Evidence map›Paper›PMID 38664827›Full record

Observational studyCardiovascular diabetology2024

Stroke incidence increases with diabetic retinopathy severity and macular edema in type 1 diabetes.

Marika I Eriksson, Kustaa Hietala, Paula Summanen, Valma Harjutsalo, Jukka Putaala, Anni Ylinen, Stefanie Hägg-Holmberg, Per-Henrik Groop, Lena M Thorn, FinnDiane Study

Open access · goldAbstract readObservational Study
In one paragraph

Observational study in Cardiovascular diabetology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
3.2field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

Marika I ErikssonFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
Kustaa HietalaFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
Paula SummanenFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
Valma HarjutsaloFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
Jukka PutaalaDepartment of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Anni YlinenFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
Stefanie Hägg-HolmbergFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
Per-Henrik GroopFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland. per-henrik.groop@helsinki.fi.
Lena M ThornFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
FinnDiane Study
Folkhälsans Forskningscentrum · FIHelsinki University Hospital · FIUniversity of Helsinki · FI

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAs the retina is suggested to mirror the brain, we hypothesized that diabetic retinopathy and macular edema are indicative of stroke risk in type 1 diabetes and sought to assess this association in individuals with type 1 diabetes.

methodsWe included 1,268 adult FinnDiane Study participants with type 1 diabetes (age 38.7 ± 11.8 years, 51.7% men vs. 48.3% women, and 31.5% had diabetic kidney disease), data on baseline diabetic retinopathy severity, and first stroke during our observational follow-up. Retinopathy was graded by the Early Treatment Diabetic Retinopathy Study (ETDRS) scale, and macular edema as clinically significant (CSME) or not. Strokes identified from registries were confirmed from medical files. Adjusted hazard ratios (HR) for stroke by retinopathy severity and CSME were calculated by Cox models adjusted for clinical confounders, including diabetic kidney disease.

resultsDuring median 18.0 (14.1-19.3) follow-up years, 130 strokes (96 ischemic, 34 hemorrhagic) occurred. With no-very mild (ETDRS 10-20) retinopathy as reference, the adjusted HR for stroke was 1.79 (95%CI 1.02-3.15) in non-proliferative (ETDRS 35-53), and 1.69 (1.02-2.82) in proliferative (ETDRS 61-85) retinopathy. Corresponding adjusted HR for ischemic stroke was 1.68 (0.91-3.10) in non-proliferative and 1.35 (0.77-2.36) in proliferative retinopathy. The adjusted HR for hemorrhagic stroke was 2.84 (0.66-12.28) in non-proliferative and 4.31 (1.16-16.10) in proliferative retinopathy. CSME did not increase HR for any stroke type after adjustment for clinical confounders (data not shown).

conclusionsStroke incidence increases with the severity of diabetic retinopathy independently of comorbid conditions, including diabetic kidney disease.

Indexed as

Diabetes Mellitus, Type 1Diabetic RetinopathyMacular EdemaSeverity of Illness IndexAdultFemaleFinlandHemorrhagic StrokeHumansIncidenceIschemic StrokeMaleMiddle AgedRegistriesRisk AssessmentRisk FactorsCerebrovascular complicationsDiabetic retinopathyMacular edemaStrokeType 1 diabetes

Identifiers

PMID38664827
PMCPMC11046873
OpenAlexW4395466064

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.