Associations of microangiopathy with risk factors, correlation of diabetic nephropathy (DN) and retinopathy (DR) as well as the concordance between different degrees of these complications were evaluated. 157 patients submitted to indirect ophtalmoscopy were referred to the Diabetes Center for the screening of DN. A standardized questionnaire including socio-demographic and clinical aspects was applied. Glycemic control was assessed by glycated hemoglobin and DN by the presence of microalbuminuria. Scores were given to DR and DN to test correlation and concordance. 103 patients (57.9±12.9 yrs) completed all the steps of the study; 72% of the referred patients had any DR, who did not differ from those without DR concerning their main characteristics. Patients were stratified into 4 groups according to the presence or absence of each complication. No difference was observed concerning gender and skin color distributions and years in school among the groups. Duration of DM was longer in patients with DN+DR as compared to those without DR, with or without DN (14.8±6.4 vs. 7.2±5.3 and 9.2±5.6 yrs, p< 0.05, respectively). Frequencies of smokers and self-reported dyslipidemia, BMI, glycemia and glycated hemoglobin did not differ among the groups. Patients with both complications showed higher mean blood pressure than those without DR, with or without DN (147±23 vs. 128±20 and 118±18mmHg, p< 0.05, respectively). Patients with DN, independent of the presence of DR, had higher A/C than those without DN (p< 0.05); A/C of the normal group and that with only DR were not different. High A/C levels in patients with both complications did not differ from the DN patients without DR. 80% of DN patients showed DR, while 74% of DR patients also had DN (c2= 6.39, p< 0.05). Significant correlation was detected between the 2 complications (r= 0.47, p< 0.05), as well as the concordance between their degrees, whose kappa was 0.154 (95%CI, 0.031-0.276, p< 0.01). Hypertension was associated with severe cases with both complications. The occurrence of microvascular complication in the absence of the other may suggest organ-specific pathogenetic factors. Our data indicated concordance between degrees of renal or retinal lesions in the microangiopathy of DM2. Patients with DN had higher risk of retinal disease. Even in microalbuminuric phase, the finding of abnormal A/C in a diabetic patient requires screening for DR.
Diabetes mellitus; Microangiopathy; Retinopathy; Nefropathy
