A study of the prognostic value of leptin to assess the risk of progression of diabetic retinopathy in patients with type 2 diabetes

Abstract

Objective — to evaluate the results of applying a mathematical model to determine the prognostic significance of blood leptin in the development and progression of diabetic retinopathy (DRP) in patients with type 2 diabetes mellitus (DM). Materials and methods. The studyincluded 59 patients (137 eyes) with type 2 DM and DRP: men (27—45.76 %) and women (32—54.24 %), mean age (58.20 ± 0.18) [42; 74] years, the average duration of diabetes from the diagnosis was (9.19 ± 0.46) [1; 35] years, the average level of glycated hemoglobin (HbA1C) was (9.10 ± 0.17) [5.1; 15.1] %.Based on the stage of DRP, patients were divided into 3 groups (1st — 42 patients, 2nd — 9 patients, 3rd — 8 patients). The inclusion criteria in the study were the patient’s informed consent to participate in study, age >18 years, the presence of type 2 DM, verified DRP. Exclusion criteria were endocrine and somatic pathologies leading to obesity (Cushing’s syndrome, hypothyroidism, hypogonadism, polycystic ovary syndrome, other endocrinopathies including hereditary, cerebral obesity), type 1 diabetes, acute infectious diseases, oncological diseases (including history of), decompensation of comorbid pathology, mental disorders, current antipsychotics or antidepressants treatment, the presence of proteinuria, clinically significant maculopathy, glaucoma and cataracts. The diagnosis of DRP was made according to the classification of Е. Kohner and М. Porta (1992), in which there are 3 main stages of DRP: non-proliferative, preproliferative and proliferative. Results and discussion. At the non-proliferative stage of DRP, a favorable prognosis (the likely absence of progression) is mainly due to normal leptin levels with a satisfactory lipid profile, subcompensation of DM (according to HbA1C) and the absence of insulin therapy. At the preproliferative stage of DRP, a favorable prognosis is mainly due to the lack of insulin therapy, and unfavorable due to moderate leptin resistance and insulin therapy. At the proliferative stage of DRP, a relatively favorable prognosis is mainly due to normoleptinemia, and the likely further deterioration of DRP is due to insulin therapy with varying degrees of leptin resistance. Conclusions. The developed mathematical model allows taking into account additional factors to evaluate the course of DRP based on blood level of adipose tissue hormone leptin.