Objective: We explore the influence of lifestyle on the progression of retinopathy.
Design: Post hoc statistical analysis.
Subjects/setting: One thousand forty-one patients with type 1 diabetes from 29 specialty clinics.
Intervention: The Diabetes Control and Complications Trial (DCCT) lifestyle data (diet, exercise, and tobacco use) and retinopathy-related risk factors (mean arterial pressure, the low-density lipoprotein/high-density lipoprotein cholesterol ratio [LDL-C/HDL-C], serum triglycerides, glycosolated hemoglobin [HbA1c] levels, body mass index [BMI], and insulin utilization) were related to the rate of progression of retinopathy.
Main outcome measures: Correlation between lifestyle data with progression of retinopathy and retinopathy-related risk factors.
Results: The percentage of calories as total fatty acids at baseline and overall positively correlated with prestudy and overall progression of retinopathy (r = .15, P < .0001 and r = .14, P < .0001, respectively). Average overall percentage of calories as dietary fiber inversely correlated with prestudy and overall progression of retinopathy (r = -.07, P = .0102 and r = -.10, P < .0002, respectively). The progression of retinopathy correlated with mean arterial pressure (prestudy r = .09, P = .0004 and overall r = .20, P < .0001), LDL-C/HDL-C (prestudy r = .13, P < .0001 and overall r = .15, P < .0001), serum triglycerides (prestudy r = .18, P < .0001 and overall r = .26, P < .0001), HbA1c (prestudy r = .10, P < .0001 and overall r = .45, P < .0001), BMI (prestudy r = .08, P <.0034 and overall r = .05, P = .08), insulin utilization (prestudy r = .19, P < .0001 and overall r = .14, P < .0001), tobacco use (prestudy r = .08, P < .0231 and overall r = .09, P < .0011), and the intensive vs conventional therapy study group (on-study r = -.27, P < .0001).
Conclusion: Tobacco use and diet, particularly the consumption of fatty acids and dietary fiber, are significantly associated with the rate of progression of diabetic retinopathy and retinopathy-related risk factors.