Ethnicity, race, and clinically significant macular edema in the Veterans Affairs Diabetes Trial (VADT)

Objective: To determine risk factors in clinically significant macular edema (CSME) and if increased CSME in minorities is due to ethnicity or other factors in the Veterans Affairs Diabetes Trial (VADT). Methods: CSME prevalence based on 7-field stereo fundus photographs in 1268 patients with type 2 diabetes was related to ethnicity, demographics and biochemistries by univariate and multivariate analyses. Results: Hispanics (H) made up 17.5% and African Americans (AA) 17.7% of the cohort. CSME prevalence was 10%. In univariate analysis, CSME was more prevalent in H, 18%, and AA, 15.6% than in non-Hispanic Whites (NHW), 6.3%, p < 0.01. Univariate regression of CSME associated with younger age, younger onset of diabetes; longer duration; retinopathy severity; and high HbA1c, BP, urine albumin/creatinine, and amputation, all p < 0.01. In multivariate regression, CSME was associated with ethnicity/race (Hispanic White vs. non-ispanic White, OR, (95% CI), 2.30, (1.35-3.92), p < 0.01; African American vs. non-Hispanic White, 2.30, (1.33-4.00), p < 0.01), diastolic BP (1.13 per 5 mm Hg, (1.02-1.23), p = 0.03), amputation (3.0, (1.11-8.13), p = 0.04), and retinopathy severity (similar to 30, (similar to 17 to similar to 59), p < 0.01). Conclusion: The prevalence of CSME in the VADT is associated with ethnicity as well as diastolic BP, amputation, and retinopathy severity. Published by Elsevier Ireland Ltd.