***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the prevalence and factors associated with diabetic retinopathy in the Australian population and to estimate the time difference between disease onset and clinical diagnosis of type 2 diabetes . RESEARCH DESIGN AND METHODS The Australian Diabetes , Obesity and Lifestyle study ( AusDiab ) included 11,247 adults aged > or = 25 years in 42 r and omly selected areas of Australia . Retinopathy was assessed in participants identified as having diabetes ( based on self-report and oral glucose tolerance test ) , impaired fasting glucose , and impaired glucose tolerance and in a r and om sample with normal glucose tolerance . Data were available for 2,177 participants . RESULTS Overall , 15.3 % of those with diabetes had retinopathy . The prevalence of retinopathy was 21.9 % in those with known type 2 diabetes ( KDM ) and 6.2 % in those newly diagnosed ( NDM ) . The prevalence of proliferative diabetic retinopathy ( PDR ) was 2.1 % in those with KDM . No cases of PDR were found in those with NDM . Untreated vision threatening retinopathy ( presence of PDR or macular edema ) was present in 1.2 % ( n = 4 ) . Factors associated with retinopathy were duration of diabetes , HbA(1c ) , and systolic blood pressure . Using linear extrapolation of the prevalence of retinopathy with diabetes duration , the onset of diabetes in this population was approximately the time of diagnosis . CONCLUSIONS This is one of the first national studies of diabetic retinopathy in a developed country . The prevalence of retinopathy was similar to that in other population -based studies . Vision threatening retinopathy was relatively rare ; however , four untreated cases were identified . Regular screening for diabetic retinopathy and more aggressive management of modifiable risk factors could reduce the numbers of people who develop vision-threatening retinopathy PURPOSE To report additional ocular outcomes of intensive treatment of hyperglycemia , blood pressure , and dyslipidemia in the Action to Control Cardiovascular Risk in Diabetes ( ACCORD ) study . DESIGN Double 2 × 2 factorial , multicenter , r and omized clinical trials in people with type 2 diabetes who had cardiovascular disease or cardiovascular risk factors . In the glycemia trial , targets of intensive and st and ard treatment were : hemoglobin A1c < 6.0 % and 7.0 % to 7.9 % , respectively , and in the blood pressure trial : systolic blood pressures of < 120 and < 140 mmHg , respectively . The dyslipidemia trial compared fenofibrate plus simvastatin with placebo plus simvastatin . PARTICIPANTS Of the 3472 ACCORD Eye Study participants enrolled , 2856 had 4-year data ( 85 % of survivors ) . METHODS Eye examinations and fundus photographs were taken at baseline and year 4 . Photographs were grade d central ly for retinopathy severity and macular edema using the Early Treatment Diabetic Retinopathy Study ( ETDRS ) methods . MAIN OUTCOME MEASURES Three or more steps of progression on the ETDRS person scale or treatment of retinopathy with photocoagulation or vitrectomy . RESULTS As previously reported , there were significant reductions in the primary outcome in the glycemia and dyslipidemia trials , but no significant effect in the blood pressure trial . Results were similar for retinopathy progression by 1 , 2 , and 4 or more steps on the person scale and for ≥ 2 steps on the eye scale . In the subgroup of patients with mild retinopathy at baseline , effect estimates were large ( odds ratios , ∼0.30 ; P < 0.001 ) , but did not reach nominal significance for participants with no retinopathy or for those with moderate to severe retinopathy at baseline . CONCLUSIONS Slowing of progression of retinopathy by intensive treatment of glycemia was observed in ACCORD participants , whose average age and diabetes duration were 62 and 10 years , respectively , and who had cardiovascular disease or cardiovascular risk factors . The effect seemed stronger in patients with mild retinopathy . Similar slowing of progression was observed in patients treated with fenofibrate , with no effect observed with intensive blood pressure treatment . This is the second study to confirm the benefits of fenofibrate in reducing diabetic retinopathy progression , and fenofibrate should be considered for treatment of diabetic retinopathy OBJECTIVE To evaluate the relationship between serum lipid levels , retinal hard exu date , and visual acuity in patients with diabetic retinopathy . DESIGN Observational data from the Early Treatment Diabetic Retinopathy Study . PARTICIPANTS Of the 3711 patients enrolled in the Early Treatment Diabetic Retinopathy Study , the first 2709 enrolled had serum lipid levels measured  . MAIN OUTCOME MEASURES Baseline fasting serum lipid levels , best-corrected visual acuity , and assessment of retinal thickening and hard exu date from stereoscopic macular photographs . RESULTS Patients with elevated total serum cholesterol levels or serum low-density lipoprotein cholesterol levels at baseline were twice as likely to have retinal hard exu date s as patients with normal levels . These patients were also at higher risk of developing hard exu date during the course of the study . The risk of losing visual acuity was associated with the extent of hard exu date even after adjusting for the extent of macular edema . CONCLUSIONS These data demonstrate that elevated serum lipid levels are associated with an increased risk of retinal hard exu date in persons with diabetic retinopathy . Although retinal hard exu date usually accompanies diabetic macular edema , increasing amounts of exu date appear to be independently associated with an increased risk of visual impairment . Lowering elevated serum lipid levels has been shown to decrease the risk of cardiovascular morbidity . The observational data from the Early Treatment Diabetic Retinopathy Study suggest that lipid lowering may also decrease the risk of hard exu date formation and associated vision loss in patients with diabetic retinopathy . Preservation of vision may be an additional motivating factor for lowering serum lipid levels in persons with diabetic retinopathy and elevated serum lipid levels Objective To evaluate the incidence of diabetic retinopathy in patients with Type 2 Diabetes Mellitus , to identify the risk factors associated with the incidence of retinopathy and to develop a risk table to predict four-year retinopathy risk stratification for clinical use , from a four-year cohort study . Design The MADIABETES Study is a prospect i ve cohort study of 3,443 out patients with Type 2 Diabetes Mellitus , sample d from 56 primary health care centers ( 131 general practitioners ) in Madrid ( Spain ) . Results The cumulative incidence of retinopathy at four-year follow-up was 8.07 % ( 95 % CI = 7.04–9.22 ) and the incidence density was 2.03 ( 95 % CI = 1.75–2.33 ) cases per 1000 patient-months or 2.43 ( 95 % CI = 2.10–2.80 ) cases per 100 patient-years . The highest adjusted hazard ratios of associated risk factors for incidence of diabetic retinopathy were LDL-C > 190 mg/dl ( HR = 7.91 ; 95 % CI = 3.39–18.47 ) , duration of diabetes longer than 22 years ( HR = 2.00 ; 95 % CI = 1.18–3.39 ) , HbA1c>8 % ( HR = 1.90 ; 95 % CI = 1.30–2.77 ) , and aspirin use ( HR = 1.65 ; 95 % CI = 1.22–2.24 ) . Microalbuminuria ( HR = 1.17 ; 95 % CI = 0.75–1.82 ) and being female ( HR = 1.12 ; 95 % CI = 0.84–1.49 ) showed a non-significant increase of diabetic retinopathy . The greatest risk is observed in females who had diabetes for more than 22 years , with microalbuminuria , HbA1c>8 % , hypertension , LDL-Cholesterol > 190 mg/dl and aspirin use . Conclusions After a four-year follow-up , the cumulative incidence of retinopathy was relatively low in comparison with other studies . Higher baseline HbA1c , aspirin use , higher LDL-Cholesterol levels , and longer duration of diabetes were the only statistically significant risk factors found for diabetic retinopathy incidence . This is the first study to demonstrate an association between aspirin use and diabetic retinopathy risk in a well-defined cohort of patients with Type 2 Diabetes Mellitus at low risk of cardiovascular events . However , further studies with patients at high cardiovascular and metabolic risk are needed to clarify this issue AIMS To determine the 10-year incidence of diabetic retinopathy ( DR ) and macular edema ( DME ) , and its relationship with its risk factors in a sample of type 1 diabetes mellitus . METHODS A total of 334 patients without diabetic retinopathy at baseline underwent a 10-year prospect i ve study , the risk factors included : age , gender , diabetes duration , HbA1c , LDL-C , HDl-C , TC/HDL-C ratio , ApoA1 , ApoB , ApoB/ApoA1 ratio , and triglycerides were recorded . Risk factors for diabetic macular edema ( DME ) were also recorded . RESULTS The 10-year incidence of any DR was 35.90 % , and 11.07 % developed DME . The risk factors for DR and DME were : diabetes duration , high glycosylated level , and arterial hypertension , and overt nephropathy was well correlated with DME . The lipid study demonstrated that ApoB/ApoA1 ratio was significant for any DR [ HRR : 0.594 ( 0.416 - 0.848 ) , p=0.01 ] , and DME [ HRR : 0.601 ( 0.433 - 0.894 ) , p=0.009 ] . The TC/HDL ratio was only significant for DME [ HRR : 0.624 ( 0.440 - 0.886 ) , p=0.008 ] ; other lipids values were not significant for any groups studied . CONCLUSIONS In the present study , the ApoB/ApoA1 ratio was significant to the 10-year incidence of diabetic retinopathy and to macular edema ; and the TC/HDL ratio was significant to a 10-year incidence of macular edema Background and Purpose — The relationship between diabetic retinopathy and ischemic stroke is uncertain and examined in this study . Methods — A population -based , prospect i ve cohort study of 1617 middle-aged persons with diabetes . Diabetic retinopathy signs were ascertained from retinal photographs , and incident ischemic stroke events were prospect ively identified and vali date d. Results — Over an average follow-up of 7.8 years , there were 75 ischemic stroke events . After adjustment for age , gender , race , center , 6-year mean arterial blood pressure , anti-hypertensive treatment use , fasting glucose , insulin treatment , duration of diabetes , high-density lipoprotein and low-density lipoprotein cholesterol levels and cigarette smoking status , diabetic retinopathy was associated with an increased risk of ischemic stroke ( hazard rate ratio , 2.34 ; 95 % CI , 1.13 to 4.86 ) . Conclusions — Diabetic retinopathy predicts incident ischemic stroke in people with diabetes , independent of other risk factors Purpose : To assess the personal and demographic risk factors for proliferative diabetic retinopathy in Latino Americans in Los Angeles County . Methods : In this prospect i ve , non-interventional , cross-sectional case control study , seven hundred and twenty-nine subjects from Los Angeles County University of Southern California Medical Center ( LAC + USC ) , Los Angeles , CA , were enrolled . All patients were recruited prospect ively from the LAC + USC Medical Center and affiliated clinics between June 2008 and June 2011 . Complete personal data and results from systemic and ophthalmic examinations were collected for all enrolled subjects . Laboratory tests such as glycosylated hemoglobin , creatinine levels , and cholesterol levels were collected prospect ively by drawing blood at the time of each patient 's clinic visit . The main outcome measures were age , gender , type of diabetes mellitus ( DM I or II ) duration of diabetes mellitus , history of hypertension , history of insulin use , height , weight , and body mass index , smoking history , glycosylated hemoglobin , creatinine levels , and cholesterol levels . Results : The mean age of subjects with no diabetic retinopathy was 56.38 years ( 
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In addition , whether serum lipids involved in the progression of DR were relatively unexplored , but fenofibrate was confirmed to benefit the DR cases .
Conclusions : Based on recent published data , we did not find obvious differences in TG , TC , and HDL-C levels between patients with DR and without DR .
However , slightly higher LDL-C levels were observed in the DR cases