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A number of landmark studies have made it abundantly clear that the goals of diabetes care involve striving for optimal metabolic and blood pressure control. The message is now loud and clear: lower HbA1C, lower lowdensity lipoprotein cholesterol, and lower blood pressure.

Type 2 diabetes is associated with a 2 - 4-fold increased risk of cardiovascular disease (CVD), and over half the excess mortality in subjects with type 2 diabetes is due to this complication. The development of macrovascular disease in type 2 diabetes is partly related to chronic hyperglycaemia, but also to other associated atherogenic factors, including dyslipidaemia, oxidative stress, endothelial damage, hypercoaguability and activation of inflammatory pathways.

The SEMDSA Congress, to be held on the Durban beachfront at the end of March 2004, promises to be an inspiring mix of international expertise and local input.

Aim To determine the prevalence of clinical and laboratory variables and genetic polymorphisms in association with diabetic retinopathy (DR) in subjects with type 2 diabetes attending a tertiary referral diabetes clinic in Durban, South Africa. Methods Cross-sectional study on 292 Indian and African patients with type 2 diabetes (71.5% women). The presence of DR was determined by direct ophthalmoscopy. Clinical and laboratory data were collected and polymorphisms in the NOS3 (rs61722009, rs2070744, rs1799983) and VEGF (rs35569394, rs2010963) genes were determined. Results DR was present in 113 (39%) subjects. Those with DR were older (60.6 ± 9.6 vs. 55.4 ± 12.9 years, p = 0.005), had longer duration diabetes (18.5 ± 8.8 vs. 11.9 ± 9.2 years, p 1c (9.2 ± 1.8 vs. 8.8 ± 1.7%, p = 0.049), serum creatinine (106.3 ± 90.2 vs. 75.2 ± 33.4 μmol/l), triglycerides (2.1 ± 1.2 vs. 1.9 ± 1.6 mmol/l, p = 0.042), proteinuria (72% vs. 28%, p = 0.001), and used more insulin (78% vs. 39% p = 0.0001), anti-hypertensive (95% vs. 80%, p = 0.0003) and lipid-lowering therapy (70% vs. 56%, p = 0.023). There was no association between DR and any of the NOS3 or VEGF gene polymorphisms studied, although there were ethnic differences. After adjustment, diabetes duration (OR 1.05, 95% CI 1.01–1.08), presence of proteinuria (OR 4.15, 95% CI 1.70–10.11) and use of insulin therapy (OR 3.38, 95% CI 1.60–7.12) were associated with DR. Conclusion Hyperglycemia, duration of diabetes and proteinuria are associated with DR in Indian and African patients in South Africa, whereas NOS3 and VEGF gene polymorphisms were not associated with DR.