Association Of Diabetic Retinopathy Research Articles

Association of diabetic retinopathy with plasma atherosclerotic index, visceral obesity index, and lipid accumulation products: NHANES 2005–2008

BackgroundAbdominal obesity, a significant risk factor for the progression of diabetic retinopathy (DR), may lead to improved visual outcomes through early assessment. This study aims to evaluate any potential associations between DR and novel lipid metabolism markers, including the Atherogenic Index of Plasma (AIP), Visceral Adiposity Index (VAI), and Lipid Accumulation Product (LAP).MethodsThis study aimed to elucidate the association between various lipid markers and DR by screening the National Health and Nutrition Examination Survey (NHANES) database in the United States from 2005 to 2008. To examine the correlation, multifactor logistic regression analysis, subgroup analysis, threshold effect analysis, interaction test, and smooth curve fitting were used.ResultsAmong the 2591 participants included, the incidence of DR was 13.6% and the mean age was 59.55 ± 12.26 years. After adjusting for important confounding covariates, logistic regression studies suggested a possible positive association between LAP, VAI, AIP, and DR occurrence (odds ratio [OR] = 1.004; 95% confidence interval [CI]: 1.002, 1.006; P < 0.0001; [OR] = 1.090; 95% [CI]: 1.037, 1.146; P = 0.0007; [OR] = 1.802; 95% [CI]: 1.240, 2.618; P = 0.0020). The nonlinear association between LAP and DR was further illustrated using an S-shaped curve by smoothing curve fitting, with the inflection point of the curve located at 63.4. Subgroup analyses and interaction tests were performed with full variable adjustment (P > 0.05 for all interactions).ConclusionStudies have shown that elevated levels of LAP, VAI, and AIP increase the likelihood of DR, suggesting that they have the potential to be predictive markers of DR, emphasizing their potential utility in risk assessment and prevention strategies, and advocating for early intervention to mitigate the likelihood of DR.

Association of diabetic retinopathy with non-alcoholic fatty liver disease in type 2 diabetes mellitus

Association of diabetic retinopathy with non-alcoholic fatty liver disease in type 2 diabetes mellitus

Association of diabetic retinopathy on all-cause and cause-specific mortality in older adults with diabetes: National Health and Nutrition Examination Survey, 2005–2008

To evaluate the effect of diabetic retinopathy (DR) status or severity on all-cause and cause-specific mortality among diabetic older adults in the United States using the most recent National Health and Nutrition Examination Survey (NHANES) follow-up mortality data. The severity of DR was graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) grading scale. Multiple covariate-adjusted Cox proportional hazards regression models, Fine and Gray competing risk regression models, and propensity score matching (PSM) methods were used to assess the risk of all-cause and cause-specific mortality in individuals with diabetes. All analyses adopted the weighted data and complex stratified design approach proposed by the NHANES guidelines. Time to death was calculated based on the time between baseline and date of death or December 31, 2019, whichever came first. Ultimately 1077 participants, representing 3,025,316 US non-hospitalized individuals with diabetes, were included in the final analysis. After a median follow-up of 12.24 years (IQR, 11.16–13.49), 379 participants were considered deceased from all-causes, with 43.90% suffering from DR, including mild DR (41.50%), moderate to severe DR (46.77%), and proliferative DR (PDR) (67.21%). DR was associated with increased all-cause, cardiovascular disease (CVD) and diabetes mellitus (DM)-specific mortality, which remained consistent after propensity score matching (PSM). Results of DR grading assessment suggested that the presence of mild, moderate to severe NPDR was significantly associated with increased risk of all-cause and CVD-specific mortality, while the presence and severity of any DR was associated with increased DM-specific mortality, with a positive trend. The presence of DR in elderly individuals with diabetes is significantly associated with the elevated all-cause and CVD mortality. The grading or severity of DR may reflect the severity of cardiovascular disease status and overall mortality risk in patients with diabetes.

Association of Diabetic Retinopathy and Sleep Quality

Sleep disorders are more common in diabetes mellitus (DM) cases rather than normal ones. In addition, this condition could be associated with diabetic retinopathy (DR) development with more inflammatory indices in circulation. In the present study, we have evaluated the association between DR and sleep quality. This cross-sectional study is a part of the second phase of the study of the elderly cohort of Amirkola City, which was conducted in 2015-2016 on all people aged 60 and higher. Of all diabetic cases, 44 cases had retinopathy and were selected as the case group. To compare two control groups, 135 diabetic patients without retinopathy and 135 people without diabetes were randomly selected. The presence and type of retinopathy were determined based on an eye physical examination by an ophthalmologist. In addition, sleep quality was evaluated based on the Pittsburgh Questionnaire. The obtained data were analyzed by ANOVA, t-test, and linear regression tests. In the present study, there was a significant difference in the score of the Pittsburgh questionnaire between people with DR (45.5±68.2) compared to diabetic people without retinopathy (76.5±48.2) and people without diabetes (95.4±36.2) (P=0.470), but diabetic people without retinopathy had significantly worse sleep quality than people without diabetes (P=0.019). Also, sleep quality in women with DR was worse than in men (P=014). In the linear regression analysis, it was observed that age, gender, diabetes, and history of depression significantly affect the sleep quality of the evaluated cases (P&lt;0.05 for all). According to the results of the present study, DR does not negatively influence the quality of sleep, and DR is not related to sleep disorders.

Association of High Sensitivity C-reactive Protein with Type II Diabetic Retinopathy

Objective: The objective of this study is to find out the association of diabetic retinopathy with serum homocysteine and high sensitivity (hs) CRP levels.&#x0D; Methods: The research was conducted out at the Army Medical College's Department of Physiology and Centre for Research in Experimental and Applied Medicine (CREAM), Rawalpindi, in partnership with the Armed Forces Institute of Ophthalmology, Rawalpindi for a tenure of 12 months. Ninety subjects, were included in the study, thirty in each group: controls, diabetic subjects, and the patients suffering from diabetic retinopathy (DR).&#x0D; Results: Healthy controls, diabetic subjects, and patients with DR were found to have mean Fasting Blood Glucose (FBG) values of 5.51 0.34 (mmol/l), 8.11 0.67 (mmol/l), and 8.73 0.90 (mmol/l), respectively (p=0.001). The mean HbA1c level in normal subjects was noted as 5.08 ± 0.27 in healthy controls as compared to 7.70 + 0.89 (mmol/l)) in diabetic subjects and 9.02 + 1.76 (mmol/l) in patients with DR (p=0.001 by ANOVA). &#x0D; In normal subjects, the mean hs CRP levels were noted to be 3.74 + 1.97 (mg/l) in healthy controls as compared to 15.32 + 2.93 (mg/l) in diabetic subjects and 26.71 + 4.88 (mg/l) in patients with diabetic retinopathy (p=0.001 by ANOVA).&#x0D; Conclusion: During the study, it was found that elevated levels of these inflammatory biomarkers can accurately predict the onset of diabetic retinopathy and that hs CRP levels are strongly related with the development of diabetic retinopathy. Monitoring these inflammatory signs in the serum can therefore help prevent diabetic microangiopathic consequences, including DR.

Association of Diabetic Retinopathy with Midlife Hepatic Steatosis Diagnosed by Elastography and Hepatic Steatosis Index in Type 2 Diabetes in an Indian Population.

Aims: People with type 2 diabetes mellitus are at increased risk of developing hepatic steatosis. We determined the prevalence of hepatic steatosis in middle-aged patients with and without diabetic retinopathy (DR) in an Indian population. We feel this information is critical, with trends of increasing chronic liver disease-related mortality at younger ages. Method: Institution-based analytical cross-sectional study with 114 middle-aged type 2 diabetes patients; 57 in each group with <15 years of duration of DM and without excessive drinking. Hepatic steatosis was determined by the hepatic steatosis index (HSI), hepatic ultrasonography (USG), and elastography. Result: The HSI in DR (37.9 ± 3.9) was more (P = 0.012) than in without diabetic retinopathy (NODR) (36.3 ± 3.3). There was no difference between two groups in liver span (P = 0.829) or in the prevalence of fatty liver (P = 0.562) as determined by conventional USG. Elastography value (kPa) was more (P = 0.001) in DR (6.51 ± 1.85) than in NODR (5.14 ± 1.60). On elastography, 50.9% in DR had a likelihood ratio (Metavir score for a stiffness value) for stage 2 Metavir score. In DR, 11.8% of those missed by USG had a likelihood ratio for ≥ stage 2 Metavir score on elastography. The presence of DR was independently correlated with kPa value (P < 0.001). Conclusion: A significantly higher prevalence of hepatic steatosis was observed in DR in this population. DR can be a useful biomarker for early hepatic screening in midlife, particularly with hepatic elastography, so that timely diagnosis of hepatic steatosis can be made.

107-OR: Association of Diabetic Retinopathy with A1C and Glucose Management Indicator Discordance

Background: Past analyses have shown significant discordance between glycated hemoglobin (A1C) and glucose management indicator (GMI). This study uses a glycation ratio (GR) defined as GMI/A1C and evaluates the association of this ratio with microvascular complications in 661 patients with diabetes. Methods: A retrospective review was done of patients with diabetes using CGM who were seen at the University of Washington (UW) Diabetes Care Center from 2012-2019. All patients had A1C and sensor data obtained fewer than 4 weeks apart. Positive discordance was defined as GMI/A1c &amp;lt;0.9. Results: This study included 661 patients of whom 90% had type 1 diabetes with a mean duration of current CGM use of 24.7 days (+/- 7.9 days). Positive discordance was found in 29.9% of participants and was associated with retinopathy (OR 2.05, CI 1.33-3.14) and nephropathy (OR 2.83, CI 1.68-4.77). The data were modeled as a continuous nonlinear function revealing an inverse relationship between GMI/A1C and diabetic retinopathy. Discussion: In this study positive discordance conferred a more than two-fold increased risk for diabetic retinopathy and nephropathy. Modeling of GMI/A1C as a continuous variable upheld this relationship for diabetic retinopathy. These data suggest that GMI/A1C ratios may allow for identification of patients at increased risk for microvascular complications. Disclosure L.Bovee: None. J.Perlman: None. T.Gooley: None. I.B.Hirsch: Consultant; Abbott Diabetes, Lifecare, Inc., Hagar, Research Support; Beta Bionics, Inc., Insulet Corporation, Dexcom, Inc.

Association of diabetic retinopathy with risk of developing cardiovascular diseases in patients undergoing hemodialysis: A population-based cohort study

Background and aimsWhile patients undergoing dialysis have substantially increased cardiovascular event rates compared with the general population, predicting individual risk remains difficult. Whether diabetic retinopathy (DR) is associated with cardiovascular diseases in this population is unclear. Methods and resultsWe conducted a nationwide cohort study of 27,686 incident hemodialysis patients with type 2 diabetes who were enrolled in Taiwan's National Health Insurance Research Database between January 1, 2010, and December 31, 2014, and had follow-up data until December 31, 2015. The primary outcome was a composite of macrovascular events, including acute coronary syndrome (ACS), acute ischemic stroke, and peripheral artery disease (PAD). A total of 10,537 (38.1%) patients had DR at baseline. We matched 9164 patients without DR (mean age, 63.7 years; 44.0% women) to 9164 patients with DR (mean age, 63.5 years; 43.8% women) by propensity score. During a median follow-up of 2.4 years, 5204 patients in the matched cohort experienced a primary outcome. The presence of DR was associated with a higher risk of a primary outcome (subdistribution hazard ratio [sHR] 1.07; 95% CI, 1.01–1.13), which reflected a higher risk of acute ischemic stroke (sHR 1.26; 95% CI, 1.14–1.39) and PAD (sHR 1.14; 95% CI, 1.05–1.25) but not ACS (sHR 0.99; 95% CI, 0.92–1.06). ConclusionsThe presence of DR signifies an increased risk of acute ischemic stroke and PAD in hemodialysis patients with type 2 diabetes, independent of the known risk factors. These results highlight the need for more comprehensive cardiovascular assessment and management in hemodialysis patients with DR.

Association of Diabetic Retinopathy with Angiographic Severity of Coronary Artery Disease in Patients with Non-ST Elevation Myocardial Infarction

Background: Bed side ophthalmoscopic examination is a simple measure of diagnosis of diabetic retinopathy and has been shown to be a predictor of poor outcome in various cardiovascular conditions including coronary artery disease (CAD). Retinopathy lesions are fairly common findings in clinic settings and may predict risk of coronary heart disease (CHD). The present study was intended to find the relationship between diabetic retinopathy with the severity of coronary artery disease in patients with NSTEMI. Methods: This cross-sectional observational study was conducted in the Department of cardiology, National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh, from March 2019 to August 2020. A total of one hundred twenty DM with NSTEMI patients undergoing coronary angiogram and also fundoscopic examination with fundal photography during the index hospitalization were included in this study. Study subjects were divided into two groups on the basis of diabetic retinopathy (Group-I: NSTEMI with diabetic retinopathy ; Group- II: NSTEMI without diabetic retinopathy). Severity of coronary artery disease was determined by Gensini score and correlation between diabetic retinopathy and Gensini score was assessed. Results: Gensini score was significantly higher in patients with diabetic retinopathy than that in patients without diabetic retinopathy (62.2±27.7 vs. 43.3±25.3,p&lt;0.001).Gensini score increased with increasing severity of diabetic retinopathy(P &lt;0.001).The risk of having severe CAD in patient with diabetic retinopathy was 13.03 (95% CI =2.410-70.419) (P&lt;0.003).A significant correlation between diabetic retinopathy and Gensini score was noted (p value &lt;0.001) Conclusion: It may be concluded that Presence and severity of diabetic retinopathy is associated with angiographically severe coronary artery disease in patient with non-ST elevation myocardial infarction (NSTEMI) and it may be considered as an independent predictor of severity of CAD.As is a bed side assessment ,so before performing coronary angiography ,it appears to be additive for risk stratification. J Inv Clin Cardiol 2023; 5(1): 7-13

Association of Diabetic Retinopathy with Chronic Kidney Disease Progression in Latinos with Type 2 Diabetes.

Diabetes remains a leading cause of blindness and kidney failure in the United States. Latinos are at increased risk for type 2 diabetes, and microvascular complications such as diabetic retinopathy (DR) and chronic kidney disease (CKD). We evaluated the association of DR with decline in kidney function in Latinos with type 2 diabetes with or without CKD in a multispecialty clinic. This is a retrospective cohort study of 351 self-identified Latino individuals with type 2 diabetes enrolled in the Latino Diabetes Initiative at Joslin Diabetes Center. Baseline demographic factors including age, sex, comorbidities, and laboratory values such as A1c and albuminuria were evaluated as predictors of kidney outcomes. The annualized change in estimated glomerular filtration rate (eGFR) was evaluated with a linear regression model. We used logistic regression to evaluate whether DR was associated with development of rapid progressors (>3 mL/min/y eGFR loss) and 30% change in eGFR per year. DR was present in 39.2% of the cohort with mild nonproliferative DR (NPDR) in 57.1%, moderate to severe NPDR in 27.8%, and proliferative DR in 15.0%. Those with DR had a longer duration of type 2 diabetes (P<.001), higher albuminuria (P=.003), and lower baseline eGFR (P=.001). We found that individuals with moderate to severe NPDR and proliferative DR had a significant decline in GFR (coefficient -6.32; 95% CI, -11.40 to -1.23) and -7.82 (-14.99 to -0.65), compared with individuals without DR. The presence of DR is a marker for increased eGFR loss, emphasizing the need for routine retinal examinations as part of comprehensive diabetes care. Individuals with DR should be considered at high risk for GFR loss.

Association of Diabetic Retinopathy with Angiographic Severity of Coronary Artery Disease in Patients with Non-ST Elevation Myocardial Infarction

Background: Bed side ophthalmoscopic examination is a simple measure of diagnosis of diabetic retinopathy and has been shown to be a predictor of poor outcome in various cardiovascular conditions including coronary artery disease. The present study was intended to find the relationship between diabetic retinopathy with the severity of coronary artery disease in patients with non ST elevation myocardial infarction (NSTEMI). Methods: This cross-sectional observational study was conducted with a total of 120 NSTEMI patients with diabetes undergoing coronary angiogram and also fundoscopic examination with fundal photography during the index hospitalization. Study subjects were divided into two groups on the basis of diabetic retinopathy (Group-I: NSTEMI with diabetic retinopathy; Group- II: NSTEMI without diabetic retinopathy). Severity of coronary artery disease was determined by Gensini score and correlation between diabetic retinopathy and Gensini score was assessed. Results: Gensini score was significantly higher in patients with diabetic retinopathy than that in patients without diabetic retinopathy (62.2±27.7 vs. 43.3±25.3, p&lt;0.001).Gensini score increased with increasing severity of diabetic retinopathy (p &lt;0.001).The risk of having severe CAD in patient with diabetic retinopathy was 13.03 (95% CI =2.410-70.419) (P&lt;0.003). A significant correlation between diabetic retinopathy and Gensini score was noted (p value &lt;0.001) Conclusion: It may be concluded that presence and severity of diabetic retinopathy is associated with angiographic severe coronary artery disease in patient with NSTEMI and it may be considered as an independent predictor of severity of CAD. As is a bed side assessment, so before performing coronary angiography, it appears to be additive for risk stratification. Cardiovasc j 2022; 15(1): 49-55

MO897: Diabetic Retinopathy and Risk of Macrovascular Complications in Patients Undergoing Hemodialysis: A National Population-Based Cohort Study

Abstract BACKGROUND AND AIMS The association of diabetic retinopathy (DR) with macrovascular complications in patients with end-stage kidney disease undergoing hemodialysis is unclear. METHOD We conducted a nationwide cohort study of 44 514 incident hemodialysis patients who were enrolled in Taiwan's national health insurance research database between 1 January 2010 and 31 December 2014 and had follow-up data until 31 December 2015. Patients with and without DR were matched by propensity score in a 1:1 ratio. The primary outcomes were acute coronary syndrome (ACS), acute ischemic stroke and hospitalizations for peripheral artery disease (PAD). RESULTS Of the 27 286 patients with type 2 diabetes, 10 537 (38.1%) had DR at baseline. We matched 9164 patients without DR (mean age, 63.7 years; 44.0% women) by propensity score to 9164 patients with DR (mean age, 63.5 years; 43.8% women). Over a median follow-up of 2.8 years, 2781 patients (15.2%) experienced ACS. Stroke occurred in 1613 patients (8.8%), and 1938 patients (10.6%) were hospitalized for PAD. In a multivariable Cox model accounting for the competing risk of death, the presence of DR was associated with an increased risk of stroke {subdistribution hazard ratio (sHR) 1.30 [95% confidence interval (95% CI) 1.17–1.44]; P &amp;lt; 0.0001} and PAD (sHR 1.17, 95% CI 1.08–1.29; P = 0.0006) but not ACS (sHR 0.99, 95% CI 0.91–1.07; P = 0.9168). The observations were consistent across patient subgroups. CONCLUSION Our findings support early identification and close monitoring and management of hemodialysis patients with DR to prevent the development of stroke and PAD.

Association of Diabetic Retinopathy with Angiographic Severity of Coronary Artery Disease in Patients with Non- ST Elevation Myocardial Infarction

Background: Bed side ophthalmoscopic examination is a simple measure of diagnosis of diabetic retinopathy and has been shown to be a predictor of poor outcome in various cardiovascular conditions including coronary artery disease (CAD). Retinopathy lesions are fairly common findings in clinic settings and may predict risk of coronary heart disease (CHD). The present study was intended to find the relationship between diabetic retinopathy with the severity of coronary artery disease in patients with NSTEMI.&#x0D; Methods: This cross-sectional observational study was conducted in the Department of cardiology, National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh, from March 2019 to August 2020. A total of 120 DM with NSTEMI patients undergoing coronary angiogram and also fundoscopic examination with fundal photography during the index hospitalization were included in this study. Study subjects were divided into two groups on the basis of diabetic retinopathy (Group-I: NSTEMI with diabetic retinopathy ; Group- II: NSTEMI without diabetic retinopathy). Severity of coronary artery disease was determined by Gensini score and correlation between diabetic retinopathy and Gensini score was assessed.&#x0D; Results: Gensini score was significantly higher in patients with diabetic retinopathy than that in patients without diabetic retinopathy (62.2±27.7 vs. 43.3±25.3,p&lt;0.001).Gensini score increased with increasing severity of diabetic retinopathy(P &lt;0.001).The risk of having severe CAD in patient with diabetic retinopathy was 13.03 (95% CI =2.410-70.419) (P&lt;0.003).A significant correlation between diabetic retinopathy and Gensini score was noted (p value &lt;0.001)&#x0D; Conclusion: It may be concluded that presence and severity of diabetic retinopathy is associated with angiographically severe coronary artery disease in patient with non-ST elevation myocardial infarction (NSTEMI) and it may be considered as an independent predictor of severity of CAD. As is a bed side assessment, so before performing coronary angiography ,it appears to be additive for risk stratification.&#x0D; University Heart Journal 2022; 18(1): 50-53

The Association of Diabetic Retinopathy and Cardiovascular Disease: A 13-Year Nationwide Population-Based Cohort Study.

Objectives: Previous studies have demonstrated that patients with diabetic retinopathy (DR) have a higher prevalence of risk factors known to be associated with cardiovascular disease (CVD). We hypothesized that patients with more severe DR could have a higher relative risk of CVD. Methods: To test this hypothesis, we used the National Health Insurance Research Database (NHIRD) to evaluate whether associations exist between DR and CVD. The data for this nationwide population-based retrospective cohort study were obtained from the NHIRD in Taiwan from 2001 to 2013. The assessed study outcome used was the incidence and other statistical analyses of CVD in patients with DR during a 13-year follow-up period. Results: Our findings obtained from 2001 to 2013 suggest that the incidence rates of CVD are 2.026 times that of diabetes mellitus (DM) without DR (95% C.I. = 1.876–2.187) and 2.75 times that of DM with DR (95% C.I. = 2.487–3.04) compared with the Non-DM group. Conclusion: The relative risk of CVD in DR was greater than that in the Non-DM group for both men and women. Targeted monitoring of DM, especially the co-existence of diabetic retinopathy, is of utmost importance in the clinical care of the DM population.

Urinary peptidome and diabetic retinopathy in the DIRECT-Protect 1 and 2 trials.

Given the association of diabetic retinopathy (DR) and kidney disease, we investigated the urinary peptidome to presence and deterioration of DR in a post hoc analysis of trials investigating the effect of candesartan on progression of DR in type 1 and type 2 diabetes, respectively. Baseline urinary peptidomic analysis was performed on a random selection of 783 and 792subjects in two randomized controlled trials, DIRECT-Protect 1 and 2, respectively. End points were two-step (RET2) and three-step (RET3) change in Early Treatment of Diabetic Retinopathy Study protocol (ETDRS) defined level. Peptide levels were correlated to baseline EDTRS level in a discovery set of 2/3 of the participants from DIRECT-Protect 1. The identified peptides were then validated cross-sectionally in the remaining 1/3 from DIRECT-Protect 1. Thereafter, peptides identified in the discovery set were assessed in the entire DIRECT-Protect 1 and 2 cohorts and significant peptides were tested longitudinally. Follow-up ranged 4.0-4.7years. 24 peptides were associated with baseline DR in the discovery set. COL3A1 (seq: NTG~) and COL4A1 (seq: DGA~) were associated with baseline DR in the validation set (Rho: -.223, p<0.001 and Rho: -.141, p=0.024). Neither was significantly associated with end points. Assessing the 24 identified peptides in the entire cohorts, several collagen peptides were associated with baseline DR and end points; however, there was no overlap across diabetes types. We identified several urinary peptides (mainly collagen) associated with the presence of DR, however they could not be conclusively associated with worsening of DR.

430-P: Urinary Proteome and Diabetic Retinopathy in the Direct-Protect 1 and 2 Trials

Background: Given the association of diabetic retinopathy (DR) to diabetic kidney disease, we investigated the urinary proteome to the presence and deterioration of DR in type 1 and type 2 diabetes in a post-hoc analysis of studies investigating the effect of candesartan on the progression of DR. Methods: Baseline urinary proteomic analysis was performed in 783 and 792 randomly chosen subjects from two RCTs: DIRECT-Protect 1 and 2. Endpoints were two-step and three-step change in DR score according to the Early Treatment of Diabetic Retinopathy Study protocol. Peptide levels were correlated to baseline DR score, using Spearman rank correlation (association presented as Rho), in a discovery set of 2/3 of participants in DIRECT-Protect 1. Identified peptide fragments were then tested cross-sectionally in a validation set of the remaining 1/3 in DIRECT-Protect 1. Thereafter, peptides identified in the discovery set were assessed in the entire DIRECT-Protect 1 and 2 cohorts in relation to baseline DR. Finally, peptides validated in the entire cohorts were tested longitudinally. Adjustment included sex, age, diabetes duration, smoking, total cholesterol, HbA1c, SBP, UAER, serum creatinine, and randomization group. Results: Follow-up ranged from 4.0-4.7 years. 24 out of 427 investigated peptide fragments were associated with baseline DR in the discovery set after adjustment for multiple testing. Two of these (COL3A1 (seq: NTG~) and COL4A1 (seq: DGA~) were also associated to baseline DR in the validation set (Rho: -0.22, p&amp;lt;0.001 and Rho: -0.14, p=0.024). Neither was associated with the development of endpoints. Investigating the discovered fragments in the full cohorts, several collagen fragments were associated with baseline DR and endpoints, in both type 1 and type 2 diabetes, however without overlap. Conclusions: Several urinary peptide fragments (mainly collagen) were associated with the presence of DR, however, they were not conclusively associated with worsening of DR. Disclosure V. Rotbain curovic: None. P. Magalhães: None. T. He: Employee; Self; Mosaiques Diagnostics GmbH. T. W. Hansen: Stock/Shareholder; Self; Novo Nordisk A/S. H. Mischak: Stock/Shareholder; Self; Mosaiques Diagnostics. P. Rossing: Advisory Panel; Self; Astellas Pharma Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Gilead Sciences, Inc., Merck KGaA, Merck Sharp &amp; Dohme Corp., Novo Nordisk A/S, Sanofi, Vifor Pharma Management Ltd.

Frequency of Diabetic Retinopathy in patients with Type-II diabetes mellitus in an upscale clinic in Karachi.

Objectives: The objective of this study is to measure the current frequency of diabetic retinopathy in Karachi and the stage at which they present first to the outpatient department. Study Design: Cross sectional study. Setting: A private clinic setup in Karachi. Period: 1st July 2015 to 30th June 2016. Material &amp; Methods: In this study, 440 eyes of 220 diabetics were included and frequency of diabetic retinopathy was measured. Individuals ranging from 20 – 80 years age were included. Ophthalmic plus systemic relevant history from every patient was taken in detail. Standard Snellen’s chart was used to check the best corrected visual acuity (BCVA). Slit lamp examination was done along with fundoscopy with +90D and +70D lens after dilatation with Tropicamide 1%. All patients were examined for diabetic retinopathy. Along with it, stage of diabetic retinopathy, association of diabetic retinopathy with hypertension, age and duration of diabetes was also taken into consideration. Results: The frequency of diabetic retinopathy amongst 220 patients was found to be 15.9% while 6.6 % of them were also having associated maculopathy. The stages of diabetic retinopathy were found to be 10.4% background diabetic retinopathy(BDR), 0.9% preproliferative diabetic retinopathy(PPDR), 3.4% proliferative diabetic retinopathy(PDR) and 1.1% advance diabetic eye disease(ADED). Overall, 58.5% of the patients also had hypertension along with it. Conclusion: Nationwide studies are needed to be conducted to prevent this complication from progressing while the incidence of diabetic retinopathy is increasing very alarmingly among the society.

Association of Diabetic Retinopathy in relation with HbA1c Levels

Association of Diabetic Retinopathy in relation with HbA1c Levels

Association of Diabetic Retinopathy and Diabetic Kidney Disease With All-Cause and Cardiovascular Mortality in a Multiethnic Asian Population

The association of diabetic microvascular complications such as diabetic retinopathy (DR) and diabetic kidney disease (DKD) with mortality in populations is not clear. To examine the association of DR and DKD separately and jointly with all-cause and cardiovascular disease (CVD) mortality in a multiethnic Asian population. A population-based cohort study was conducted including 2964 adults between the ages of 40 and 80 years with diabetes who participated in the Singapore Epidemiology of Eye Diseases study (baseline, 2004-2011). Data analysis was performed from January to May 2018. Diabetic retinopathy ascertained from retinal photographs and DKD from estimated glomerular filtration rate. All-cause and CVD mortality obtained by linkage with the National Registry of Births and Deaths until May 2017. Of the 2964 adults (mean [SD] age, 61.8 [10.0] years; 1464 [49.4%] female; 592 Chinese, 1052 Malay, and 1320 Indian), 29.9% of the participants had DR, while 20.7% had DKD. Over a median (interquartile range) follow-up of 8.8 (7.2-11.0) years, 610 deaths occurred (20.6%), of which 267 (9.0%) were due to CVD. In separate models, the multivariable hazard ratios for all-cause and CVD mortality were 1.54 (95% CI, 1.24-1.91) and 1.74 (95% CI, 1.27-2.40), respectively, for DR and 2.04 (95% CI, 1.64-2.56) and 2.29 (95% CI, 1.64-3.19), respectively, for DKD. In models including both DR and DKD, the subgroup with DKD alone (27.1% and 12.6%) followed by DR alone (6.5% and 5.2%) contributed substantially to the excess risk of all-cause and CVD mortality. Compared with those with no DR and DKD, the hazard ratios of all-cause and CVD mortality were 1.89 (95% CI, 1.40-2.57) and 2.26 (95% CI, 1.42-3.61), respectively, for DKD alone and 1.38 (95% CI, 1.03-1.86) and 1.64 (95% CI, 1.06-2.56), respectively, for DR alone. Hazard ratios for all-cause and CVD mortality were 2.76 (95% CI, 2.05-3.72) and 3.41 (95% CI, 2.19-5.32), respectively, for those with both DKD and DR. The relative excess risk associated with the interaction was 0.49 (95% CI, -0.29 to 1.27; P = .20) for all-cause mortality and 0.51 (95% CI, -0.83 to 1.85; P = .50) for CVD mortality. These results suggest that risks of all-cause and CVD mortality were significantly higher in those with DKD and DR, but DKD was more strongly associated with excess risk. The findings underscore the importance of early identification and close monitoring and management of patients with DR and DKD to reduce the risk of death.

Association of Diabetic Retinopathy and Lipid Profile in Diabetic Patients in Mathura District

Background: It is estimated that diabetes mellitus affects 4 percent of the world’s population, almost half of whom have some degree of diabetic retinopathy at any given time. Elevated serum lipid levels are associated with an increased risk of retinal hard exudate in persons with diabetic retinopathy. Therefore the current study was undertaken to determine the association of serum lipid profile with diabetic retinopathy and its severity. Subjects and Methods: One hundred fifty diabetic patients, out of these, 75 diabetic patients with retinopathy served as the study group I and 75 diabetic patients with no retinopathy formed group II (control group). Simultaneously, 75 age and sex matched healthy subjects were also studied as controls (group III). Serum total cholesterol, serum triglyceride, serum low density lipoprotein and serum high density lipoprotein were measured by using enzymatic method and autoanylyser. Fasting blood sugar and post prandial blood sugar were estimated by using GOD POD method. Results: Most of the patients in Group I had some degree of visual impairment. However there was no statistical significance with p >0.05. The mean value of total cholesterol was higher in both group I and group II with value being higher in group1 (229.09mg/dl) as compared to group II (215.32mg/dl). Triglyceride levels also followed the similar trend with group I having mean value of 238.95mg/dl and group II having 179.93 mg/dl. But only total cholesterol value had statistical significance p < 0.05. Conclusion: The present study demonstrated statistically significant correlation between diabetic retinopathy and hypercholesterolemia. Increased cholesterol level was significantly associated with the occurrence of all grades of retinopathy especially severe NPDR, very severe NPDR and PDR. No correlation was found between lipid profile and visual acuity. These data suggest that hyperlipidaemia should be promptly treated in diabetic patients.