Diabetic Retinopathy and Dementia Association, Beyond Diabetes Severity.

Document Type


Publication Date


Publication Title

American journal of ophthalmology


washington; swedish


PURPOSE: To investigate whether associations between diabetic retinopathy (DR) and dementia and Alzheimer's disease (AD) remain significant after controlling for several measures of diabetes severity.

DESIGN: Retrospective cohort study.

METHODS: ACT is a prospective cohort study of adults ≥ 65 years, randomly selected and recruited from the membership rolls of Kaiser Permanente Washington, who are dementia free at enrollment and followed biennially until incident dementia. ACT participants were included in this study if they had at enrollment or developed type 2 diabetes mellitus during follow-up, and data were collected through September, 2018 (3,516 person-years of follow-up). Diabetes was defined by ≥2 diabetes medication fills in one year. Diagnosis of DR was based on International Classification of Diseases Ninth and Tenth Revision codes. Estimates of microalbuminuria, long-term glycemia, and renal function from longitudinal laboratory records were used as indicators of diabetes severity. AD and dementia were diagnosed using research criteria at expert consensus meetings.

RESULTS: A total of 536 participants (median baseline age 75 [interquartile range 71-80], 54% women) met inclusion criteria. Significant associations between DR >5 years duration with dementia (hazard ratio 1.81 [95% confidence interval 1.23-2.65]) and AD (1.80 [1.15-2.82]) were not altered by adjustment for estimates of microalbuminuria, long-term glycemia, and renal function (dementia: 1.69 [1.14-2.50]; AD: 1.73 [1.10-2.74]).

CONCLUSIONS: Among people with type 2 diabetes, DR itself appears to be an important biomarker of dementia risk in addition to glycemia and renal complications.

Clinical Institute

Kidney & Diabetes

Clinical Institute

Mental Health


Behavioral Health