall), Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Denver.
Footnotes
Accepted for publication June 6, 1990.
Reprint requests to the Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, 4200 E Ninth Ave, PO Box B140, Denver, CO 80262 (Dr Chase).
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