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

ObjectiveTo 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).MethodsCSME 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.ResultsHispanics (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-Hispanic 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 (∼30, (∼17 to ∼59), p < 0.01).ConclusionThe prevalence of CSME in the VADT is associated with ethnicity as well as diastolic BP, amputation, and retinopathy severity.