Retinal vascular geometry predicts incident renal dysfunction in young people with type 1 diabetes

OBJECTIVE - To examine the relationship between retinal vascular geometry parameters and development of incident renal dysfunction in young people with type 1 diabetes. RESEARCH DESIGN AND METHODS - This was a prospective cohort study of 511 adolescents with type 1 diabetes of at least 2 years duration, with normal albumin excretion rate (AER) and no retinopathy at baseline while attending an Australian tertiary-care hospital. AER was quantified using three overnight, timed urine specimen collections and early renal dysfunction was defined as AER >7.5 µg/min. Retinal vascular geometry (including length-to-diameter ratio [LDR] and simple tortuosity [ST]) was quantified from baseline retinal photographs. Generalized estimating equations were used to examine the relationship between incident renal dysfunction and baseline venular LDR and ST, adjusting for age, diabetes duration, glycated hemoglobin (A1C), blood pressure (BP), BMI, and cholesterol. RESULTS - Diabetes duration at baseline was 4.8 (IQR 3.3-7.5) years. After amedian 3.7 (2.3-5.7) years follow-up, 34% of participants developed incident renal dysfunction. In multivariate analysis, higher retinal venular LDR (odds ratio 1.7, 95% CI 1.2-2.4; quartile 4 vs. 1-3) and lower venular ST (1.6, 1.1-2.2; quartile 1 vs. 2-4) predicted incident renal dysfunction. CONCLUSIONS - Retinal venular geometry independently predicted incident renal dysfunction in young people with type 1 diabetes. These noninvasive retinal measures may help to elucidate early mechanistic pathways for microvascular complications. Retinal venular geometry may be a useful tool to identify individuals at high risk of renal disease early in the course of diabetes. © 2012 by the American Diabetes Association.

Empowering Art: Reconfiguring narratives of trauma and hope in the Australian national imaginary

Aboriginal art has been the source of much contention between art curators, gallery owners, art critics and Aboriginal artists themselves. Early aesthetic debates about whether so-called traditional works should be considered ethnographic or artistic have led, at times, to conflicts over the rights of Aboriginal people to have their works exhibited according to the criteria applied to other kinds of Western artworks. This article explores how the dilemmas of troubled ethno-histories are critically embodied and reconfigured in texture and colour. It considers the problems that silenced histories pose for those responsible for their display to the public. As Aboriginal images often conceal troubled intercultural encounters it asks how artworks can be used to provide a counter-polemic to national rhetoric as artists seek to reshape and improve intergenerational futures. This text is published as a counterpart to the contribution to Disturbing Pasts from the artist Heather Kamarra Shearer.