Diabetic Retinopathy In Relation Research Articles

Association between Diabetic Foot Ulcer and Diabetic Retinopathy

Diabetes mellitus is a metabolic disorder with disturbance in carbohydrate, protein and fat metabolism because of partial or complete deficiency of insulin secretion or action. As it can cause various complications and Diabetic retinopathy being the most common and perhaps the most serious of all ocular complications. Diabetic foot ulcer is one of the most serious and disabling complications of diabetes mellitus which result in significantly elevated morbidity and mortality. Aim of the study was to assess the severity of diabetic retinopathy in relation to various grades of diabetic foot ulcer among 100 patients with clinically diagnosed type 2 Diabetes Mellitus with diabetic foot ulcer patients. 25% of the study participants were found to have Moderate NPDR with 15% of the study participants having severe NPDR. 11.1% of study participants with grade 4 DFU had PDR with HRC and 33.3% of study participants with grade 4 DFU had Severe NPDR. 47.1% and 35.3% of study participants with grade 3 DFU had Severe NPDR and moderate NPDR respectively. The association was found to be statistically significant between the severity of diabetic retinopathy and the grades of diabetic foot ulcer of the study participants. The study concluded that the severity of diabetic retinopathy increases with the increase in the stages of DFU and there is a possibility that the presence of DFU can predict the progression to advanced stages of DR. The results of our study support the need for a system of ophthalmological referral in case of detection of DFU, as well as a prompt referral of DR patients to a DFU specialist. Also, in advanced age DFU patients, and particularly those with longer duration of diabetes, early detection of DR and timely treatment may decrease the risk of severe vision loss or blindness. Keywords: diabetic foot ulcer, diabetic retinopathy, risk factors, severity, India

Assessment of Retinal Nerve Fiber Layer Thickness using Optical Coherence Tomograghy (OCT) in patients with Diabetic Retinopathy in relation to HbA1c

Assessment of Retinal Nerve Fiber Layer Thickness using Optical Coherence Tomograghy (OCT) in patients with Diabetic Retinopathy in relation to HbA1c

Association of Diabetic Retinopathy in relation with HbA1c Levels

Association of Diabetic Retinopathy in relation with HbA1c Levels

Optical Coherence Tomography Assessment of Macular and Choroidal Thickness in Patients with Proliferative Diabetic Retinopathy in Relation to Hemoglobin A1C

Background: Diabetic retinopathy affects up to 80 % of all patients who have had diabetes for 10 years or more. Despite these intimidating statistics, research indicates that at least 90% of these new cases could be reduced if there were proper treatment and monitoring of the eyes blindness. Objective: To evaluate the relation of macular and choroidal thickness to HbA1c in patients with proliferative diabetic retinopathy. Patients and methods: This study included 40 eyes of 33 patients with a diagnosis of proliferative diabetic retinopathy (PDR). Patients were recruited from Retinal Clinic in Imbaba Eye Hospital and they were asked to participate in this study. This study was designed as an observational, cross-sectional and non-coherent study in the period from 5/2018 to 4/2019. Results: the results showed that the macular thickness was higher and the choroidal thickness was lower in uncontrolled HbA1c group than controlled HbA1c group. We assumed that increase level of glycosylated hemoglobin lead to increase macular thickness and decrease choroidal thickness and increase incidence of diabetic macular edema and choroidal atrophy. Conclusion: Optical coherence tomography is a sensitive and noninvasive diagnostic tool in the evaluation of macular and choroidal thickness. Hypertension is also an important risk factor in the development of diabetic retinopathy, diabetic macular edema and diabetic choroidopathy.

Molecular and Pathophysiological Mechanisms of Diabetic Retinopathy in Relation to Adhesion Molecules.

Diabetic Retinopathy (DR) is considered as a most common microvascular complication of diabetes affected by one in three people who are suffered for diabetes. Several pathophysiological mechanisms and adhesion molecules may play an etiologic role in the development of diabetes and its complications. The adhesion molecules located on both leucocytes and endothelial cells and considered as important molecules which can assessed the endothelial function. The functions of adhesion molecules involved in the cellular margination, slow rolling and transmigration of leukocytes. Hyperglycemia and its immediate biochemical sequelae or the low-grade inflammation directly alter endothelial function or influence endothelial cell functioning indirectly by induce oxidative stress and activates leukocytosis and leukocyte-endothelial cell interactions by the increased expression of adhesion molecules, growth factors, inflammatory factors, chemokines etc. and results DR. This review summarized the several pathophysiological mechanisms and role of adhesion molecules in disruption of homeostasis of vasculature by leukocytes in the development of diabetic retinopathy.

Assessment of Macular Thickness Using OCT in Patients with Diabetic Retinopathy in Relation to HbA1c

Background: diabetic retinopathy (DR) is the specific micro vascular complication of diabetes mellitus (DM) and affects 1 of 3 with DM. DR remains a leading cause of vision loss in working adult population. Patients with severe levels of DR are reported to have poor quality of life and reduced physical, emotional and social wellbeing. Objectives: to evaluate the relation of macular thickness to HbA1c in patients with diabetic retinopathy. Patients and Methods: this study included 30 eyes of 16 patients with a diagnosis of diabetic retinopathy (DR). Patients were recruited from Retinal Clinic in Bab El-Shearyah University hospital and asked to participate in this study. This study was designed as an observational, cross-sectional and non-coherent study in the period from 12/2018 to 5/2019. Results: the controlled HbA1c group and uncontrolled HbA1c group were comparable in age, sex, type of diabetes mellitus and best corrected visual acuity, but controlled HbA1c group had shorter duration of diabetes mellitus and lower glycosylated haemoglobin level than uncontrolled HbA1c group. Six (40.0%) patients of controlled HbA1c group were hypertensive patients and 11(73.3%) patients of uncontrolled HbA1c group were hypertensive patients. Conclusion: intensive glycemic control might affect retinal vasculature and decrease ischemia and affect the development and progression of diabetic retinopathy.

Diabetic Retinopathy in Relation with eGDR Value in Patients with Type 1 Diabetes Mellitus

Type 1 diabetes mellitus (T1DM) is a chronic disease which represents a major issue for public health. Type 1 diabetes is occurred most frequently in childhood and adolescence, although in recent years due to the increase in the prevalence of obesity in this category of population has been registered a growing number of cases of type 2 diabetes among children and adolescents (1, 2).

Pentraxin 3 and retinopathy among type 2 diabetic patients in relation to carotid atherosclerosis and systolic and diastolic cardiac function — a pilot study

Introduction. Diabetic retinopathy (DR) is the leading cause of vision loss worldwide. Global prevalence of any diabetic retinopathy is assessed to be 35.4%. Several studies proved that chronic low-grade inflammation may be involved in the pathogenesis of DR. Some studies indicate that macroangiopathic diabetic complications may be associated with microangiopathic ones that is why a “common soil” mechanism of diabetic micro- and macroangiogpathy has been proposed. The aim of this study was to evaluate the association of pentraxin 3 (PTX3), an inflammation’s biomarker, with diabetic retinopathy in relation to atherosclerosis in carotid arteries and systolic and diastolic cardiac function. Material and methods. 43 eligible patients with type 2 diabetes were enrolled into the study and dived into two groups on the basis of presence or lack of retinopathy. Anthropometric, biochemical and carotid as well as cardiac ultrasound parameters were analyzed. Results. There was no direct association between PTX3 concentration and the presence of diabetic retinopathy, but there was a significant correlation between PTX3 and HbA1c value, age and IMT (intima media thickness) in carotid arteries among patients with diabetic retinopathy. Conclusions. There is a great need for further, larger, studies on inflammatory biomarkers such as PTX3 and micro and macrovascular complications of diabetes mellitus in order to detect predisposed patients early enough to implement early therapeutic intervention of this complication.

Periodontitis is associated with diabetic retinopathy in non-obese adults.

Patients with diabetes retinopathy appear to show increased susceptibility to periodontal disease. This study was performed to assess the relationship between periodontitis and the prevalence of diabetic retinopathy in a large probability sample of the Korean population. A subgroup analysis was performed using body mass index <25 kg/m2 as the criterion to evaluate the effect of obesity on this relationship. This study is based on data from the Korean National Health and Nutrition Examination Survey of the Korean population, conducted between 2008 and 2010. The presence of diabetic retinopathy in relation to demographic variables and anthropometric characteristics of the participants is presented as means with their standard errors. The presence of periodontitis and presence of retinopathy categorized by body mass index (<25 and ≥25 kg/m2) were evaluated. Multiple logistic regression analyses were used to assess the associations between periodontitis and diabetic retinopathy after adjustment with variables, including age, sex, smoking, drinking, exercise, hypertension, metabolic syndrome, HbA1c, and duration of diabetes mellitus. There was a statistically significant increase in the prevalence of periodontitis in individuals who had proliferative diabetic retinopathy. The odds ratios [95% confidence intervals] of prevalence of diabetic retinopathy were 1.193 [0.757-1.881] for the whole population after adjustments with confounding factors. Subgroup analysis after adjustments with confounding factors showed that the odds ratios [95% confidence intervals] of prevalence were 2.206 [1.114-4.366] and 0.588 [0.326-1.061] among participants with body mass index <25 kg/m2 and body mass index 37 ≥25 kg/m2, respectively. The diabetic retinopathy was positively associated with the presence of periodontitis in non-obese diabetic Korean adults after adjustment with confounding variables. Our findings suggest that when a periodontist finds the presence of periodontitis in non-obese diabetic patients, timely evaluation of the patient's ophthalmic evaluation should be 44 recommended.

Monitoring of Diabetic Retinopathy in relation to Bariatric Surgery: a Prospective Observational Study.

To investigate the need for closer perioperative monitoring of diabetic retinopathy in patients with type 2 diabetes undergoing bariatric surgery. Prospective observational clinical study of 56 patients with type 2 diabetes undergoing bariatric surgery. The patients were examined with 7-field fundus images and optical coherence tomography scans 2weeks before and 1, 3, 6 and 12months after bariatric surgery. Worsening was defined as a two-step change in the Wisconsin Epidemiologic Study of Diabetic Retinopathy scale or appearance or worsening of macular edema. Postoperative changes were analyzed in a mixed model. Six patients (11%) had any worsening at any visit, and three (5%) persisted at 1year. Of the 24 patients with preoperative retinopathy, 4-13% worsened and 9-22% improved, with significant overall improvement at 6months (p = 0.01). Only one (3%) of the 32 patients without preoperative diabetic retinopathy had a transient worsening at 6months. No patients developed macular edema, but the whole cohort had a minor increase in center point foveal thickness that peaked 6months postoperatively. The patients were required to have good glucose control preoperatively where HbA1c was 6.4 ± 1.9%. Diabetic retinopathy was clinically stable after bariatric surgery, and none of the observed changes would have resulted in a changed screening interval at our center. This supports adherence to regular diabetic retinopathy screening guidelines following bariatric surgery in well-controlled patients. A clinically negligible but statistically significant foveal thickening 6months postoperatively warrants further study.

Choroidal thickness in diabetic retinopathy in relation to long-term systemic treatments for diabetes mellitus.

To measure central choroidal thickness (CCT) in patients with diabetic retinopathy (DR) and analyze the correlation with clinical backgrounds regarding medications for diabetes mellitus (DM). We retrospectively identified 86 patients with DR (172 eyes) and 43 healthy subjects (57 eyes) who underwent spectral-domain optical coherence tomography. Among the 86 patients with DM who had received no intraocular treatments, 61 were diabetic patients who had continuously received systemic treatments for DM (under treatment group). Twenty-five were patients who had discontinued the treatments or had not received any treatment for DM until this study started (no treatment group). The results of CCT acquired by 2 masked raters showed a significant correlation coefficient (r = 0.98), indicating high reproducibility in this study. No correlation of CCT was noted between normal (272 ± 71 µm) and DM eyes (264 ± 77 µm), the presence of diabetic macular edema, or CCT and the severity of DR in the patients examined. Interestingly, there was a significant decrease in CCT (175 ± 42 µm) in eyes with mild/moderate nonproliferative DR (NPDR) in the no treatment group (p&lt;0.05), whereas CCT was prominently thicker in eyes with severe NPDR (354 ± 76 µm) and proliferative DR (286 ± 74 µm) than in eyes without DR. This study demonstrated that CCT was significantly decreased in the presence of mild/moderate NPDR in the no treatment group, suggesting that a continuously high blood sugar state caused by insufficient treatments for DM may facilitate vascular damage in the choroid in the early stage of DR.

Screening intervals for diabetic retinopathy and incidence of visual loss: a systematic review

Screening for diabetic retinopathy can help to prevent this complication, but evidence regarding frequency of screening is uncertain. This paper systematically reviews the published literature on the relationship between screening intervals for diabetic retinopathy and the incidence of visual loss. The PubMed and EMBASE databases were searched until December 2012. Twenty five studies fulfilled the inclusion criteria, as these assessed the incidence/prevalence of sight-threatening diabetic retinopathy in relation to screening frequency. The included studies comprised 15 evaluations of real-world screening programmes, three studies modelling the natural history of diabetic retinopathy and seven cost-effectiveness studies. In evaluations of diabetic retinopathy screening programmes, the appropriate screening interval ranged from one to four years, in people with no retinopathy at baseline. Despite study heterogeneity, the overall tendency observed in these programmes was that 2-year screening intervals among people with no diabetic retinopathy at diagnosis were not associated with high incidence of sight-threatening diabetic retinopathy. The modelling studies (non-economic and economic) assessed a range of screening intervals (1-5years). The aggregated evidence from both the natural history and cost-effectiveness models favors a screening interval >1year, but ≤2years. Such an interval would be appropriate, safe and cost-effective for people with no diabetic retinopathy at diagnosis, while screening intervals ≤1year would be preferable for people with pre-existing diabetic retinopathy. A 2-year screening interval for people with no sight threatening diabetic retinopathy at diagnosis may be safely adopted. For patients with pre-existing diabetic retinopathy, a shorter interval ≤1year is warranted.

Incidence and Progression of Diabetic Retinopathy During 17 Years of a Population-Based Screening Program in England

OBJECTIVETo estimate the incidence of diabetic retinopathy in relation to retinopathy grade at first examination and other prognostic characteristics.RESEARCH DESIGN AND METHODSThis was a dynamic cohort study of 20,686 people with type 2 diabetes who had annual retinal photography up to 14 times between 1990 and 2006. Cumulative and annual incidence rates were estimated using life tables, and risk factors for progression were identified using Cox regression analysis.RESULTSOf 20,686 patients without proliferative diabetic retinopathy (PDR) or sight-threatening maculopathy at their first retinal examination (baseline), 16,444 (79%) did not have retinopathy, 3,632 (18%) had nonproliferative retinopathy, and 610 (2.9%) had preproliferative retinopathy. After 5 years, few patients without retinopathy at baseline developed preproliferative retinopathy (cumulative incidence 4.0%), sight-threatening maculopathy (0.59%), or PDR (0.68%); after 10 years, the respective cumulative incidences were 16.4, 1.2, and 1.5%. Among those with nonproliferative (background) retinopathy at baseline, after 1 year 23% developed preproliferative retinopathy, 5.2% developed maculopathy, and 6.1% developed PDR; after 10 years, the respective cumulative incidences were 53, 9.6, and 11%. Patients with nonproliferative retinopathy at baseline were five times more likely to develop preproliferative, PDR, or maculopathy than those without retinopathy at baseline (adjusted hazard ratio 5.0 [95% CI 4.4–5.6]).CONCLUSIONSFew patients without diabetic retinopathy at the initial screening examination developed preproliferative retinopathy, PDR, or sight-threatening maculopathy after 5–10 years of follow-up. Screening intervals longer than a year may be appropriate for such patients.

Secondary prevention of diabetic retinopathy in type I diabetes mellitus. Dependence on retinopathy status before the intervention

To assess prospectively the effect of improving the metabolic state on the course of diabetic retinopathy in relation to the extent of retinal changes before intervention. 140 patients with type I (insulin-dependent) diabetes mellitus (IDDM) (55 men, 85 women; mean age 30 +/- 11 years; mean duration of illness 11 +/- 8 years), underwent intensified insulin treatment and were then followed for 4 years. At the beginning of the trial fundoscopy was unremarkable in 68 patients (stage 0), a few microaneurysms and (or) punctate bleeding (stage 1) in 21, nonproliferative retinopathy (stage 2) in 27, preproliferative retinopathy (stage 3) in six, proliferative retinopathy (stage 4) in 14, and proliferative retinopathy with complications (stage 5) in four. The average retinopathy stage was 1.2 +/- 1.0, mean HbA1c value 7.0 +/- 1.3%). The retinopathy remained unchanged in 94 patients (group A), it improved in 16 (group B), and deteriorated in 30 (group C). There was no significant change in mean HbA1c value in any of the groups (A: 6.2 +/- 0.9%; B: 6.4 +/- 1.0%; C: 6.3 +/- 6.0%). There were also no differences with respect to blood glucose, M-value according to Schlichtkrull, frequency of hypoglycaemia, serum lipids, blood pressure and renal biopsy parameters. However, significant differences (P < 0.001 C vs. A and B) were found in relation to duration of diabetes (A: 9.3 +/- 7.2 years; B: 8.8 +/- 8.6 years; C: 16.9 +/- 7.8 years) and mean retinopathy stage at beginning of the study (A: 0.8 +/- 0.8; B: 1.2 +/- 0.7; C: 2.4 +/- 1.6). Decisive for the course of retinopathy in patients with IDDM of long duration and secondarily optimised metabolic state is the duration of illness and especially the degree of fundal changes when intensified insulin treatment is undertaken.

A Community-Based Epidemiologic Study of Gender Differences in the Relationship between Insulin Resistance/β-Cell Dysfunction and Diabetic Retinopathy among Type 2 Diabetic Patients in Kinmen, Taiwan

Purpose: The purpose of this study was to explore whether there were gender differences in the relation of insulin resistance and β-cell dysfunction to diabetic retinopathy among type 2 diabetic patients. Methods: From 1999 to 2002, a screening regimen for diabetic retinopathy was performed by a panel of ophthalmologists using ophthalmoscopy and 45-degree color fundus photography to examine the fundus in a total of 971 type 2 diabetic patients examined between 1991 and 1993 in Kinmen, Taiwan. Seven hundred and twenty-five type 2 diabetic patients (301 males and 424 females) attended ophthalmological fundus checkup. Results: The response rate in males and females was 71.3 and 77.2%. The proportion of diabetic retinopathy at the first eye screening was 16.3% in males and 20.1% in females. From the multiple logistic regression, the type of diabetes (known cases vs. new cases) was a significant factor of diabetic retinopathy in both males (OR = 3.65, 95% CI: 1.59–8.37) and females (OR = 3.66, 95% CI: 2.01–6.70). Diabetic retinopathy was also strongly affected by the homeostasis model assessment of insulin resistance (HOMA IR) and homeostasis model assessment of β-cell dysfunction (HOMA β-cell) (p < 0.0001 for trend test). In males, those who were in the 2nd quartile, 3rd quartile, and 4th quartile of HOMA IR had 4.87 times (95% CI: 1.18–20.11), 6.83 times (95% CI: 1.91–24.46), and 10.15 times (95% CI: 2.42–42.56) the risk for diabetic retinopathy as compared to those in the 1st quartile. There was a reduced risk for diabetic retinopathy in relation to HOMA β-cell for the 2nd quartile, 3rd quartile, and 4th quartile of 86% (95% CI: 37–97%), 95% (95% CI: 77–99%), and 96% (95% CI: 78–99%) as compared to that in the 1st quartile. Only the 4th quartile had a significant risk (OR = 2.62, 95% CI: 1.17–5.86) for diabetic retinopathy as compared to that in the 1st quartile in females. The reduced risk for diabetic retinopathy found in relation to HOMA β-cell for the 3rd and 4th quartiles were 66% (95% CI: 6–88%) and 66% (95% CI: 10–87%) as compared to that in the 1st quartile. Conclusions: Gender differences in the relationship between insulin resistance/β-cell dysfunction and diabetic retinopathy were demonstrated in type 2 diabetic patients.

Diabetic retinopathy, visual acuity, and medical risk indicators. A continuous 10-year follow-up study in Type 1 diabetic patients under routine care

The objective of this study was to describe incidence and progression of diabetic retinopathy in relation to medical risk indicators as well as visual acuity outcome after a continuous follow-up period of 10 years in a Type 1 diabetic population treated under routine care. The incidence and progression of retinopathy and their association to HbA 1c, blood pressure, urinary albumin, serum creatinine levels, and insulin dosage were studied prospectively in 452 Type 1 diabetic patients. The degree of retinopathy was classified as no retinopathy, background, or sight-threatening retinopathy, i.e. clinically significant macular edema, severe nonproliferative, or proliferative retinopathy. Impaired visual acuity was defined as a visual acuity <0.5 and blindness as a visual acuity ≤0.1 in the best eye. In patients still alive at follow-up ( n=344), 61% (69/114) developed any retinopathy, 45% (51/114) background retinopathy, and 16% (18/114) sight-threatening retinopathy. Progression from background to sight-threatening retinopathy occurred in 56% (73/131). In 2% (6/335), visual acuity dropped to <0.5 and in less than 1% (3/340) to ≤0.1. Patients who developed any retinopathy and patients who progressed to sight-threatening retinopathy had higher mean HbA 1c levels over time compared to those who remained stable ( P<.001 in both cases). Patients who developed any retinopathy had higher levels of mean diastolic blood pressure ( P=.036), whereas no differences were seen in systolic blood pressure levels between the groups. Cox regression analysis, including all patients, showed mean HbA 1c to be an independent risk indicator for both development and progression of retinopathy, whereas mean diastolic blood pressure was only a risk indicator for the incidence of retinopathy. Metabolic control is an important risk indicator for both development and progression of retinopathy, whereas diastolic blood pressure is important for the development of retinopathy in Type 1 diabetes. The number of patients who became blind during 10 years of follow-up was low.

Prevalence of diabetic retinopathy in relation to age at onset of the diabetes, treatment, duration and glycemic control.

To study the frequency of diabetic retinopathy in relation to age at diagnosis, treatment, duration of diabetes and glycemic control as measured by means of HbA1c levels, we performed a cross-sectional, registered-based study in the Helsingborg area of southern Sweden, comprising 2232 diabetic patients. Of the known diabetic population < 75 years old, approximately 70% were estimated to be included. We graded retinopathy according to the alternative classification of the Wisconsin study. With an age at diagnosis < 30 years (19% of patients) the prevalence of retinopathy was 64%, whereas with an age at diagnosis > or = 30 years the prevalence of retinopathy was 57% in insulin-treated, and 26% in non-insulin treated patients. Levels of glycated hemoglobin and duration of diabetes were associated with retinopathy in the group with younger onset. In the older-onset group, there was a relationship between retinopathy and duration of diabetes and insulin treatment; glycated hemoglobin had a relationship which was of borderline significance with any retinopathy, but clearly significant with the pooled group: severe non-proliferative, proliferative retinopathy and/or macular edema. Hyperglycemia and duration of diabetes were thus associated with retinopathy in both younger- and older-onset diabetes, but hyperglycemia less so in the older-onset group.

Lp(a) is not related to retinopathy in diabetic subjects.

To examine the association between Lp(a) concentrations and the severity of retinopathy in 22 younger-onset and 48 older-onset diabetic subjects from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR), a population-based study of diabetic retinopathy. We used a subset of the WESDR population with standardized protocols and stereoscopic color fundus photography to determine the severity of diabetic retinopathy in relation to Lp(a) concentrations. Lp(a) concentrations were measured by a monoclonal anti-Lp(a) antibody. Lp(a) levels were not significantly different between younger-onset or older-onset subjects with and without retinopathy. Our results do not support a link between higher levels of Lp(a) and severe retinopathy in either younger-onset or older-onset diabetic subjects but this needs confirmation in larger prospective studies.

Influence of pregnancy on diabetic retinopathy

A prospective study of the influence of pregnancy on diabetic retinopathy was started at Rigshospitalet, Copenhagen in 1979. At present 145 women with insulin-dependent diabetes have been included. Preliminarily, it seems that women belonging to White classes B and C do not develop persistent retinopathy as a consequence of pregnancy. Women with retinopathy at the onset of pregnancy deteriorate in 50% of the cases, but post-partum regression is common. Development of proliferative changes is exceptional, and proliferations developed during pregnancy in most cases disappear spontaneously after delivery. Consequently, treatment with photocoagulation during pregnancy and in the early post-partum period should be restricted. Close ophthalmological supervision during pregnancy is essential and the ophthalmologist must be aware of the spontaneous course of diabetic retinopathy in relation to pregnancy.