Abstract
BackgroundType 2 diabetes mellitus (T2DM) is a chronic incurable disease associated with multi-systemic complications. The chronic complications related to T2DM induce growing burden to the national health system. Diabetic retinopathy (DR) is the most serious ocular complication associated with T2DM and one of the leading causes of secondary blindness. The association between insulin use and DR risk has also been reported in different studies.MethodsIn order to obtain more informative results on the relationship between insulin intake and risk of DR and to take into account more recent evidence, we conducted this meta-analysis by including all available relevant cohort studies. A systemic literature search was performed via electronic databases inclu-apding Pubmed and EMBASE to identify all available relevant studies until February 2014. A total of seven cohort studies were included in this meta-analysis. In this meta-analysis, we conducted a rigorous search of all available published cohort studies to quantify the possible association between insulin use and incidental DR in individuals with type 2 diabetes.ResultsAlthough major heterogeneity existed in this study, the significant association between insulin use and risk of DR was detected. The subgroup analyses by study design, region, data source and adjustment of HbA1c generated similar results. Also, when the DM duration was adjusted, no result was reported with significant difference.ConclusionThe results of this meta-analysis helps to better explore the role of insulin use in DR risk development. Meanwhile, our results are statistically robust and yield important conclusions. The underlying mechanism by which insulin use increases DR risk should be explored in future in vitro and in vivo studies. Additional large-scale, well-designed studies with sufficient data are needed to confirm our findings.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2003724731291657
Highlights
Type 2 diabetes mellitus (T2DM) is a chronic incurable disease associated with multi-systemic complications
In a cross-sectional, multi-centered, hospital-based study, the results showed that there was more prevalent non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) in insulin-taking than those in non-insulin-taking groups [8]
Out of 69 articles that examined the association between insulin use and Diabetic retinopathy (DR) risk, 12 studies were excluded because of not being cohort design-based studies, 44 studies were excluded because of no data available in usable format, and 6 studies were excluded because of the mixture of T1DM and T2DM
Summary
Type 2 diabetes mellitus (T2DM) is a chronic incurable disease associated with multi-systemic complications. It is a significant and growing source of morbidity and mortality in the whole world [1,2]. The use of insulin has been reported to be associated with various diseases, such as hypertension, limb ischemia and diverse types of cancers [5,6,7,8]. In order to obtain more informative and reliable results on the relationship between insulin intake and risk of DR and to take into account more recent evidence, we conducted this meta-analysis by including all the available relevant cohort studies [9]
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