{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:37:37Z","timestamp":1789587457875,"version":"build-2803163510"},"reference-count":34,"publisher":"American Diabetes Association","issue":"5","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":3787,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2011,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The prognostic significance of diabetic retinopathy (DR) for death and cardiovascular (CV) outcomes is debated. We investigated the association of DR with all-cause mortality and CV events in patients with diabetes by a systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>The electronic databases Medline and Embase were searched for cohort studies that evaluated DR in type 2 or type 1 diabetic patients and reported total mortality and\/or fatal and nonfatal CV events, including myocardial infarction, angina pectoris, coronary artery bypass graft, ischemic changes on a conventional 12-lead electrocardiogram, transient ischemic attack, nonfatal stroke, or lower leg amputation. Data extraction was performed by two reviewers independently. Pooled effect estimates were obtained by using random-effects meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The analysis included 20 studies that fulfilled the inclusion criteria, providing data from 19,234 patients. In patients with type 2 diabetes (n = 14,896), the presence of any degree of DR increased the chance for all-cause mortality and\/or CV events by 2.34 (95% CI 1.96\u20132.80) compared with patients without DR. In patients with type 1 diabetes (n = 4,438), the corresponding odds ratio was 4.10 (1.50\u201311.18). These associations remained after adjusting for traditional CV risk factors. DR was also predictive of all-cause mortality in type 2 diabetes (odds ratio 2.41 [1.87\u20133.10]) and type 1 diabetes (3.65 [1.05\u201312.66]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The presence of DR was associated with an increased risk of all-cause mortality and CV events in both type 2 and type 1 diabetic patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc11-0079","type":"journal-article","created":{"date-parts":[[2011,4,27]],"date-time":"2011-04-27T17:27:24Z","timestamp":1303925244000},"page":"1238-1244","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":217,"title":["Diabetic Retinopathy Predicts All-Cause Mortality and Cardiovascular Events in Both Type 1 and 2 Diabetes"],"prefix":"10.2337","volume":"34","author":[{"given":"Caroline K.","family":"Kramer","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ticiana C.","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis H.","family":"Canani","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge L.","family":"Gross","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela J.","family":"Azevedo","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2011,4,20]]},"reference":[{"key":"2022031302461655000_B1","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1001\/jama.2010.1111","article-title":"Prevalence of diabetic retinopathy in the United States, 2005\u20132008","volume":"304","author":"Zhang","year":"2010","journal-title":"JAMA"},{"key":"2022031302461655000_B2","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.2337\/diacare.27.10.2540","article-title":"Diabetic retinopathy","volume":"27","author":"Fong","year":"2004","journal-title":"Diabetes Care"},{"key":"2022031302461655000_B3","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1001\/archinte.1997.00440340025002","article-title":"The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus. 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