{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:00:12Z","timestamp":1787860812861,"version":"build-2784847793"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,9,6]],"date-time":"2018-09-06T00:00:00Z","timestamp":1536192000000},"content-version":"vor","delay-in-days":36,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010374","name":"Stichting Blindenhulp","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010374","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate risk factors for the development and progression of diabetic retinopathy (<jats:styled-content style=\"fixed-case\">DR<\/jats:styled-content>) and long\u2010term visual outcomes in Dutch patients with type 1 diabetes mellitus (T1<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cumulative incidences were calculated for <jats:styled-content style=\"fixed-case\">DR<\/jats:styled-content>, vision\u2010threatening <jats:styled-content style=\"fixed-case\">DR<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">VTDR<\/jats:styled-content>), defined as (pre)proliferative <jats:styled-content style=\"fixed-case\">DR<\/jats:styled-content> and diabetic macular oedema, and best\u2010corrected visual acuity (<jats:styled-content style=\"fixed-case\">BCVA<\/jats:styled-content>) &lt;0.5 and &lt;0.3 at the most recent eye examination. The following factors were assessed: duration of diabetes, age of onset of T1<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>, gender, mean HbA1c, HbA1c variability (defined as coefficient of variation of five separate HbA1c measurements), mean arterial blood pressure, body mass index, albuminuria and lipid profile. We used multivariable Cox regression models to identify factors associated with <jats:styled-content style=\"fixed-case\">DR<\/jats:styled-content> development and progression to <jats:styled-content style=\"fixed-case\">VTDR<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found 25\u2010year cumulative incidences of 63% for <jats:styled-content style=\"fixed-case\">DR<\/jats:styled-content>, 21% for <jats:styled-content style=\"fixed-case\">VTDR<\/jats:styled-content>, 2% for <jats:styled-content style=\"fixed-case\">BCVA<\/jats:styled-content> &lt;0.5, and 1% for <jats:styled-content style=\"fixed-case\">BCVA<\/jats:styled-content> &lt;0.3. Mean HbA1c (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.023, p\u00a0&lt;\u00a00.001), HbA1c variability (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.054, p\u00a0&lt;\u00a00.001), age of onset of T1<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.024, p\u00a0&lt;\u00a00.001), <jats:styled-content style=\"fixed-case\">HDL<\/jats:styled-content> cholesterol (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 0.502, p\u00a0=\u00a00.002) and total cholesterol (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.210, p\u00a0=\u00a00.029) showed an independent association with faster development of any form of <jats:styled-content style=\"fixed-case\">DR<\/jats:styled-content>. The mean HbA1c (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.023, p\u00a0&lt;\u00a00.001) and the presence of albuminuria (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 2.940, p\u00a0=\u00a00.028) were associated with faster progression to <jats:styled-content style=\"fixed-case\">VTDR<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These data show relatively low cumulative incidences of <jats:styled-content style=\"fixed-case\">DR<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> VTDR<\/jats:styled-content> and visual impairment. Higher mean HbA1c, HbA1c variability, age of onset of T1<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content> and total cholesterol were independently associated with the risk of <jats:styled-content style=\"fixed-case\">DR<\/jats:styled-content> development, and a protective association was found for <jats:styled-content style=\"fixed-case\">HDL<\/jats:styled-content> cholesterol in subjects with T1<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>.\u00a0Mean HbA1c and presence of albuminuria were associated with progression of <jats:styled-content style=\"fixed-case\">DR<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.13815","type":"journal-article","created":{"date-parts":[[2018,9,6]],"date-time":"2018-09-06T12:21:29Z","timestamp":1536236489000},"page":"459-464","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Risk factors for development and progression of diabetic retinopathy in Dutch patients with type 1 diabetes mellitus"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2481-7686","authenticated-orcid":false,"given":"Vivian","family":"Schreur","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freekje","family":"van Asten","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heijan","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Weeda","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joannes M.M.","family":"Groenewoud","sequence":"additional","affiliation":[{"name":"Department of Health Evidence Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cees J.","family":"Tack","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carel B.","family":"Hoyng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiko K.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline C.W.","family":"Klaver","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands"},{"name":"Department of Ophthalmology Erasmus Medical Center Rotterdam The Netherlands"},{"name":"Department of Epidemiology Erasmus Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Jeroen Klevering","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,6]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-S012"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-013-0527-1"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1900\/RDS.2013.10.121"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(93)31562-9"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199309303291401"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.116.7.874"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-012-0283-6"},{"key":"e_1_2_5_9_1","unstructured":"European Union.Directive 2006\/126\/EC of the European Parliament and of the council of 20 December 2006 on driving licences (Recast)(Text with EEA relevance) [Online]. 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