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The French DESIR Study

Pascale Massin, MD, PhD; Céline Lange, MSc; Jean Tichet, MD; Sylviane Vol, MSc; Ali Erginay, MD; Martine Cailleau, MD; Eveline Eschwège, MD; Beverley Balkau, PhD; for the DESIR (Data From an Epidemiological Study on the Insulin Resistance Syndrome) Study Group

Arch Ophthalmol. 2011;129(2):188-195. doi:10.1001/archophthalmol.2010.353

Objective  To evaluate the predictive values of hemoglobin A_1c (HbA_1c) and fasting plasma glucose (FPG) for retinopathy 10 years after the baseline examination.

Methods  Seven hundred men and women from the DESIR (Data From an Epidemiological Study on the Insulin Resistance Syndrome) Study underwent evaluation for retinopathy using a nonmydriatic digital camera. During the preceding 9 years, 235 had diabetes mellitus (treated or FPG level of 126 mg/dL at least once), 227 had an impaired FPG level (110-125 mg/dL) at least once, and 238 always had glucose levels within reference limits (<110 mg/dL).

Results  Compared with those without retinopathy, the 44 participants with retinopathy at 10 years had higher baseline mean (SD) levels of FPG (130 [49] vs 106 [22] mg/dL) and HbA_1c (6.4% [1.6%] vs 5.7% [0.7%]) (both, P < .001). The frequency of retinopathy at 10 years, standardized according to the distribution of glycemia across the entire DESIR population, was 3.6%. In our population, FPG levels of 108 and 116 mg/dL had positive predictive values of 8.4% and 14.0%, respectively, for retinopathy at 10 years; HbA_1c levels of 6.0% and 6.5% had positive predictive values of 6.0% and 14.8%, respectively. After 10 years of follow-up, retinopathy was equally frequent in participants with impaired FPG levels and in those who became diabetic during the study (8.6% and 6.7%, respectively), lower than in those with diabetes at baseline (13.9%).

Conclusion  Because the positive predictive values for retinopathy increase sharply from 108 mg/dL for FPG and from 6.0% for HbA_1c levels, these thresholds are proposed to identify those at risk of retinopathy 10 years later.

Author Affiliations: Ophthalmology Department, Assistance Publique Hôpitaux de Paris, Hôpital Lariboisière (Drs Massin and Erginay), Paris; Institut National de la Santé et de la Recherche Médicale (INSERM), Center for Research in Epidemiology and Health of Populations, Unité 1018, Epidemiology of Diabetes, Obesity, and Chronic Kidney Disease Over the Lifecourse and Determinants of Early Nutrition (Ms Lange and Drs Eschwège and Balkau), and University Paris-Sud 11, Unité Mixte de Recherche en Santé 1018 (Ms Lange and Drs Eschwège and Balkau), Villejuif; and Institut Inter-Régional pour la Santé, La Riche (Drs Tichet and Cailleau, Ms Vol, and the DESIR Study Group), France.

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