Microvascular Complications In Diabetic Patients Research Articles

Research Progress of Diabetes and Erectile Dysfunction

In recent years, studies have shown that there is a significant correlation between diabetes and erectile dysfunction. Diabetes mellitus-induced erectile dysfunction (DMED) is one of the common microvascular complications in diabetic patients. The incidence is gradually increasing and tends to be younger, which seriously affects the quality of life of patients. This article reviews the relationship mechanism and treatment between diabetes and erectile dysfunction.

Bioinformatics analysis of immune infiltration in human diabetic retinopathy and identification of immune-related hub genes and their ceRNA networks

Diabetic retinopathy (DR) is the most common microvascular complication in diabetic patients, and recent studies have shown that immune regulatory mechanisms are closely associated with retinal damage in DR. Therefore, this study focused on exploring immune cells and immune-related genes (IRGs) in DR and gaining insight into the ceRNA mechanisms by which IRGs regulate DR progression. Four datasets from human DR model retinal tissues were obtained from the Gene Expression Omnibus (GEO) database. R software was first used to identify differentially expressed mRNAs (DE-mRNAs) in the dataset GSE160306-mRNAs, then the distribution of immune cells in the gene matrix was analyzed by xCell and ImmuCellAI, ImmPort and InnateDB database were used to obtain immune-related hub genes (IRHGs) in the DR, and finally the STRING online tool and Cytoscape to construct the immune-related ceRNA network. The datasets GSE102485, GSE160308 and GSE160306-lncRNAs were used to validate the results of the ceRNA network further. The results of immune cell infiltration analysis showed that macrophages are important immune cells in DR; immune-related gene screening showed that FCGR2B is an IRHG in DR, and 2 immune-related ceRNA networks of IRHG were obtained: DDN-AS1/miR-10a-5p/FCGR2B and LINC01515/miR-10a-5p/FCGR2B. Our study suggests that infiltration of immune cells, especially the immune role of macrophages, is an important component of DR progression; the immune-related hub gene FCGR2B and its ceRNA network may be a key regulatory network for DR progression. The discovery of key immune cells, IRHG and ceRNA networks in this study may provide new prospects for early intervention and targeted treatment of DR.

Biomarkers of Oxidative Stress in Diabetic Microvascular Complications Review Article

Reactive oxygen species (ROS) are produced as a result of biochemical processes that are not in balance with the body's antioxidant defense mechanism. This metabolic dysfunction is referred to the oxidative stress (OS). Metabolic dysfunction-associated diseases are affected by changes in the redox balance. It is now widely recognized that oxidative stress significantly affects diabetes mellitus (DM), particularly type 2 diabetes. The biochemical changes associated with DM could disturb the oxidative milieu, leading to several microvascular complications in diabetic patients. Thus, DM is a perfect disease to explore the harmful consequences of oxidative stress and how to treat it. Oxidative stress triggered by hyperglycemia is an important contributor to the effects of diabetic microvascular diseases. Uncontrolled hyperglycemia carried by deficiencies in insulin secretion or action produces a number of problems, such as peripheral vascular disorders, nephropathy, neuropathy, retinopathy, increased morbidity and/or mortality, as well as the incidence of diabetes mellitus (DM) are rising globally. The development and progression of diabetic problems are strongly correlated with reactive oxygen species and oxidative stress, according to a wide body of research. This review aims to explore various markers of oxidative stress and the role of ROS in the pathogenesis and progression of late diabetic microvascular complications.

Causal influence of immune factors on the risk of diabetic retinopathy: a mendelian randomization study

ObjectivesDiabetic retinopathy (DR) is a prevalent microvascular complication in diabetic patients. Various mechanisms have been implicated in the pathogenesis of DR. Previous studies have observed the relationship between immune factors and DR, but the causal relationship has not been determined.MethodsWe conducted a two-sample Mendelian randomization (MR) analysis of 731 immune cells and DR, using publicly available genome-wide association study (GWAS) summary statistics, to evaluate potential causal relationships between them. Four types of immune traits were included in the analysis through flow cytometry. GWAS statistics for DR were obtained from the Finngen database, which performed GWAS on 190,594 European individuals (Ncase = 14,584, Ncontrol = 176,010) to assess genetically predicted DR. The primary method used to perform causality analysis was inverse variance weighting (IVW).ResultsFollowing false discovery rate (FDR) correction, 11MFI-DR, 5AC-DR, 5RC-DR, and 1MP-DR reached a significant causal association level (PFDR < 0.05). Notably, all AC traits exhibited potential associations with a decreased risk of DR(OR < 1), while a majority of MFI traits, along with the singular MP trait, exhibited potential associations with an increased risk of DR (OR > 1). The highest proportion of T-cell subsets in the final results.ConclusionThis study elucidates that the progression of DR is intricately influenced by immune responses, thereby confirming the immunological susceptibility of DR. Our findings may offer new targets for diagnosing and treating DR, as well as aid in developing therapeutic strategies from an immunological standpoint.

Marrow mesenchymal stem cell mediates diabetic nephropathy progression via modulation of Smad2/3/WTAP/m6A/ENO1 axis.

Diabetic nephropathy (DN) is one of the common microvascular complications in diabetic patients. Marrow mesenchymal stem cells (MSCs) have attracted attention in DN therapy but the underlying mechanism remains unclear. Here, we show that MSC administration alleviates high glucose (HG)-induced human kidney tubular epithelial cell (HK-2 cell) injury and ameliorates renal injury in DN mice. We identify that Smad2/3 is responsible for MSCs-regulated DN progression. The activity of Smad2/3 was predominantly upregulated in HG-induced HK-2 cell and DN mice and suppressed with MSC administration. Activation of Smad2/3 via transforming growth factor-β1 (TGF-β1) administration abrogates the protective effect of MSCs on HG-induced HK-2 cell injury and renal injury of DN mice. Smad2/3 has been reported to interact with methyltransferase of N6-methyladenosine (m6A) complex and we found a methyltransferase, Wilms' tumor 1-associating protein (WTAP), is involved in MSCs-Smad2/3-regulated DN development. Moreover, WTAP overexpression abrogates the improvement of MSCs on HG-induced HK-2 cell injury and renal injury of DN mice. Subsequently, α-enolase (ENO1)is the downstream target of WTAP-mediated m6A modification and contributes to the MSCs-mediated regulation. Collectively, these findings reveal a molecular mechanism in DN progression and indicate that Smad2/3/WTAP/ENO1 may present a target for MSCs-mediated DN therapy.

Postbiotics: emerging therapeutic approach in diabetic retinopathy.

Diabetic retinopathy (DR) is a prevalent microvascular complication in diabetic patients that poses a serious risk as it can cause substantial visual impairment and even vision loss. Due to the prolonged onset of DR, lengthy treatment duration, and limited therapeutic effectiveness, it is extremely important to find a new strategy for the treatment of DR. Postbiotic is an emerging dietary supplement which consists of the inactivate microbiota and its metabolites. Numerous animal experiments have demonstrated that intervention with postbiotics reduces hyperglycemia, attenuates retinal peripapillary and endothelial cell damage, improves retinal microcirculatory dysfunction, and consequently delays the progression of DR. More strikingly, unlike conventional probiotics and prebiotics, postbiotics with small molecules can directly colonize the intestinal epithelial cells, and exert heat-resistant, acid-resistant, and durable for storage. Despite few clinical significance, oral administration with postbiotics might become the effective management for the prevention and treatment of DR. In this review, we summarized the basic conception, classification, molecular mechanisms, and the advances in the therapeutic implications of postbiotics in the pathogenesis of DR. Postbiotics present great potential as a viable adjunctive therapy for DR.

Renal affection among type 2 diabetic patients and their families

Background and Aim It was believed that both environmental and genetic factors are involved in the pathogenesis of tyrje 2 diabetes mellitus (T2DM). We aimed to figure out the renal affection in patients with T2DM and their family relatives. Patients and methods The current study included 80 patients with T2DM without history of kidney diseases and 80 family members of the diabetic patients neither known to be diabetic nor had kidney diseases compared with 80 apparently healthy persons as a normal control group without a family history of diabetes. Results The prevalence of microvascular complications in diabetic patients and their relatives was as follows: nephropathy (27.5 and 5%, respectively), neuropathy (30 and 8.75%, respectively), and retinopathy (18.83 and 6.2%, respectively). Overall, 22.5% of the relatives had metabolic srtndrome. Microvascular complications of diabetes were associated with longer disease duration, elevated blood pressure, and poor glycemic control, whereas microvascular complications in relatives were associated with one or more of t.he metabolic components of metabolic syndrome. Conclusion screening of diabetic patients for microvascular complications is mandatory as early as possible.The detection of the metabolic components in T2 diabetic relatives can predict the prediabetic state and also can predict the possible occurrence of microvascular complications before happening, and early management can delay them.

Matrix Metalloproteinase-2 (MMP-2) and-9 (MMP-9) Gene Variants and Microvascular Complications in Type 2 Diabetes Patients.

Vascular complications are the leading cause of increased morbidity and mortality of diabetic patients. It has been postulated that matrix metalloproteinases MMP-2 and MMP-9, zinc-dependent endopeptidases through remodeling of the extracellular matrix, can contribute to the onset and progression of diabetic vascular complications. The aim of our study was to assess whether there is a major difference in single nucleotide polymorphisms in the MMP-2 (at position -1306C˃T) and MMP-9 (at position -1562C˃T) gene in type 2 diabetic patients and healthy controls and to determine whether there is an association of these gene variants with the presence of microvascular complications in diabetic patients. Our study included 102 type 2 diabetes patients and a control group which was comprised of 56 healthy controls. All diabetic patients were screened for microvascular diabetes complications. Genotypes were detected by polymerase chain reactions followed by restriction analyses with specific endonucleases and their frequencies were determined. The MMP-2 variant -1306C>T showed a negative correlation with type 2 diabetes (p=0.028). It was also shown that the presence of the -1306C allele increases the probability of developing type 2 diabetes. This was a 2.2 fold increase and that the -1306 T allele has a protective role in regards to type 2 diabetes. The MMP-2 variant -1306T showed a negative correlation with diabetic polyneuropathy (p=0.017), meaning that allele-1306T has a protective role in regards to diabetic polyneuropathy while the presence of allele -1306C increases the probability of developing diabetic polyneuropathy by 3.4 fold. Our study showed that the MMP-2 gene variant (-1306C) doubles the risk of developing type 2 diabetes, and for the first time an association of this gene variant and the presence of diabetic polyneuropathy was shown.

Inflammation in Diabetic Kidney Disease: Focus on New Therapeutic Considerations

Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD) in the U.S. and worldwide. A role of chronic low-grade inflammation in the microvascular complications in diabetic patients has now been widely accepted, and anti-inflammatory therapies for DKD are being actively pursued. Such therapies may be especially useful in the treatment of patients with chronic kidney disease (CKD) with normal to only moderately increased albuminuria, a DKD phenotype which is becoming more frequent. Current pharmacologic treatment for DKD includes inhibitors of the renin-angiotensin-aldosterone system (RAAS) and the sodium-glucose co-transporter 2 (SGLT2) in the proximal tubule. Both classes of agents are known to reduce blood pressure but also are thought to have anti-inflammatory, antioxidant, and anti-fibrotic effects independent of their hemodynamic actions. Large clinical trials with experimental agents such as bardoxolone and selonsertib that target inflammation and oxidative stress in DKD have been carried out or are in progress. The non-specific phosphodiesterase inhibitor pentoxifylline (PTX) is also being studied in a large US trial to see if this FDA-approved drug may be able to be repurposed to treat DKD. Other agents have also shown promising effects in small clinical trials but require further large-scale investigation.

Neutrophil-lymphocyte ratio and its relation to microvascular complication in geriatric patients with diabetes: a case-controlled study

BackgroundDiabetes mellitus is a complex chronic disease characterized by chronic hyperglycemia resulting from defective insulin secretion, defective insulin action, or both. Chronic hyperglycemia related to diabetes can lead to end-organ dysfunction or failure, and changes related to diabetes involving arterioles and capillaries are responsible for long-term microvascular complications in diabetic patients. The neutrophil-to-lymphocyte ratio (NLR) is a novel, simple, and inexpensive marker of subclinical inflammation.Aim of workTo evaluate the possibility that neutrophil-lymphocyte ratio (NLR) could be used as a predictor of microvascular complications during follow-up of elderly patients with type 2 diabetes.Patients and methodsSixty elderly diabetes patients ≥ 65 years old, diagnosed 16 according to ADA criteria, were collected from the endocrine clinic in Kasr El-Ainy Hospital. For every patient, full history and examination were done (including 18 neurological and fundus examinations). Labs (CBC with a differential in blood and 19 albumin/creatinine ratio in urine) were done and the neutrophil/lymphocyte ratio.ResultsWe found that NLR has a statistically significant difference in the detection of nephropathy and retinopathy. There is a significant correlation between nephropathy and NL ratio in all patients (r = 0.44, P < 0.001). Elderly diabetic patients (with or without hypertension) with microvascular complications had a higher NLR value than those without complications.ConclusionNLR value can be used as a non-invasive simple marker for predicting microvascular complications in elderly diabetics with/without hypertension.

Diabetes: Its Complications and Inflammation Markers

Type 2 Diabetes (T2DM) is a chronic inflammatory metabolic disease of high prevalence around the world. The elevated inflammation markers such as Neutrophil Lymphocyte Ratio (NLR), and Platelet Lymphocyte Ratio (PLR) are associated with macrovascular and microvascular complications and have been described as a predictors of mortality in patients with renal damage, atherosclerosis and cardiovascular diseases. The chronic inflammation state and the oxidative stress associated with aging could accelerate the microvascular complications in diabetic patients.

Prediction of microvascular complications in diabetic patients without obstructive coronary stenosis based on peri-coronary adipose tissue attenuation model.

To investigate the predictive value of peri-coronary adipose tissue (PCAT) attenuation for microvascular complications in diabetic patients without significant stenosis and to develop a prediction model for early risk stratification. This study retrospectively included patients clinically identified for coronary computed tomography angiography (CCTA) and type 2 diabetes between January 2017 and December 2020. All patients were followed up for at least 1 year. The clinical data and CCTA-based imaging characteristics (including PCAT of major epicardial vessels, high-risk plaque features) were recorded. In the training cohort comprising of 579 patients, two models were developed: model 1 with the inclusion of clinical factors and model 2 incorporating clinical factors + RCAPCAT using multivariable logistic regression analysis. An internal validation cohort comprising 249 patients and an independent external validation cohort of 269 patients were used to validate the proposed models. Microvascular complications occurred in 69.1% (758/1097) of the current cohort during follow-up. In the training cohort, model 2 exhibited improved predictive power over model 1 based on clinical factors (AUC = 0.820 versus 0.781, p = 0.003) with lower prediction error (Brier score = 0.146 versus 0.164) compared to model 1. Model 2 accurately categorized 78.58% of patients with diabetic microvascular complications. Similar performance of model 2 in the internal validation cohort and the external validation cohort was further confirmed. The model incorporating clinical factors and RCAPCAT predicts the development of microvascular complications in diabetic patients without significant coronary stenosis. • Hypertension, HbA1c, duration of diabetes, and RCAPCAT were independent risk factors for microvascular complications. • The prediction model integrating RCAPCAT exhibited improved predictive power over the model only based on clinical factors (AUC = 0.820 versus 0.781, p = 0.003) and showed lower prediction error (Brier score=0.146 versus 0.164).

Disease Progression and Associations of Microvascular Complications in Diabetic Patients: A Study From South India.

Diabetes mellitus (DM) is a chronic metabolic disease characterized by inappropriately elevated blood glucose levels. If not treated at the early stage, it can lead to complications like diabetic retinopathy (DR) and diabetic nephropathy (DN) which are often associated with severe morbidity and mortality. This study was designed to identify the prevalence of retinopathy and nephropathy in diabetic patients and alsoto determine the correlation between DRand DN. In this cross-sectional study, a total of 84 diabetic patients (Male: Female- 53:31) were included. The mean age at presentation was 54.06 ± 9.85 years. Among them, 28% of patients had a duration of diabetes of < 5 years. Nearly 42% and 30% of patients had diabetes between 5-10 years, and more than 10 years respectively. At the time of presentation to us, a total of 42.8% of patients had a combination of nephropathy and retinopathy, 40.4% of patients had only retinopathy, and 16.6% of patients with only nephropathy. Among patients with nephropathy andmicroalbuminuria, only 5.9% had DR ranging from mild to a moderate degree and none had severe DR. In patients with macroalbuminuria, 26.2% had moderate to severe DR. Microvascular complications are more prevalent in diabetics with disease progression. Microalbuminuria is a marker for retinopathy and these patients require ophthalmic evaluation at the earliest. Early recognition and management of these, can reduce the occurrence of complications as well as disease progression, thus reducing the related mortality.

M6A transferase METTL3 regulates endothelial-mesenchymal transition in diabetic retinopathy via lncRNA SNHG7/KHSRP/MKL1 axis

Diabetic retinopathy is one of the microvascular complications in diabetic patients and the leading cause of blindness worldwide. The levels of METTL3, lncRNA SNHG7, KHSRP, MKL1, endothelial and mesenchymal markers were determined by RT-qPCR or western blot assays in vitro and in vivo. H&E staining was used to observe the retinal structure in a mouse model of DR. The expression levels of METTL3 and SNHG7 were significantly downregulated in DR patients, DR mice and high glucose-induced HRMECs cells. Notably, METTL3 installed the m6A modification and enhanced the stability of SNHG7. Besides, METTL3 inhibited HRMECs EndoMT by promoting the expression of SNHG7. Additionally, SNHG7 was found to weaken MKL1 mRNA stability by binding to the RNA-binding protein KHSRP. Furthermore, we verified that METTL3 regulated EndoMT in DR through the SNHG7/MKL1 axis. We conclude that METTL3 regulates endothelial-mesenchymal transition in DR via the SNHG7/KHSRP/MKL1 axis, providing a new target for DR treatment.

Predicting diabetic nephropathy in type 2 diabetic patients using machine learning algorithms.

Global healthcare centers today are challenged by the dramatic increase in the prevalence of diabetes. Also, complications from diabetes are a major cause of deaths worldwide. One of the most frequent microvascular complications in diabetic patients is diabetic nephropathy (DN) which is the leading cause of death and end-stage renal disease (ESRD). Despite the different risk factors for DN identified in previous research, machine learning (ML) methods can help determine the importance of the predictors and prioritize them. The main focus of this investigation is on predicting the incidence of DN in type 2 diabetic mellitus (T2DM) patients using ML algorithms. Demographic information, laboratory results, and examinations on 6235 patients with T2DM covering a period of 10years (2011-2020) were extracted from the electronic database of the Diabetes Clinic of the Imam Khomeini Hospital Complex (IKHC) in Iran. Recursive feature elimination using the cross-validation (RFECV) technique was then used with the three classification algorithms to select the important risk factors. Next, five ML algorithms were used to construct a predictive model for DN in T2DM patients. Finally, the results of the algorithms were evaluated according to the AUC criteria and the one with the best performance in terms of prediction and classification was selected. The 18 DN risk factors selected by RFECV were age, diabetes duration, BMI, SBP, hypertension, retinopathy, ALT, CVD, 2HPP, uric acid, HbA1c, waist-to-hip ratio, cholesterol, LDL, HDL, FBS, triglyceride, and serum insulin. Based on a 10-fold cross-validation, the best performance among the five classification algorithms was that of the random forest with 85% AUC. This investigation validates the known risk factors for DN and emphasizes the importance of controlling the blood pressure, weight, cholesterol, and blood sugar of T2DM patients. In addition, as an example of the application of ML approaches in medical predictions, the findings of this study demonstrate the advantages of using these techniques.

Noncoding RNAs in diabetic nephropathy

Abstract Diabetic nephropathy (DN) is a major microvascular complication in diabetic patients. It has become the leading cause of end-stage renal disease (ESRD) in individuals living in urban areas undergoing dialysis. DN diagnosis primarily depends on the course of diabetes and the detection of albuminuria. However, the onset of DN is obscure, and many patients have already developed ESRD when they are diagnosed with DN. Hence, early diagnosis of DN progression and early interventional strategies are essential. Noncoding RNAs (ncRNAs) are a class of RNA transcripts that are transcribed from DNA but are not translated into proteins. They play an important role in regulating gene expression and protein synthesis. Several studies have demonstrated that ncRNAs are abundantly present in the blood, urine, and tissues and have the potential to aid in the diagnosis and treatment of DN. This review focuses on the role of microRNAs, long ncRNAs, and circular RNAs in DN and their potential value as biomarkers and therapeutic targets.

Investigation of Influencing Factors on the Prevalence of Retinopathy in Diabetic Patients Based on Medical Big Data.

As one of the most important organs of human beings, the eyes can receive external visual information and play an important role in perception. Therefore, the method of maintaining eye health is a problem that people pay attention to. Omental disease is one of the most serious microvascular complications in diabetic patients, and it is also the main cause of blindness in patients. The purpose of this article is to investigate the main factors that influence the prevalence of retinopathy in diabetic patients based on medical big data. In this article, a method for investigating the causes of the incidence of retinopathy in diabetic patients based on medical big data is proposed, and a questionnaire survey method and other methods are used for experimental investigation. Combining the data in the figure in the experiment in this article, it can be seen that among diabetic patients, the prevalence of diabetes in men is 12.4%, and the prevalence of diabetes in women is 8.4%. From the data in the figure, it can be known that the rate of retinopathy caused by various factors is between 5% and 7%, and the total prevalence of retinopathy is 47.5%. There are many factors affecting the prevalence of retinopathy in diabetic patients, such as the duration of diabetes, urinary albumin index, glycosylated hemoglobin index, and fasting blood glucose level; various factors lead to an increase in the prevalence of retinopathy in diabetic patients. The results show that there are many factors affecting the prevalence of retinopathy in diabetic patients, so patients should pay attention to exercise, control their diet, and prevent retinopathy.

IDF21-0448 Role of miR27b on the regulation of angiogenesis in diabetic foot ulcer through Nrf2 signaling

Background: Diabetic foot ulcer (DFU) is a serious microvascular complication in diabetic patients with significant morbidity and mortality. The prevalence of chronic wounds continues to be a key focus of wound care research. Prolonged hyperglycemia-induced slow lymphangiogenesis associated with chronic oxidative stress is a major hallmark for poor wound closure in diabetic patients. Nrf2, a stress-activated transcription factor, combat oxidative stress by increasing antioxidant defense in many diseases, including diabetes. Recently we have reported the association of Nrf2 on the regulation of angiogenesis in DFU patients. Aim: This study aims to decipher the role of miR27b on the regulation of angiogenesis in DFU through Nrf2 signaling and further validation using in vitro system. Method: This study recruited a total of 20 patients with acute DFU and chronic DFU with no other diabetic complications. The expression of miR27b, Nrf2, HO1, SDF-1a and VEGF were studied in the tissues biopsies of study subjects using qPCR. The in vitro studies were carried out using human endothelial cells, EA.hy926 (ECs), exposed to a hyperglycemic microenvironment (High glucose with cytokine cocktail) for 24 hrs. The role of miR27b in regulating angiogenesis was demonstrated using antisense oligonucleotide targeting miR27b. Further, the association of Nrf2 with miR27b was studied using small molecule Nrf2 activators under the hyperglycemic microenvironment. Results: The wound size, levels of CRP, and WBC counts were significantly higher in chronic than in acute DFU. We found a significant reduction in Nrf2, HO1, SDF-1α, and VEGF gene expressions and miR27b in chronic DFU subjects compared with acute DFU subjects. Further, the ECs under hyperglycemic microenvironment also showed reduced expressions of miR27b, Nrf2, HO1 and other angiogenic markers. The knockdown of miR27b using antisense revealed the positive regulation of miR27b in angiogenesis. Further, we observed a significant up-regulation of miR27b in ECs exposed to small molecule Nrf2 activators such as pterostilbene and resveratrol under a hyperglycemic microenvironment. Discussion: Angiogenesis is the crucial step in the wound healing process which is impaired in DFU. Our results were consistent with a few earlier reports suggesting a reduced level of angiogenic markers such as SDF-1α and VEGF with the progression of DFU. We also found a decreased expression of the master regulator Nrf2 in the progression of DFU. Further, we have studied miR27b mediated Nrf2 regulation in tissue biopsies of chronic DFU patients and confirmed by in vitro studies. Inhibiting miR27b by antisense in ECs decreased angiogenic signaling, suggesting its positive role in wound healing. Of note, we confirmed the association of miR27b with the Nrf2 loop by exposing ECs with Nrf2 activators and ameliorated the dysregulated angiogenic signaling. In conclusion, our findings from this study have shown miR27b as an upstream target of Nrf2 that regulates angiogenesis in DFU through Nrf2.

IDF21-0008 The Relationship between Diabetic Retinopathy and other Diabetic Vascular Complications

Background: Diabetic retinopathy (DR) affects approximately one-quarter of individuals with Type 2 diabetes, which is the most common microvascular complication in diabetic patients. However, the direct or indirect relationship between diabetic retinopathy and other diabetic vascular complications remains unknown.

Effect of Chinese Patent Medicines on Ocular Fundus Signs and Vision in Calcium Dobesilate-Treated Persons With Non-Proliferative Diabetic Retinopathy: A Systematic Review and Meta-Analysis.

BackgroundDiabetic retinopathy (DR), one of the commonest microvascular complications in diabetic patients, is featured by a series of fundus lesions. Conventional Western medicine therapies for DR are always with modest treatment outcome. This paper is to assess the ocular fundus signs, vision and safety of Chinese patent medicines (CPMs) as an add-on treatment for DR.Method7 electronic databases were searched to determine eligible trials. Randomized controlled trials (RCTs) of non-proliferative diabetic retinopathy (NPDR) in which the intervention group received CPMs combined with calcium dobesilate (CD), and the control group received only CD were included for analysis. Two reviewers extracted the data independently. Results expressing as mean differences (MD) and relative risks (RR) were analyzed with a fixed-effects or random-effects models.Results19 RCTs involved 1568 participants with 1622 eyes met our inclusion criteria. The results suggested that compared with CD alone, CPMs plus CD for NPDR was superior at reducing the microaneurysm volume (MD -3.37; 95% confidence interval [CI], -3.59 to -3.14), microaneurysm counts (MD -2.29; 95%CI -2.97 to -1.61), hemorrhage area (MD -0.79; 95%CI -0.83 to -0.75), and macular thickness (MD -59.72; 95%CI -63.24 to -56.20). Participants in CPMs plus CD group also achieved a better vision. No obvious adverse events occurred.ConclusionCPMs as an add-on therapy for NPDR have additional benefits and be generally safe. This meta‐analysis demonstrated that CPMs combined with CD could improve retinal microaneurysm, hemorrhage, macular thickness, visual acuity, fasting blood glucose (FBG), and glycosylated hemoglobin (HbAlc) compared with CD alone. Further studies are needed to provide more conclusive evidence.Systematic Review RegistrationPROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42021257999.