Effects of prolonged type 2 diabetes on changes in peripapillary retinal nerve fiber layer thickness in diabetic eyes without clinical diabetic retinopathy

Min-Woo Lee,Hyung-Bin Lim,Ki-Yup Nam,Young-Hoon Lee,Gi-Seok Park,Jung-Yeul Kim,Min-Su Kim

doi:10.1038/s41598-021-86306-y

Min-Woo Lee, Hyung-Bin Lim + Show 5 more

Open Access

https://doi.org/10.1038/s41598-021-86306-y

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Abstract

To identify the effects of prolonged type 2 diabetes (T2DM) on changes in peripapillary retinal nerve fiber layer (pRNFL) thickness in patients without clinical diabetic retinopathy. Subjects were divided into two groups: controls and patients with T2DM (DM group). After the initial visits, the pRNFL thicknesses were measured three more times at 1-year intervals. Subgroup analyses were performed in patients with T2DM duration ≥ 10 years. The mean pRNFL thickness at each visit was 95.8 ± 8.1, 95.4 ± 8.3, 94.9 ± 8.1, and 94.5 ± 8.3 μm in the control group (P = 0.138) (n = 55); and 93.4 ± 9.1, 92.1 ± 9.3, 90.9 ± 9.3, and 89.5 ± 9.2 μm in the DM group (P < 0.001) (n = 85). The estimated rate of reduction in mean pRNFL thickness was − 0.45 μm/year in the control group and − 1.34 μm/year in the DM group, respectively. In the DM group, the BCVA and HbA1c (both P = 0.001) were significant factors associated with pRNFL reduction. In patients with T2DM duration ≥ 10 years, the estimated pRNFL reduction rate was − 1.61 μm/year, and hypertension was a significant factor affecting the pRNFL reduction (P = 0.046). We confirmed rapid pRNFL reduction over time in T2DM, and the reduction rate was higher in patients with T2DM ≥ 10 years. Additionally, BCVA and HbA1c levels were significantly associated with the change in pRNFL thickness in T2DM patients.

Highlights

Type 2 diabetes (T2DM) constitutes a global health problem and induces macrovascular and microvascular complications causing more than 2 million deaths every y ear[1]
Metabolic pathways triggered by hyperglycemia such as the polyol and hexosamine pathways, the de novo synthesis of diacylglycerol-protein kinase C, and the production of free radicals are closely associated with Diabetic retinal neurodegeneration (DRN), which causes the apoptosis of retinal ganglion c ells[7,8]
This study identified the longitudinal reductions in peripapillary retinal nerve fiber layer (pRNFL) thickness in T2DM patients without diabetic retinopathy (DR) by DRN as previous studies[7,9,10,11]

Summary

Introduction

Type 2 diabetes (T2DM) constitutes a global health problem and induces macrovascular and microvascular complications causing more than 2 million deaths every y ear[1]. Metabolic pathways triggered by hyperglycemia such as the polyol and hexosamine pathways, the de novo synthesis of diacylglycerol-protein kinase C, and the production of free radicals are closely associated with DRN, which causes the apoptosis of retinal ganglion c ells[7,8]. Such retinal ganglion cell loss would result in a reduction in the thickness of the retinal nerve fiber layer (RNFL). Lim et al.[10] found that T2DM was associated with accelerated pRNFL loss regardless of whether or not DR progression, suggesting that DRN may proceed the microvascular abnormalities associated with DR progression. The purpose of this study was to identify the effects of prolonged T2DM on longitudinal changes in pRNFL by comparing pRNFL thickness of normal individuals and DM patients

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