Publication:

A prospective study of serum lipids and the risk of diabetic retinopathy in type 1 diabetes

Background Diabetic retinopathy (DR) remains a leading cause of vision loss among individuals with type 1 diabetes, yet factors beyond hyperglycemia that contribute to its onset and progression are not fully understood. Dyslipidemia has been proposed as a modifiable risk factor, but evidence has been inconsistent

Methods This prospective cohort study investigated the relationship between serum lipid levels and the risk of incident and progressive DR in 1,360 participants with type 1 diabetes, aged 14–38 years, followed for a mean of 6.2 years. Participants were stratified into primary prevention and secondary intervention groups and underwent annual fasting lipid measurements and standardized retinal photography, with outcomes graded according to the early treatment diabetic retinopathy study (ETDRS) scale.

Results During follow-up, 312 new cases of DR, 286 cases of DR progression, and 94 cases of proliferative DR were identified. Higher LDL cholesterol and elevated total-to-HDL cholesterol ratio were significantly associated with incident DR (HR 2.68 and 3.05, respectively, highest vs. lowest quintile), while triglycerides and total-to-HDL cholesterol ratio predicted disease progression (HR 2.12 and 1.95, respectively). Associations with proliferative DR were attenuated after adjustment for glycemic control. HDL cholesterol showed no independent effect.

Conclusions These findings suggest that lipid abnormalities contribute primarily to the early development and progression of DR rather than proliferative disease. Given that dyslipidemia is a modifiable risk factor, early identification and treatment may reduce the burden of vision loss in type 1 diabetes. Lipid management, alongside strict glycemic control, should be considered in preventive ophthalmic care.