Development Of Diabetic Retinopathy In Patients Research Articles

Highly-Expressed MiR-221-3p Distinctly Increases the Incidence of Diabetic Retinopathy in Patients With Type 2 Diabetes Mellitus.

Diabetic retinopathy (DR) is the leading cause of blindness in patients with diabetes mellitus (DM). MiR-221-3p is implicated in microvascular dysfunction in DR, and we explored their relationship. Patients with type 2 diabetes mellitus (T2DM) were allocated to the non-DR (NDR)/nonproliferative DR (NPDR)/proliferative DR (PDR) groups, with their clinical baseline and pathological data collected. The miR-221-3p and VEGF levels were determined by reverse transcription quantitative polymerase chain reaction (RT-qPCR) and ELISA, respectively. Peripheral blood endothelial progenitor cell (EPC) and endothelial cell (EC) ratios were ascertained by flow cytometry. The correlations between miR-221-3p levels and VEGF/EPCs/ECs, the predictive value of serum miR-221-3p levels in DR, and the independent risk factors for DR occurrence in T2DM were analyzed by Pearson's correlation analysis, receiver operating characteristic (ROC) curve, and multifactorial logistic regression analysis. Serum miR-221-3p was highly expressed in DR. Clinical severity of DR was positively correlated with miR-221-3p levels. Endothelial function was impaired in DR. Serum miR-221-3p levels in DR were favorably correlated with VEGF and ECs and negatively associated with EPCs. The area under the curve of serum miR-221-3p in evaluating DR occurrence in patients with T2DM was 0.8178 (1.235 cutoff value, 69.62% sensitivity, and 82.35% specificity). High expression of miR-221-3p increased DR incidence in patients with T2DM. Diabetes course, VEGF, EPCs, ECs, and miR-221-3p levels were independent risk factors for DR development in patients with T2DM. Serum miR-221-3p levels in patients with DR were positively correlated with VEGF and ECs and negatively linked with EPCs. Highly expressed miR-221-3p distinctly increased DR incidence in patients with T2DM and was an independent risk factor for DR development in patients with T2DM. This study assessed serum miR-221-3p level and endothelial function indicators (VEGF, EPCs, and ECs) in patients with DR and analyzed the correlation between each indicator. We found that high serum miR-221-3p expression prominently increased the incidence of DR in patients with T2DM and was an independent risk factor for the development of DR in patients with T2DM. This study provided a scientific basis for further clarification of the pathogenesis of DR, and also provided new ideas for clinical prediction and management of DR.

Association of the serum chemerin level with the development of diabetic retinopathy in patients with type 1 diabetes mellitus.

In patients with type 2 diabetes mellitus, the development of diabetic retinopathy (DR) correlates positively with elevated serum chemerin levels. This study was aimed at investigating the probable association between the serum chemerin level and the development of DR in patients with type 1 diabetes mellitus (T1DM). In this cross-sectional study, we included Egyptians and classified them into four groups: group 1, including healthy individuals; group 2, including patients with T1DM without DR; group 3, including patients with T1DM with non-proliferative DR (NPDR); and group 4, including patients with T1DM with proliferative DR (PDR). The assessment included best-corrected distance visual acuity assessment, slit-lamp biomicroscopy, funduscopy, fundus fluorescein angiography, and macular ocular coherence tomography. Fasting blood samples were obtained from all participants to measure serum chemerin, glycated hemoglobin (HbA1c), total cholesterol, triglyceride, and creatinine levels. Serum chemerin levels were compared among the groups, and their correlations with age, duration of diabetes, HbA1c, total cholesterol, triglyceride, and creatinine levels were analyzed. We recruited 209 participants, including 46 healthy individuals in group 1, 52 patients (T1DM and no DR) in group 2, 61 patients (T1DM and NPDR) in group 3, and 50 patients (T1DM and PDR) in group 4, with comparable mean ages and sex ratios among groups. The diabetes duration, body mass index, HbA1c, total cholesterol, triglyceride, and serum chemerin levels differed significantly among the groups (all P < 0.001), whereas the creatinine level did not (P > 0.05). The serum chemerin level was significantly higher in group 4 than in groups 3 and 2, in group 3 than in group 2, and in groups 3 and 4 than in group 1 (all P < 0.001). However, it was comparable between groups 1 and 2 (P > 0.05). It correlated with the duration of T1DM and HbA1c, total cholesterol, triglyceride, and creatinine levels but not with age. Patients with T1DM with DR showed higher serum chemerin levels than those with T1DM without DR or healthy individuals. Serum chemerin levels were higher in those with PDR than in those with NPDR. Thus, serum chemerin levels are a potential biomarker of the development and severity of DR in patients with T1DM. Nevertheless, future diagnostic accuracy studies are required to confirm these potential applications.

Early Onset Age Increased the Risk of Diabetic Retinopathy in Type 2 Diabetes Patients with Duration of 10-20 Years and HbA1C ≥7%: A Hospital-Based Case-Control Study.

Background The relationship between onset age of diabetes and diabetic retinopathy (DR) is controversy and not concluded. Therefore, this hospital-based case-control study aimed to investigate the influence of diabetes onset age on the development of DR in patients with type 2 diabetes (T2D), independent of diabetic duration and HbA1c levels. Methods A sample of 780 T2D patients with diabetic duration of 10–20 years and glycated hemoglobin (HbA1c) ≥7% were enrolled in the study. 338 T2D patients with onset age ≤45 years were further selected as cases (early onset) and 79 with onset age ≥ 55 years were chosen as controls (elderly onset). International Clinical Diabetic Retinopathy Disease Severity Scale was applied to estimate the severity of DR. Results The prevalence of DR and proliferative diabetic retinopathy (PDR) was notably increased in the early onset group. When stratified by duration of diabetes, the impact of younger age on the risk of DR turned to be greatest in patients with diabetic duration ≥15 years (OR = 5.202, 95% CI 2.625–10.310). In groups stratified by HbA1c, the risk of DR was highest in patients with younger onset age and HbA1c ≥ 9% (OR = 3.889, 95% CI 1.852–8.167). Compared with the elderly onset group, the risk of DR (OR = 1.776, 95% CI = 1.326–2.380, p < 0.001) and PDR (OR = 1.605, 95% CI = 1.106–2.329, p = 0.013) in younger diagnosed patients was increased after multivariable adjustment. Conclusions Age of onset was an independent risk factor for developing DR and PDR. This suggests that it is urgent to closely monitor and treat the metabolic disorders in younger T2D patients to delay the occurrence and progression of DR.

428-P: The Association between Monocyte to High-Density Lipoprotein Cholesterol Ratio and Diabetic Retinopathy

Retinal chronic inflammation plays a pivotal role in the development of diabetic retinopathy (DR). Monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) is associated with inflammatory and oxidative stress status. Some studies suggest that an elevated MHR can be a biomarker for diabetic complications. However, there are not adequate studies on MHR and DR. A total of 771 patients with T2DM and 607 healthy controls were included in this cross-sectional study. MHR and eye examination were checked. The predictive role of MHR on the development of DR in T2DM patients was analyzed. The MHR in patients with DR was significantly higher than that of both the non-DR diabetic patients (P &amp;lt; 0.05) and the healthy controls (P &amp;lt; 0.01). No significance were observed in the MHR of different DR severity grades. Moreover, MHR was similar between patients with non-macular edema and macular edema. Logistic regression analysis demonstrated that MHR was independently associated with the development of DR in diabetic patients [OR =1.377, 95% CI: 1.176-1.613, P &amp;lt; 0.01]. MHR can be an independent predictor of the development of DR in patients with T2DM. Disclosure Y. Tan: None. X. Tang: None. Y. Chen: None.

Effects of Fibrates on Risk of Development of Diabetic Retinopathy in Japanese Working Age Patients with Type 2 Diabetes and Dyslipidemia: a Retrospective Cohort Study

The aims of the present study were to investigate the effects of fenofibrate and bezafibrate on the risk of development of diabetic retinopathy (DR) in patients with type 2 diabetes and dyslipidemia. Japanese working age patients with type 2 diabetes and dyslipidemia were extracted from the Nihon University School of Medicine Clinical Data Warehouse. These patients were divided into three groups: control group (n=2549), fenofibrate group (n=40), and bezafibrate group (n=135). Multivariate logistic regression analysis was performed to assess the association between fibrates and the development of DR. After adjustment for covariates, fenofibrate showed no association with the risk of DR [adjusted odds ratio (OR), 0.160; 95% CI, 0.021-1.209; p=0.0758]. Bezafibrate also showed no association with the risk of DR (adjusted OR, 0.731; 95% CI, 0.411-1.299; p=0.2855). However, poor control of hemoglobin A1c (HbA1c ≥8.0%; adjusted OR, 3.623; 95% CI, 2.649-4.956; p<0.0001) and high low-density lipoprotein cholesterol (LDL-C ≥140 mg/dL; adjusted OR, 1.399; 95% CI, 1.013-1.932; p=0.0415) within the follow-up period of type 2 diabetes and dyslipidemia increased the risk of DR. Our results suggested that to prevent development of DR in patients with type 2 diabetes and dyslipidemia, controlling LDL-C levels as well as HbA1c levels under coexistence type 2 diabetes and dyslipidemia is more important than the selection of fibrate.

Study of new pathogenetic mechanisms of diabetic retinopathy development in patients with diabetic foot syndrome

Introduction and purpose. Diabetes is one of the underlying causes of blindness and other long-term negative consequences that significantly affect patients’ quality of life. The study aimed to determine the indicators characterizing the pathogenetic mechanisms of the development of vascular dysfunction, in particular diabetic retinopathy (DR), and the relationship of these changes with nitric oxide. Material and methods. There were 2114 patients with various surgical diseases under observation (including 1073 patients with purulent-septic soft tissue diseases), among them there were 193 patients with type 2 diabetes mellitus (DM) and 134 patients with Wagner stage 2-5 diabetic foot syndrome (DFS) and diabetic retinopathy in the main group (268 eyes). The comparison group included 59 patients (118 eyes) of the corresponding age with DM without DFS and DR. Both groups were the same in age and gender. Results. The level of the end products of nitric oxide metabolism in peripheral blood was found to be 1.78 times (p&lt;0.01) higher compared with patients without DR. A decrease in the activity of superoxide dismutase (SOD) in patients with DR was by 1.56 times (p&lt;0.01) lower relative to the comparison group. The content of thiobarbituric acid (TBA)-active products in the peripheral blood of patients of the main group exceeded by 1.58 times (p &lt;0.01) the reference values of patients without DR. When determining the content of S-nitrosithiols, an increase in these indicators in the main group was found to be 2.38 times (p&lt;0.01). Patients in the main group with DR also showed a 5.13-fold (p&lt;0.001) increase in peripheral blood homocysteine concentration. NO is known to have both positive and harmful effects depending on its concentration. On the one hand, NO causes relaxation of blood vessels by reducing blood pressure, prevents platelet aggregation and adhesion, limits LDL cholesterol oxidation, suppresses smooth muscle cell proliferation, and reduces the expression of proinflammatory genes that are associated with atherogenesis. It is known that NO can have both positive and harmful effects, depending on its concentration. On the one hand, NO causes relaxation of blood vessels, reducing blood pressure, prevents platelet aggregation and adhesion, limits the oxidation of LDL cholesterol, suppresses the proliferation of smooth muscle cells, and reduces the expression of pro-inflammatory genes that are associated with atherogenesis. On the other hand, NO interacts with O2-, leading to the inactivation of NO and the production of peroxynitrite, which post-transcriptionally modifies proteins and negatively affects their function. This can contribute to endothelial dysfunction by stimulating the production of inflammatory mediators and lipid peroxidation and thus increasing cell permeability. Conclusions. The findings show that the patients with diabetes mellitus complicated by retinopathy and DFS had a significant increase in the content of nitric oxide in the peripheral blood, the cause of which is hyperglycemia. The use of an intercellular mediator (nitric oxide), which contributes to the physiological regulation of the hemodynamics of the eye, protects vascular endothelial cells from pathogenic factors of ischemia, will help clinicians choose an effective pharmacological therapy appropriate for a particular patient and a particular eye.

Socioeconomic deprivation and development of diabetic retinopathy in patients with type 1 diabetes mellitus

IntroductionVery little is known about the influence of socioeconomic status on type 1 diabetes mellitus (T1DM) complications. Our aim was to determine whether socioeconomic level is a risk factor for...

Структурные изменения хориоидеи при диабетической ретинопатии

Blindness and low vision, as a social medical problem, occupy one of the leading places in both healthcare and the state economy. Diabetic retinopathy (DR) is a vision-threatening microvascular disease, the most common diabetes complication that affects the retina, causing blindness among working-age adults in developed countries. Difficulties in determining the starting, key pathogenetic links and early diagnosis of this disease do not allow to accurately determine the initial moment of occurrence, and known treatment methods are aimed, as a rule, at slowing down the pathological process. Purpose. Analysis of literature data on the clinical and diagnostic features of diabetic retinopathy. Material and methods. To analyze the literature, information was searched on this problem up to 10 years deep in PubMed / MEDLINE, PMC, Web of Since. For the search, the following terms were used individually or in combination: "diabetes mellitus", "diabetic retinopathy", "diabetic vasculopathy", "optical coherence tomography", "fluorescence angiography", "complications". The search criteria were key studies related to diabetic retinopathy, vasculopathy: meta-analyzes, original studies, retrospective and cohort studies. Results and discussions. Oxygen from the capillary layer of the choroid through the Bruch membrane and retinal pigment epithelium (RPE) gets to the outer retinal layers. Due to complications in the bloodstream, nutrition is impaired which leads to diabetic retinal changes. It is advisable and necessary to study changes in the structures of the choroid in large samples using angio-OCT, since changes in the choroid can be the primary prognostic markers of the development of diabetes in the absence of clinical manifestations of diabetic retinopathy. Conclusion. Changes in the structure of the choroid can become a marker for predicting the development of DR in patients with type 2 diabetes, more accurately and quickly establish a diagnosis in the early stages of the disease, and prescribe appropriate therapy in a timely manner. As a result, patients receive timely care and treatment costs will decrease. Keywords: diabetes mellitus, diabetic retinopathy, choroid, diabetic choriopathy, OCT angiography, choroid structures.

Risk factors for retinopathy in hemodialysis patients with type 2 diabetes mellitus

There is limited knowledge on the prevalence and risk factors of diabetic retinopathy (DR) in dialysis patients. We have investigated the association between diabetes mellitus and lipid-related biomarkers and retinopathy in hemodialysis patients. We reviewed 1,255 hemodialysis patients with type 2 diabetes mellitus (T2DM) who participated in the German Diabetes and Dialysis Study (4D Study). Associations between categorical clinical, biochemical variables and diabetic retinopathy were examined by logistic regression. On average, patients were 66 ± 8 years of age, 54% were male and the HbA1c was 6.7% ± 1.3%. DR, found in 71% of the patients, was significantly and positively associated with fasting glucose, HbA1c, time on dialysis, age, systolic blood pressure, body mass index and the prevalence of other microvascular diseases (e.g. neuropathy). Unexpectedly, DR was associated with high HDL cholesterol and high apolipoproteins AI and AII. Patients with coronary artery disease were less likely to have DR. DR was not associated with gender, smoking, diastolic blood pressure, VLDL cholesterol, triglycerides, and LDL cholesterol. In summary, the prevalence of DR in patients with type 2 diabetes mellitus requiring hemodialysis is higher than in patients suffering from T2DM, who do not receive hemodialysis. DR was positively related to systolic blood pressure (BP), glucometabolic control, and, paradoxically, HDL cholesterol. This data suggests that glucose and blood pressure control may delay the development of DR in patients with diabetes mellitus on dialysis.

Analysis of association between common variants of uncoupling proteins genes and diabetic retinopathy in a Chinese population

BackgroundThe aim of this study was to explore the association between diabetic retinopathy (DR) and the variants of uncoupling proteins (UCPs) genes in a Chinese population of type 2 diabetes, in total and in patients of different glycemic status separately.MethodsThis case-control study included a total of 3107 participants from two datasets, among which 662 were DR patients (21.31%). Eighteen tag single nucleotide polymorphisms (SNPs) of UCP1, UCP2, and UCP3 were selected as genetic markers. TaqMan probes, Sequenom MassARRAY MALDI-TOF mass spectrometry platform and Affymetrix Genome-Wide Human SNP Array were used for genotyping. Online SHEsis software was used for association analysis. Bonferroni correction was used for multiple comparisons correction.ResultsThree SNPs of UCP1: rs7688743 (A allele, OR = 1.192, p = 0.013), rs3811787 (T allele, OR = 0.863, p = 0.023), and rs10011540 (G allele, OR = 1.368, p = 0.004) showed association with DR after the adjustment of glucose, but only rs10011540 was marginally significantly associated with DR when Bonferroni correction was strictly applied (padj = 0.048). In patients with uncontrolled glucose, rs7688743 (A allele, p = 0.012, OR = 1.309), rs10011540 (G allele, p = 0.033, OR = 1.432), and rs3811787 (T allele, p = 0.022, OR = 0.811) were associated with DR, while in participants with well controlled glucose, the rs2734827 of UCP3 was associated with DR (A allele, p = 0.017, OR = 0.532). Rs3811787 of UCP1 showed a protective effect to sight threatening DR (T allele, p = 0.007, OR = 0.490), and the association existed after the adjustment for environmental factors and the correction. In patients with uncontrolled glucose, the rs3811787 of UCP1 (T allele, p = 0.017, OR = 0.467) and the rs591758 of UCP3 (C allele, p = 0.026, OR = 0.103) were associated with STDR. While in those with well controlled glucose, only the rs7688743 of UCP1 showed a protective effect (A allele, p = 0.024, OR = 0.049). None of the associations remain significant when Bonferroni correction was strictly applied (all p < 0.05).ConclusionsThe rs10011540 and rs3811787 of the UCP1 gene was marginally significantly associated with DR in Chinese type 2 diabetes patients. There might be different mechanisms of DR development in patients with different glycemic status.

Prevalence and risk factors for diabetic retinopathy in a cross-sectional population-based study from rural southern China: Dongguan Eye Study

Research questionThe current population-based study aimed to investigate the prevalence of diabetic retinopathy (DR) and risk factors among residents over 40 years old in the rural area of Dongguan, southern...

Abnormally Low or High Ankle-Brachial Index Is Associated With the Development of Diabetic Retinopathy in Type 2 Diabetes Mellitus

Although some studies have reported an association between peripheral artery disease (PAD) and diabetic retinopathy (DR) in patients with diabetes, whether or not a causal relationship exists is unknown. The aim of this study was to investigate whether PAD, as indicated by an abnormally low or high ankle-brachial index (ABI), is associated with the development of DR in patients with type 2 diabetes mellitus (DM) without DR. We enrolled 414 (221 men and 193 women) patients with type 2 DM who underwent ABI measurements at our outpatient clinic. PAD was defined as an abnormally low (<0.9) or high (≥1.3) ABI in either leg, and DR was defined as being non-proliferative or proliferative. Of the enrolled patients, 69 (16.7%) had an ABI <0.9 or ≥1.3. The median follow-up period was 23 (15–40) months, during which 74 (17.9%) patients developed DR. In multivariate analysis, an ABI <0.9 or ≥1.3 was independently associated with the development of DR (vs. ABI ≥0.9 to <1.3; hazard ratio, 2.186; 95% confidence interval, 1.261 to 3.789; p = 0.005). An abnormal ABI was associated with the development of DR in our patients with type 2 DM without DR.

Genetic predictors associated with diabetic retinopathy in patients with diabetic foot.

INTRODUCTION Early detection of diabetic retinopathy (DR) is crucial for preventing irreversible blindness. Recent studies identified some of the genetic factors involved in the pathology of DR, although their precise underlying mechanisms remain unclear. OBJECTIVES This pilot study aimed to determine genetic predictors of DR among patients with type 2 diabetes (T2D) and diabetic foot (DF) based on pathogenetic pathways. PATIENTS AND METHODS The study included 114 patients with T2D and DF (64 with DR, 50 without DR). Genetic analysis was performed for each patient and the following alterations were analyzed: rs759853 (AKR1B1), rs1800469 (TGFB1), rs2073618 and rs3134069 (TNFRSF11B), rs6330 and rs11466112 (NGF), rs1801133 (MTHFR), rs8192678 (PPARGC1A), rs1799983 (NOS3), rs1553005 (CALCA), and rs121917832 (CDKN1B). RESULTS Correlations with DR were identified for the following single nucleotide variants (SNVs): rs759853, rs2073618, and rs3134069. Carriers of the G allele of the rs759853 variant had a higher risk of DR in the dominant model (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.15-7.81; P = 0.02). We analyzed 2 SNVs of the osteoprotegerin gene (rs3134069 and rs2073618), and found that the A allele of the rs3134069 variant decreased the risk of DR in both the recessive and additive models (OR, 3.33; 95% CI, 1.07-10.3; P = 0.04). Conversely, there were fewer carriers of the C allele of the rs2073618 variant in patients with DR in the dominant model (OR, 0.28; 95% CI, 0.09-0.92; P = 0.04). CONCLUSIONS The results of our study suggest that the SNVs rs759853, rs3134069, and rs2073618 may be involved in the development of DR in patients with T2D and DF.

Macrovascular function indices for the prediction of diabetic retinopathy development in patients with type 2 diabetes.

Macrovascular function indices for the prediction of diabetic retinopathy development in patients with type 2 diabetes.

The Role of Dyslipidemia Control in the Progression of Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus

Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus (DM) and is considered as the leading cause of visual impairment in working-aged adults worldwide. Dyslipidemia has been associated with DR, but not with progression to the proliferative form of DR, although the exact role in the pathogenesis of DR and diabetic macular edema (DME) remains controversial. As a result, a reasonable question arising is whether control of dyslipidemia may alter the course of DR. Statins do not appear to have an impact on DR progression. On the other hand, fenofibrate has been found to significantly reduce the rate of progression of DR in patients with pre-existing mild DR, although it has no impact on patient’s vision nor on the prevention of DR development in patients with type 2 DM without DR. An interesting point that needs further evaluation is why patients without DR or those with severe DR appear to have no benefit from fenofibrate treatment.

Eoidemiologic studay on the prevalence rate and risk factors of diabetic retinopathy in eastern countryside of Changzhi

Objective To estimate the prevalence rate and risk factors of diabetic retinopathy (DR) in rural residents in Changzhi. Methods With the help of an established resident health data, a epidemiology study was performed on 63 409 residents (≥15 years old) in the rural area of Changzhi; while the standard of diagnosis of diabetes was in accordance with the standard made by WHO in 1997. Diabetes was diagnosed in 2632 residents, and these patients underwent the investigation and examination including the disease history, glycosylated hemoglobin (HbAlc), fasting blood glucose, visual acuity, ocular diseases and intraocular pressure. The standard of DR was drawn according to the diagnosis standard made by Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association in 1985. The data was statistically analyzed by SPSS 13.0 software. Results A total of 57 500 residents underwent the examination with the participating rate of 90.68% ; 2632(4. 58%) were diagnosed as with diabetes, in whom 986 were with DR (with DR prevalence of 37.46%). The duration of diabetes was the independent risk factor of DR (r=0. 210,P<0. 001). The duration of diabetes and combined with hypertension were the influence factors of the development of DR. The visual acuity in residents with or without DR differed significantly(P<0.01). The level of HbA1c was positively related to DR. Conclusions The incidence of DR is high in residents with diabetes in eastern countryside area of Changzhi. The duration of diabetes and combined with hypertension were the influence factors of the development of DR. The level of HbAlc may be the important indicator which can monitor the occurrence and development of DR in patients with diabetes. Key words: Diabetic retinopathy/epidemiology; Diabetic retinopathy/diagnosis; Epidemiologic methods