Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes.

Jin A Choi,Dong Hyun Jee,Jin-Woo Kwon,Yu-Bae Ahn,Seung-Hyun Ko,Yun-Sub Shim,Chan Kee Park,Jae-Seung Yun,Hyo Won Kim

doi:10.1371/journal.pone.0174377

Jin A Choi, Dong Hyun Jee + Show 7 more

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BackgroundTo investigate changes in the neural retina according to the presence of retinal nerve fiber layer (RNFL) defects in type 2 diabetes, and to determine the association between inner retina thickness and the severity of diabetic complications.MethodsWe studied non-glaucomatous patients with type 2 diabetes and control subjects Circumpapillary RNFL and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured by spectral-domain optical coherence tomography. In patients with type 2 diabetes, a cardiovascular autonomic function test (AFT) was performed, which included the heart rate parameter of beat-beat variation—with deep breathing, in response to the Valsalva maneuver, and on postural change from lying to standing. The results of each test were scored as 0 for normal and 1 for abnormal. A total AFT score of 1 was defined as early cardiovascular autonomic neuropathy (CAN), and an AFT score≥ 2 as definite CAN.ResultsWe compared control eyes (n = 70), diabetic eyes with RNFL defects (n = 47), and eyes without RNFL defects (n = 30). The average RNFL and GCIPL thicknesses were significantly different among groups (all, P<0.05). On post-hoc testing, diabetic eyes with RNFL defects had a significantly thinner average GCIPL thickness than those without RNFL defects. On multivariate analyses, significantly thinner average GCIPL was seen in early CAN staging (B = -4.32, P = 0.016) and in definite CAN staging (B = -10.33, P<0.001), compared with no CAN involvement, after adjusting for confounding parameters.ConclusionsCardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.

Highlights

It is widely recognized that the early neurodegenerative changes that characterize diabetes involve dysfunction and degeneration of retinal neurons even before the manifestation of vascular symptoms.[1, 2] High blood glucose induces apoptosis in retinal neural cells.[3]
We studied non-glaucomatous patients with type 2 diabetes and control subjects Circumpapillary retinal nerve fiber layer (RNFL) and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured by spectral-domain optical coherence tomography
The average RNFL and ganglion cell layer and inner plexiform layer (GCIPL) thicknesses were significantly different among groups

Summary

Introduction

It is widely recognized that the early neurodegenerative changes that characterize diabetes involve dysfunction and degeneration of retinal neurons even before the manifestation of vascular symptoms.[1, 2] High blood glucose induces apoptosis in retinal neural cells.[3] Increased neurofilament phosphorylation,[4] glial cell reactivity during metabolic stress,[5, 6] microglial activation, and altered glutamate regulation [7] are involved in neurodegeneration in the diabetic retina These early changes especially involve the inner retina, as shown by the reduction in thickness of the retinal nerve fiber layer (RNFL)[8] and loss of ganglion cell bodies.[9]. To investigate changes in the neural retina according to the presence of retinal nerve fiber layer (RNFL) defects in type 2 diabetes, and to determine the association between inner retina thickness and the severity of diabetic complications

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