Association of blood glucose control and lipids with diabetic retinopathy in the veterans affairs Diabetes trial (VADT)

OBJECTIVE: This study examined whether lipids modify the relationship between intensive glucose control (INT) and diabetic retinopathy (DR). RESEARCH DESIGN AND METHODS: The incidence and progression of DR were assessed in 858 of 1,791 participants with 7-field stereoscopic fundus photographs at baseline and 5 years later. RESULTS: Odds of DR progression were lower by ∼40% in those with baseline total cholesterol (TC) ≥200 mg/dL (P = 0.007), LDL-C ≥120 mg/dL (P < 0.02), or HDL-C ≥40 mg/dL (P < 0.007) in the INT arm versus standard glycemic treatment. Odds of DR progression were reduced by ∼40% in those who had TC ≥140 mg/dL (P ≥ 0.024), triglycerides (TG) ≥120 mg/dL (P = 0.004), or HDL-C ≥45 mg/dL (P = 0.01) at the fifth year. Odds of DR progression were lower by ∼40-50% with reductions of TC by ≥40 mg/dL (P < 0.0001), of LDL-C of ≥40 mg/dL (P < 0.004), and of TG by ≥60 mg/dL (P = 0.004) at the fifth year. Odds of DR progression increased by 80% with increases in TC of ≥20 mg/dL (P < 0.0001) and by 180% with increases in LDL-C by ≥60 mg/dL (P < 0.004). After adjusting for covariants, those with higher TC at baseline and lower TC during and at the fifth year and higher HDL-C throughout study had significantly decreased odds of DR progression in INT. CONCLUSIONS: INT was associated with decreased odds of progression but not with onset of retinopathy in those with worse lipid levels at baseline and more improved lipid levels during the study. Higher HDL-C was consistently associated with better response to INT throughout the study.