Degree Of Diabetic Retinopathy Research Articles

Robust segmentation of retinal layers in optical coherence tomography images based on a multistage active contour model

Optical Coherence Tomography (OCT) constitutes an imaging technique that is increasing its popularity in the ophthalmology field, since it offers a more complete set of information about the main retinal structures. Hence, it offers detailed information about the eye fundus morphology, allowing the identification of many intraretinal pathological signs. For that reason, over the recent years, Computer-Aided Diagnosis (CAD) systems have spread to work with this image modality and analyze its information. A crucial step for the analysis of the retinal tissues implies the identification and delimitation of the different retinal layers. In this context, we present in this work a fully automatic method for the identification of the main retinal layers that delimits the retinal region. Thus, an active contour-based model was completely adapted and optimized to segment these main retinal boundaries. This fully automatic method uses the information of the horizontal placement of these retinal layers and their relative location over the analyzed images to restrict the search space, considering the presence of shadows that are normally generated by pathological or non-pathological artifacts. The validation process was done using the groundtruth of an expert ophthalmologist analyzing healthy as well as unhealthy patients with different degrees of diabetic retinopathy (without macular edema, with macular edema and with lesions in the photoreceptor layers). Quantitative results are in line with the state of the art of this domain, providing accurate segmentations of the retinal layers even when significative pathological alterations are present in the eye fundus. Therefore, the proposed method is robust enough to be used in complex environments, making it feasible for the ophthalmologists in their routine clinical practice.

The relation between retinopathy grade and coronary artery disease in acute coronary syndrome diabetics

Background: Diabetic retinopathy (DR) was found to be associated with an increased risk for coronary artery disease (CAD). However, there are less data about the relation between the degree of DR and the angiographic severity of CAD. Objective: The objective of the study is to examine the relation between the degree of DR and the angiographic severity of CAD in patients with acute coronary syndrome (ACS). Patients and Methods: Fifty diabetic patients with ACS were enrolled in this study. History, clinical examination, echocardiography, coronary angiography, and fundus examination were done to all patients. According to the degree of DR, patients were classified into two groups: Group I – patients with no or mild nonproliferative (NP) DR (n = 27) and Group II – patients with moderate or severe NP DR or with proliferative DR (n = 23). Results: Population characteristics, risk factors, diabetes duration, insulin use, and echocardiographic measures were comparable in the two groups. Patients in Group II had significantly more number of diseased vessels, more maximum stenosis, and higher Gensini score than those of Group I. There was a significant correlation between the degree of DR and the number of diseased vessels (r = 0.358, P =0.011) and highly significant correlation between the degree of DR and maximum stenosis (r = 0.452, P =0.001) and Gensini score (r = 0.706, P

NEW PREDICTIVE FACTORS OF DIABETIC MACULOPATHY DEVELOPMENT IN DIABETES MELLITUS TYPE 2

Relevance. In diabetes mellitus (DM), a cascade of pathological reactions unfolds in the vascular endothelium with the formation of endothelial dysfunction (EDF). Its main factors are endothelium hormone – endothelin-1 (ET1), nitric oxide (NO), endothelial NO-synthase (eNOS), and also tumor necrosis factor-α (TNFα). But the unexplored question remains whether EDFs can be used as prognostic markers for the development of diabetic maculopathy.
 Objective: to find out the prognostic value of EDF factors in the development of diabetic maculopathy (DM) in type 2 diabetes.
 Material and methods. This study included 152 patients (304 eyes) with type 2 diabetes, which were divided into groups according to the degree of diabetic retinopathy (DR): 1st – initial non-proliferative DR, 2nd – moderate or severe non-proliferative DR and 3rd – proliferative DR. DM was determined by the presence of specific diabetic retinal changes in the macular area according to the International Clinical Gravity Scale of the American Academy of Ophthalmology (2002). The control group consisted of 95 people. The content of ET1, eNOS and TNFα was determined by ELISA; the content of the final NO metabolites (NOx) was determined spectrophotometrically. Statistical data processing was performed using Statistica 10 (StatSoft, Inc., USA).
 Results. With the progression of DR, there was an increase in the frequency and severity level of DM (p=2.0e-06), which was accompanied by an increase in the blood levels ET1 (3.7-4.7 times), NOx (1.4-1.5 times) and TNFα (4.2-6.5 times), with a progressive decrease in the level of eNOS (P<0.01). Multifactorial logistic regression analysis (GLZ package; StatSoft, Inc., USA) showed that pathogenetic factors for the DM development were multiple increase in blood levels of ET1 and TNFα, which was confirmed by building a logistic regression model with satisfactory results of adequacy (p=0.039).
 Conclusions. This study confirmed the significant role of EDF in type 2 diabetes and proved the prognostic value of ET1 and TNFα blood levels for the development of DM.

The macular capillary morphology in diabetic patients by optical coherence tomography angiography

Objective To observe the macular capillary morphology in diabetic patients. Methods A total of 61 patients (104 eyes) with diabetes mellitus (DM group) and 31 healthy controls (41 eyes) were enrolled in the study. According to the degree of diabetic retinopathy (DR), the DM group was divided into non-DR (NDR) group, non-proliferative DR (NPDR) group, and proliferative DR (PDR) group. There were 13 patients (23 eyes), 21 patients (34 eyes) and 27 patients (47 eyes) in each group, respectively. According to whether there was diabetic macular edema (DME), the DM patients were divided into DME group and non-DME group, each had 20 patients (28 eyes) and 41 patients (76 eyes), respectively. The age (F=2.045) and sex (χ2=2.589) between the control group, the NDR group, the NPDR group and PDR group were not statistically significant (P=0.908, 0.374). The 3 mm × 3 mm region in macula was scanned by optical coherence tomography angiography (OCTA), and the retinal capillary morphological changes of superficial capillary layer (SCL) and deep capillary layer (DCL) were observed. Chi-square test and t test were used to compare data among different groups. Results There was no abnormal change of retinal capillary morphology in control group. Microaneurysms and foveal avascular zone (FAZ) integrity erosion can be found in NDR group. There were microaneurysms, FAZ integrity erosion, vascular tortuosity bending, capillary non-perfusion and venous beading in NPDR and PDR groups. The microaneurysms of DCL were significantly more than that of the SCL (t=4.759, P<0.001). The eyes with microaneurysms in NDR group, NPDR group, and PDR group showed significant differences (χ2=44.071, P<0.001), and the eyes with FAZ integrity erosion among these three groups also showed significant differences (χ2=30.759, P<0.001). Compared with NPDR group and PDR group, there were significant differences in vascular tortuosity bending and capillary non-perfusion (vascular tortuosity bending: OR=0.213, 95%CI 0.070−0.648, P=0.004; capillary non-perfusion: OR=0.073, 95%CI 0.022−0.251, P<0.001), and there was no significant difference in venous beading (OR=0.415, 95%CI 0.143−1.208, P=0.102). SCL blood flow density in the 4 groups (control, NDR, NPDR and PDR group) was 49.233±1.694, 48.453±2.581, 45.020±4.685 and 40.667±4.516, respectively. While the difference between the control and NDR group was not significant, the differences between other pairs (control vs NPDR/PDR, NDR vs NPDR/PDR, NPDR vs PDR) were significant. The ratio of FAZ integrity erosion and non-perfusion of DME group was significantly higher than those of non-DME group (vascular tortuosity bending: OR=7.719, 95%CI 1.645−36.228, P=0.004; capillary non-perfusion: OR=14.560, 95%CI 3.134−67.646, P<0.001). Conclusions OCTA can distinctively detect the abnormal retinal capillary changes of SCL and DCL in diabetic patients. Even in DM patients without diabetic retinopathy, OCTA can detect abnormal blood vessels. Key words: Diabetic retinopathy; Regional blood flow; Tomography, optical coherence; Foveal avascular zone

Flavoprotein Fluorescence Correlation with Visual Acuity Response in Patients Receiving Anti-VEGF Injection for Diabetic Macular Edema.

Anti-VEGF treatment of diabetic macular edema (DME) complicating diabetic retinopathy (DR) has greatly improved structural and visual outcomes for patients with diabetes mellitus. However, up to 50% of patients are either nonresponsive or refractory to anti-VEGF treatment (no improvement in BCVA or central macular thickness (CMT)). It is believed that factors such as mitochondrial structural and functional damage, due to oxidative stress, are partially responsible for this lack of improvement. Flavoprotein fluorescence (FPF) has been shown to be a sensitive marker of mitochondrial function and has been found to correlate with the degree of diabetic retinopathy. FPF may also provide additional information regarding therapeutic response of patients receiving anti-VEGF treatment for DME. Eight patients with DR and DME with clinically significant DME (CSDME) who underwent anti-VEGF (bevacizumab) treatment were imaged before injection and at follow-up visit using FPF in addition to standard color fundus photography and OCT CMT. A strong correlation r = 0.98 (p = 0.000015) between the FPF decrease and the BCVA improvement was observed; BCVA improved as FPF values decreased. Notably, in the same patients, the correlation between OCT CMT decrease and BCVA improvement (r = 0.688) was not found to be significant (p = 0.13). These findings suggest that FPF can detect improvement in metabolic function preceding structural improvement and even with small changes in edema. Additionally, FPF may be supplementary to current diagnostic methods for earlier detection of therapeutic response to anti-VEGF treatment in patients with DME.

Multifocal electroretinography changes at the 1-year follow-up in a cohort of diabetic macular edema patients treated with ranibizumab

PurposeTo determine the changes in the multifocal electroretinogram (mfERG) at 1 year in a clinical series of diabetic macular edema (DME) patients treated with ranibizumab (RNBZ) using a pro re nata protocol.MethodsWe analyzed a clinical series of 35 eyes of 35 patients with DME at baseline and after treating them with RNBZ over 1 year, in order to determine the change in the macular function, which was assessed by means of the response density and the implicit time of the first-order kernel (FOK) P1 wave of the mfERG at the foveola (R1), fovea (R2) and parafovea (R3). These electrophysiological parameters were studied taking into account different independent variables, such as DME type, degree of diabetic retinopathy (DR), level of preservation of both the ellipsoid zone (IS/OS) and the external limiting membrane (ELM) and changes in central retinal thickness (CRT) and total macular volume (TMV). We also studied the relationship between the response density and the best-corrected visual acuity (BCVA).ResultsEyes with cystic and spongiform DME showed better response density with respect to the serous type (p < 0.001) at baseline. Similarly, eyes with high IS/OS and ELM preservation rates showed higher initial response density compared to the others (p < 0.001). Eyes with moderate DR had better response density compared to those with severe and proliferative DR (p = 0.001). At the beginning of the study, those eyes with proliferative and severe DR showed longer implicit times with respect to those with moderate DR (p = 0.04). The response density significantly increased in eyes that anatomically restored the IS/OS and the ELM after being treated with RNBZ (both p < 0.001). Similarly, eyes with spongiform DME further improved the response density with respect to those with cystic and serous DME (p < 0.001). On the contrary, eyes with hard exudates showed less improvement in their response density at the end of the study (p < 0.001). We observed a significant relationship between BCVA and the response density achieved at the end of the study (p = 0.012). Eyes with severe and proliferative DR significantly shortened implicit time compared to those with moderate DR (p = 0.04).ConclusionsThe multifocal electroretinogram allowed us to differentiate groups of eyes with DME according to their electrophysiological profile, both initially and after being treated with RNBZ. Ranibizumab increased the response density in all DME types included in the study, with a maximum response in those eyes with spongiform type. Once treated with RNBZ, the macular electrophysiological activity improved in eyes that had a well-preserved ellipsoid zone and ELM. The presence of hard exudates was a limitation to the response density achieved at the foveola.

Relationship between glomerular filtration rate and diabetic retinopathy in type 2 diabetic patients

Objective To investigate the relationship between glomerular filtration rate (GFR) and diabetic retinopathy (DR) and macular thickness in patients with type 2 diabetes mellitus (T2DM). Methods A total of 161 T2DM inpatients were enrolled in this study. There were 95 males (95 eyes) and 66 females (66 eyes), with an average age of (62.2±11.0) years. The average duration of diabetes was (14.8±7.9) years. The patients were grouped according to the degree of DR. Among them, 91 patients were no DR, 24 patients were mild non-proliferative DR (NPDR), 24 patients were moderate NPDR, 13 patients were severe NPDR and 9 eyes were proliferative DR (PDR). Severe NPDR and PDR were combine into severe DR group for statistical analysis. All patients underwent direct ophthalmoscope, fundus colorized photography, spectral domain optical coherence tomography (SD-OCT), fasting blood-glucose, glycated hemoglobin and renal function examinations. GFR was evaluated by 99 mTcDTPA. DR degree was evaluated by direct ophthalmoscope and fundus colorized photography. Central subfield (CSF), central macular volume and mean retinal thickness (MRT) were measure by SD-OCT. The correlation between GFR and DR staging and macular retinal thickness were analyzed by Spearman correlation analysis and Pearson correlation analysis. Logistic regression analysis was used to analyze the correlation between GFR and presence of DR. Results GFR was gradually decreased in patients with no DR, mild NPDR, moderate NPDR and severe DR (F=12.32, P<0.001). Pearson correlation analysis demonstrated that GFR was negatively correlated to CSF (r=-0.202, P=0.010); but no correlation with MRT (r=-0.087, P=0.272). Spearman correlation analysis demonstrated that GFR was negatively correlated to DR staging (r=-0.325, P<0.001). The difference of DR prevalence rate in normal, slight abnormal renal function and renal insufficiency patients was significant (χ2=12.32, P=0.002). Logistic regression analysis demonstrated that lower levels of GFR was significantly associated with presence of DR (95% confidence interval=1.71–4.32, odds ratio=2.72, P<0.001). Conclusion In T2DM patients, GFR is negatively correlated to DR staging and CSF. Lower GFR is independent risk factors for DR. Key words: Diabetes mellitustype 2/complications; Diabetic retinopathy; Glomerular filtration rate; Retina/physiopathology; Tomography, optical coherence

Correlational Study of Diabetic Retinopathy and Hearing Loss.

Our research goal was to complete a retrospective chart review to determine if there is a correlation between the level of diabetic retinopathy and diabetic neurosensory hearing loss. A retrospective analysis of 175 Department of Veterans Affairs Computerized Patient Record System charts was completed at the VA Portland Health Care System. Subjects were classified by degree of diabetic retinopathy as follows: no diabetic retinopathy (n = 80), mild nonproliferative diabetic retinopathy (n = 51), moderate nonproliferative diabetic retinopathy (n = 25), and combined severe nonproliferative diabetic retinopathy and proliferative diabetic retinopathy (PDR) (n = 17). Degree of sensorineural hearing was collected for each ear. Additionally, measures of diabetic control, including hemoglobin A1C, and creatinine, were recorded. After controlling for diabetic control, as measured by HbA1C and creatinine, level of diabetic retinopathy was significantly associated with hearing loss severity in both ears (right ear, P = .018 and left ear, P = .007). When adjusted to include diabetes control, the severity of diabetic retinopathy showed a correlation with degree of hearing loss at most levels. Because of this association, recommendation for hearing evaluations may be considered for those with mild, moderate, or severe nonproliferative or proliferative diabetic retinopathy.

Prevalence of dry eye in diabetics

Purpose The aim of this work is to study the prevalence of dry eye in type II diabetic patients and to correlate the dry eye with the duration of the diabetes and the level of Glycosylated Hemoglobin (Hb 1 Ac). Patients and methods It is a prospective randomized study in which 100 eyes (50 diabetics, 50 control) with type II diabetes mellitus is included in the study attending in department of ophthalmology Ain Shams University. Dry eye was confirmed by tear film break up time (TBUT) and Schirmer I test. Results Schirmer and tear film BUT values were lower among the uncontrolled diabetic patients. There is highly statistically significant relation between severity of dry eye by Schirmer test with duration of diabetes, hypertension, Debris in tear film, degree of diabetic retinopathy, Glycosylated Hemoglobin (HbA1C), with P value 0.003, 0.044, 0.000, 0.000, 0.000 respectively. There is highly statistically significant relation between severity of dry eye by BUT test with duration of DM, HTN, Debris in tear film, DR, HbA1C, with P value 0.002, 0.032, 0.000, 0.001, 0.000 respectively. Conclusion Diabetic patients are more prone to suffering from dry eye than normal subjects. These abnormalities can result in severe complications. Early examination of the diabetic patients for the detection of the ocular surface disorders is indicated.

Knowledge, attitudes, and practices on diabetic retinopathy among medical residents and general practitioners in Khartoum, Sudan

Background: Diabetic retinopathy (DR) is one of the major complications of diabetes mellitus (DM) and is the leading cause of blindness among working people. It constitutes 5% of the global causes of blindness. Knowledge, attitudes, and practices (KAPs) on DR among medical residents (MRs) and general practitioners (GPs) should be well assessed to insure a very good level of DR care. These groups are the most important primary health provider of the diabetic care network. Objectives: The aim is to assess the KAPs on DR among MRs and GPs in Sudan. Materials and Methods: Two hundred and twenty-five doctors, as the study population, were chosen from Khartoum state nonconsultant nonprivate working doctors, who are working in 22 general hospitals distributed across Khartoum state, between August and September 2016. All the selected study Personale were working in these hospitals, and they were exposed to diabetic patient's care which is available within the facilities of these hospitals. Specialist, consultants, and private doctors were excluded from the study. Data were collected through a well-designed self-administered questionnaire. The questionnaire was mainly included closed-ended questions with a few open-ended ones. It contains questions on demographic data, knowledge and awareness levels, practices toward screening DR, and questions on attitudes toward DR. At the end of the survey, the entire data were coded and entered into a Microsoft Excel spreadsheet in a personal computer. The responses were analyzed using Statistical Program for Social Sciences (SPSS) version 20 (Manufactured by IBM SPSS Inc., PASW Statistics for Windows, Version 20.0; 2009. Chicago: SPSS Inc., IL, USA). Results: Two hundred and twenty-five doctors; (GPs and MRs); were included in the current study. One hundred and thirty-seven (61%) of the responded participants were female and 88 (39%) were male. The mean age of the study group was 27.7 ± 8.0 years (range: 20–36 years). Two hundred and twenty-five questionnaires were distributed to all members, only 180 (93.75%) members completed the questionnaires. Fifty-eight (32%) has MBBS and 123 (68%) has MBBS + part one in medicine. Their years of medical practice was ranged from 2 years. One hundred and sixty-one (92.5%) and 155 (89.0%) mentioned eye and kidney, respectively, as the organs affected by DM. One hundred and fifty-eight (90.8%) mentioned retina as the part of the eye that can be affected. One hundred and eighteen (68.0%) mentioned poor glucose control as the factor that influences the presence or severity of DR. Fifty-nine (34.0%) mentioned duration of DM. Fifty-six (32.4%) high blood pressure high and 13 (7.5%) lipid level is important for DR degree. One hundred and sixty-four (95.0%) respondents, mentioned retina as the part of the eye that should be examined first for changes for DR. Ninety-one percent noted that DM can cause eye complications; new vessel formations. Hemorrhages, retinal detachment… etc. Seventy-five percent have the attitude to examine the diabetics when only the vision is affected. Fifty-one percent strongly agreed to do eye examination in diabetic pregnant and to do fundoscopy for any diabetic patient. Thirty-seven percent strongly agree to check eyes when lipid is high. Most of the respondents, i.e., 99 (59%) strongly disagree that ophthalmology training in medical school was enough to detect patients with DR. Seventy-two (42%) do visual acuity for their diabetic patients and 50 (30%) examine the fundus (retina). One hundred and twenty-six (75%) disagree that eye examination is only required in diabetic patients when vision is affected. Conclusion: Participants generally had a poor knowledge on DR although they had good knowledge about relationship between DR and others end organs which can be affected by microvascular complication of diabetes mellitus and good practice in referral of diabetic patients 136(81%). Undergraduate ophthalmology training in medical school is not adequate.

Usability of Medical Devices for Patients With Diabetes Who Are Visually Impaired or Blind.

The estimation is that every third to fourth patient with diabetes suffers from some degree of diabetic retinopathy. Medical products for insulin administration (such as insulin pens and pumps) or glucose monitoring not optimized to the needs of these patients' represent a high barrier for optimal diabetes therapy in daily practice. To date, the number of devices suitable for visually impaired and blind patients with diabetes is scarce. This manuscript outlines the specific needs of this patient group with regard to systems for insulin administration, blood glucose measurement, and continuous glucose monitoring. We see the clear need for a policy requirement for manufacturers to provide accessible/user friendly technical aids for visually impaired and blind patients with diabetes. This would represent an important step toward improving the situation for this impressively large patient group.

Analysis of correlation between dry eye and diabetic retinopathy in type 2 diabetic patients

AIM : To investigate the correlation between dry eye and different degrees of diabetic retinopathy( DR) in type 2diabetic patients.METHODS: In the cross-sectional study,340 patients( 340 eyes) with type 2 diabetes were enrolled. Tear film function tests including tear meniscus height,tear film breakup time( BUT),fluorescein staining,Schirmer Ⅰtest were perform ed followed by surveying questionnaires about dry eye. Retinal status was evaluated by retinal color photography and indirect ophthalm oscopy exam with dilated pupils to evaluate DR and whether com panied by macular edem a.RESULTS: The prevalence of dry eye was 49. 41%. The m ean duration of diabetes in patients with dry eye was11. 15±7. 07 a,while 6. 92±5. 45 a without dry eye( P<0. 01).Dry eye had the positive correlation to the development of DR. The incidence of dry eye in people with mild nonproliferative diabetic retinopathy( NPDR),moderate NPDR,severe NPDR and proliferative diabetic retinopathy( PDR) was 1. 097 times,1. 724 times,2. 86 times and 5. 43 times respectively, com pared with people without DR.The occurrence of dry eye in people with m acular edem a increased by 3. 697 times com pared with people without m acular edem a.CONCLUSION: Dry eye was more prevalent in people with type 2 diabetes. The incidence of dry eye increased gradually with the occurrence and developm ent ofdiabetic retinopathy.

The Degree of Diabetic Retinopathy in Patients with Type 2 Diabetes Correlates with the Presence and Severity of Coronary Heart Disease.

Both diabetic retinopathy (DR) and coronary heart disease (CHD) are clinically significant in diabetic patients. We investigated the correlation between the severity of DR and the presence and severity of CHD among type 2 diabetic patients. A total of 175 patients who were examined at the DR clinic and underwent dual-source computed tomography (DSCT) angiography within 6 months were included. The degree of DR was graded as no DR, nonproliferative DR (NPDR), and proliferative DR (PDR). The severity of CHD and the numbers of significant stenotic coronary artery on DSCT angiography according to DR grade were assessed. The mean Agatston Calcium Score (ACS) in patients with PDR was significantly higher than other groups (P < 0.001). The overall odds of an ACS increase were about 4.7-fold higher in PDR group than in no DR group (P < 0.001). In PDR group, in comparison with in no DR, the odds of having 1 or 2 arterial involvement were 3-fold higher (P = 0.044), and those of having 3 were 17-fold higher (P = 0.011). The c-index, one of the predictability values in regression analysis model, was not significantly increased when PDR was added to classical CHD risk factors (0.671 to 0.706, P = 0.111). Conclusively, patients with PDR develop a greater likelihood of not only having CHD, but being more severe nature. PDR has no additional effect to classical CHD risk factors for predicting CHD.

MiR-92a Corrects CD34+ Cell Dysfunction in Diabetes by Modulating Core Circadian Genes Involved in Progenitor Differentiation.

Autologous CD34+ cells are widely used for vascular repair; however, in individuals with diabetes and microvascular disease these cells are dysfunctional. In this study, we examine expression of the clock genes Clock, Bmal, Per1, Per2, Cry1, and Cry2 in CD34+ cells of diabetic and nondiabetic origin and determine the small encoding RNA (miRNA) profile of these cells. The degree of diabetic retinopathy (DR) was assessed. As CD34+ cells acquired mature endothelial markers, they exhibit robust oscillations of clock genes. siRNA treatment of CD34+ cells revealed Per2 as the only clock gene necessary to maintain the undifferentiated state of CD34+ cells. Twenty-five miRNAs targeting clock genes were identified. Three of the miRNAs (miR-18b, miR-16, and miR-34c) were found only in diabetic progenitors. The expression of the Per2-regulatory miRNA, miR-92a, was markedly reduced in CD34+ cells from individuals with DR compared with control subjects and patients with diabetes with no DR. Restoration of miR-92a levels in CD34+ cells from patients with diabetes with DR reduced the inflammatory phenotype of these cells and the diabetes-induced propensity toward myeloid differentiation. Our studies suggest that restoring levels of miR-92a could enhance the usefulness of CD34+ cells in autologous cell therapy.

Rapid assessment of avoidable blindness and diabetic retinopathy in Republic of Moldova

ObjectiveTo evaluate the prevalence and causes of blindness and visual impairment, the prevalence of diabetes mellitus and diabetic retinopathy among people aged ≥50 years in the Republic of Moldova using...

A prospective cross-sectional study on quality of life and treatment satisfaction in type 2 diabetic patients with retinopathy without other major late diabetic complications.

BackgroundTo assess quality of life and treatment satisfaction in patients with type 2 diabetes mellitus with diabetic retinopathy (DR) using validated instruments, with comparison to patients without DR.MethodsA prospective cross-sectional study was designed to assess the influence of retinopathy on quality of life and treatment satisfaction in patients with type 2 diabetes mellitus who do not have any other advanced late complications that could interfere with these outcomes. We included 148 patients with DR and 149 without DR, all without other advanced diabetic complications. Quality of life was assessed using the Audit of Diabetes Dependent Quality of Life (ADDQoL) questionnaire, and treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Clinical and treatment variables related to diabetes were also collected. The degree of DR was classified according to the International Clinical Classification System. Multivariate linear regression models were used to model the ADDQoL and DTSQ scores according to sociodemographical and clinical characteristics, and to model the adjusted relationship of DTSQ with ADDQoL. In DR patients, a subanalysis assessed the relationship of these scores with the degree of retinopathy, severity of macular edema, and previous photocoagulation treatment.ResultsDR was associated with significantly lower quality of life (p < 0.001), when examining the two general quality of life items and most of the specific domains. Concerning DTSQ, no difference was found in the total score, and only two domains that assess the perception of glycemic control (hyper- and hypoglycemia) showed a worse score in DR (p < 0.001 and p = 0.008, respectively). Quality of life was significantly affected by the severity of DR, and treatment satisfaction was significantly affected by the severity of macular edema. In the multivariate analysis, a significant effect of the interaction between diabetes duration, insulin therapy, and the presence of DR was found for both, ADDQoL and DTSQ.ConclusionIn the absence of other major complications, DR has a negative impact on quality of life in patients with type 2 diabetes. Further, treatment satisfaction was not affected by the presence of DR.

Hemostatic biomarkers in selected group of patients with type 1 diabetes: are they associated with different degrees of diabetic retinopathy

Hemostatic biomarkers in selected group of patients with type 1 diabetes: are they associated with different degrees of diabetic retinopathy

Effect on the retinal fiber thickness in early diabetes

To observe the change of the retinal fiber layer thickness in patients at early stage of diabetes. A case-control study. A total of 157 patients with diabetes, who were divided into four groups according to the degree of diabetic retinopathy in fundus photos, and 40 normal patients were examined by optical coherence tomography (OCT). The difference among the group was assessed by χ(2) test, One-Way ANOVA test and LSD test. The superior RNFL around optic nerve was not statistically thinner in NDR group than normal group (P = 0.195) . The superior RNFL around optic nerve was statistically thinner in miNPDR group, moNPDR group and sNPDR group (P = 0.13,0.02,0.00) . The thickness of fovea in both moNPDR group and sNPDR group were thicker than normal (P = 0.003,0.001) . In fovea, the superior RNFL was thinner in all diabetic groups (P < 0.01). In early stage of diabetes, the RNFL both in optic nerve and fovea were thinner, which would precede the microvascular changes.

Could donor multipotent mesenchymal stromal cells prevent or delay the onset of diabetic retinopathy?

Diabetes mellitus is a complex metabolic disease that has become a global epidemic with more than 285 million cases worldwide. Major medical advances over the past decades have substantially improved its management, extending patients' survival. The latter is accompanied by an increased risk of developing chronic macro- and microvascular complications. Amongst them, diabetic retinopathy (DR) is the most common and frightening. Furthermore, during the past two decades, it has become the leading cause of visual loss. Irrespective of the type of diabetes, DR follows a well-known clinical and temporal course characterized by pericytes and neuronal cell loss, formation of acellular-occluded capillaries, occasional microaneurysms, increased leucostasis and thickening of the vascular basement membrane. These alterations progressively affect the integrity of retinal microvessels, leading to the breakdown of the blood-retinal barrier, widespread haemorrhage and neovascularization. Finally, tractional retinal detachment occurs leading to blindness. Nowadays, there is growing evidence that local inflammation and oxidative stress play pivotal roles in the pathogenesis of DR. Both processes have been associated with pericytes and neuronal degeneration observed early during DR progression. They may also be linked to sustained retinal vasculature damage that results in abnormal neovascularization. Currently, DR therapeutic options depend on highly invasive surgical procedures performed only at advanced stages of the disease, and which have proved to be ineffective to restore visual acuity. Therefore, the availability of less invasive and more effective strategies aimed to prevent or delay the onset of DR is highly desirable. Multipotent mesenchymal stromal cells, also referred to as mesenchymal stem cells (MSCs), are promising healing agents as they contribute to tissue regeneration by pleiotropic mechanisms, with no evidence of significant adverse events. Here, we revise the pathophysiology of DR to identify therapeutic targets for donor MSCs. Also, we discuss whether an MSC-based therapy could prevent or delay the onset of DR.

VEGF Levels in Plasma in Relation to Platelet Activation, Glycemic Control, and Microvascular Complications in Type 1 Diabetes

OBJECTIVEIncreased levels of vascular endothelial growth factor (VEGF) in human plasma samples have suggested that circulating VEGF is a cause of endothelial dysfunction in diabetes mellitus. However, artificial release of VEGF from platelets as a source of VEGF in plasma samples, as also occurs in serum samples, has not been ruled out in these studies.RESEARCH DESIGN AND METHODSWe determined VEGF levels in plasma collected in both citrate and PECT, a medium that inactivates platelets, in a cross-sectional cohort of 21 healthy subjects and 64 patients with type 1 diabetes. In addition, we evaluated whether VEGF levels in both types of plasma correlated with the presence of diabetes, glycemic control, markers of in vivo or ex vivo platelet activation, and degree of diabetic retinopathy and nephropathy.RESULTSVEGF levels were invariably low in PECT plasma of both nondiabetic and diabetic subjects and were unrelated to any other diabetes-related variable studied. In contrast, VEGF levels in citrate plasma were 150% higher in diabetic patients than in control subjects and correlated with diabetes-related variables. Multiple linear regression analysis showed that levels of platelet factor 4, a marker for ex vivo platelet activation, and HbA1c were the independent predictors of VEGF levels in citrate plasma. Platelet activation, in vivo and ex vivo, was similar in diabetic persons and control subjects.CONCLUSIONSLike serum, citrate plasma is not suitable for reliable measurements of circulating VEGF. The low levels of VEGF in vivo, as represented by measurements in PECT plasma in our study, do not support a role of circulating VEGF in endothelial dysfunction in type 1 diabetes. Higher levels of VEGF in citrate plasma samples of diabetic persons do not represent the in vivo situation, but mainly originate from higher artificial ex vivo release from platelets correlating with the degree of glycemic control.