non-DR Group Research Articles

The impact of multiple metals exposure on the risk of developing proliferative diabetic retinopathy in Anhui, China: a case-control study.

Through multiple different pathways, the environmental multiple metals make their ways to the human bodies, where they induce different levels of the oxidative stress response. This study further investigated the impact of multiple-metal exposure on the risk of developing proliferative diabetic retinopathy (PDR). We designed a case-control study with type 2 diabetic patients (T2D), in which the case group was the proliferative diabetic retinopathy group (PDR group), while the control group was the non-diabetic retinopathy group (NDR group). Graphite furnace atomic absorption spectrometry (GFAAS) and inductively coupled plasma optical emission spectrometry (ICP-OES) were used to detect the metal levels in our participants' urine samples. The least absolute shrinkage and selection operator (LASSO) regression approach was used to include these representative trace elements in a multiple exposure model. Following that, logistic regression models and Bayesian kernel machine regression (BKMR) models were used to describe the effect of different elements and also analyze their combined effect. In the single-element model, we discovered that lithium (Li), cadmium (Cd), and strontium (Sr) were all positively related to PDR. The multiple-exposure model revealed a positive relationship between Li and PDR risk, with a maximum quartile OR of 2.80 (95% CI: 1.10-7.16). The BKMR model also revealed that selenium (Se) might act as a protective agent, whereas magnesium (Mg), Li, and Cd may raise the risk of PDR. In conclusion, our study not only revealed an association between exposure to multiple metals and PDR risk but it also implied that urine samples might be a useful tool to assess PDR risk.

Associations of levels of high-molecular-weight adiponectin, secreted frizzled-related protein 5 and vascular endothelial growth factor-165 with diabetic retinopathy

Abstract Background: The pathogenesis of diabetic retinopathy (DR) remains unclear. The aim of the study was to explore the associations of DR with the levels of high-molecular-weight adiponectin (HMW-ADP), secreted frizzled-related protein 5 (SFRP-5) as well as vascular endothelial growth factor-165 (VEGF165). Methods: Based on the diagnostic criteria for DR, non-DR (NDR), proliferative DR (PDR) plus non-proliferative DR (NPDR) groups were set up for type 2 diabetes mellitus (T2DM) patients (n=180) treated from January 2020 to March 2021. The control group consisted of another 60 healthy subjects undergoing physical examinations. Their clinical data were compared. Receiver operating characteristic curves were plotted to assess the predictive values of HMW-ADP, VEGF165 and SFRP-5 for DR. The predictive efficiency of the established nomogram model was assessed. Results: The differences in age, fasting plasma glucose (FPG), T2DM duration, triglyceride (TG), hypertension history, high-density lipoprotein cholesterol (HDL-C), glycosylated haemoglobin (HbA1c), serum creatinine (Scr), homeostasis model assessment of insulin resistance (HOMA-IR), urine acid (UA), SFRP-5 HMW-ADP, and VEGF165 were significant between control and DR groups (P<0.05). HMW-ADP, VEGF165 and SFRP-5 had predictive values for DR (AUC>0.7), and the predictive efficiency of their combination was highest. The duration of T2DM, Scr, UA and VEGF165 were independent risk factors for DR, while HMW-ADP and SFRP-5 were protective factors (P<0.05). Preferable discrimination and accuracy together with clinical applicability were obtained for the nomogram prediction model. Conclusions: The three indicators as a whole have a high predictive value for DR, as potential indicators for the clinical screening of high-risk groups.

Correlation Between Blood Glucose Indexes Generated by the Flash Glucose Monitoring System and Diabetic Vascular Complications.

To discuss the relationship between time in range (TIR) which is deprived of the FGMS and the risk of diabetic vascular complications and to provide a theoretical foundation for the clinical application of TIR and other FGMS-deprived indexes. Patients with T2DM who wore the FGMS sensor continuously were enrolled. Relevant indexes such as TIR, time below range (TBR), time above range (TAR), a standard deviation of blood glucose (SDBG), coefficient of variation of blood glucose (CV), and mean amplitude of glycemic excursion (MAGE) generated by the FGMS were recorded, and the risk of diabetic vascular complications were followed up for one year. The TIR was measured by continuous glucose monitoring at baseline, and patients were grouped according to TIR every 20%. Finally, the Cox proportional hazards regression model was used to estimate the association of different levels of TIR with different rates of diabetic vascular complications. TIR was negatively correlated with HbA1C, CV, SDBG, and amplitude of glycemic excursion (MV), wherein, the lower the TIR, the higher the HbA1C, CV, SDBG, and MV. TIR in the diabetic microvascular complication was significantly lower than that in the non-microvascular complication group, and the difference was statistically significant. TIR <40% was identified as a risk factor for DN, DPN, and DR according to the risk assessment. The mean TAR in the DN group was significantly higher than that in the non-DN group. TAR, CV, SD, MAGE, and HbA1C in the DR group were significantly higher than those in the non-DR group. TAR, ABG, CV, SD, MAGE, and HbA1C in the DPN group were significantly higher than those in the non-DPN group. The relationships between the TIR and the prevalence and risk of diabetic vascular complications and the HbA1C may be negative. Other CGM-deprived indexes such as CV and MV should be integrated into glycemic control and diabetes complication prediction.

Longitudinal changes of parafoveal vessel density in diabetic patients without clinical retinopathy using optical coherence tomography angiography

Purpose The purpose of this study was to identify the rate of parafoveal vessel density (VD) changes associated with the progression from non-diabetic retinopathy (NDR) to early stages of DR over a year. Methods This longitudinal cohort study enrolled diabetic patients from the Guangzhou community in China. The patients with NDR at baseline were included and underwent comprehensive examinations at baseline and after 1 year. A commercial OCTA device (Triton Plus, Topcon, Tokyo, Japan) was employed to quantify the foveal VD in the superficial and deep capillary plexuses. The rates of change in parafoveal VD over time in the incident DR and NDR groups were compared after a year. Results A total of 448 NDR patients were included in the study. Among them, 382 (83.2%) were stable and 66 (14.4%) developed incident DR during the 1-year follow-up. The average parafoveal VD in the superficial capillary plexus (SCP) reduced significantly more quickly in the incident DR group than in the NDR group (-1.95 ± 0.45%/year vs. -0.45 ± 0.19/year, P= 0.002). The VD reduction rate for the deep capillary plexus was not significantly different for the groups (P = 0.156). Conclusions The incident DR group experienced a significantly faster reduction in parafoveal VD in the SCP compared with the stable group. Our findings further provide supporting evidence that parafoveal VD in the SCP may be used as an early indicator of the pre-clinical stages of DR.

The Ratio of Fibrinogen to Albumin is Related to the Occurrence of Retinopathy in Type 2 Diabetic Patients.

Type 2 diabetic retinopathy is a long-term chronic inflammatory disease. The aim of this study was to investigate the relationship between fibrinogen to albumin ratio (FAR) and retinopathy in type 2 diabetic patients. This was a retrospective study that included 500 patients with type 2 diabetes mellitus (T2DM), and were divided into non-diabetic retinopathy group (NDR, n=297) and diabetic retinopathy group (DR, n=203) according to fundus examination findings, and the DR group was further divided into non-proliferative retinopathy group (NPDR, n=182) and proliferative retinopathy group (PDR, n=21). Baseline data of patients were collected, and the fibrinogen to albumin ratio (FAR) and neutrophil to lymphocyte ratio (NLR) were calculated to analyze the correlation between FAR and NLR and type 2 diabetic retinopathy. The FAR and NLR were significantly higher in the DR group compared with the NDR group (both P < 0.001). Spearman correlation analysis showed that FAR was positively correlated with NLR and DR (P < 0.05). As the FAR quartile increased, the prevalence of DR increased (14.8%, 16.7%, 25.1%, and 43.30%, respectively; P < 0.05). Multifactorial logistic regression analysis showed that FAR, diabetic course, systolic blood pressure (SBP) and diabetic peripheral neuropathy (DPN) were risk factors for the development of DR in patients with T2DM. The area under the ROC curve for FAR to predict DR progression was 0.708, with an optimal critical value of 7.04, and the area under the ROC curve for diabetes duration and SBP to predict DR was 0.705 and 0.588, respectively. Our findings show for the first time that FAR is an independent risk factor for assessing DR in patients with type 2 diabetes.

Analysis of retinal and choroidal characteristics in patients with early diabetic retinopathy using WSS-OCTA.

Diabetic retinopathy (DR) is one of the most common and destructive microvascular complications of DM, and has become a major cause of irreversible visual impairment. The purpose of this study was to evaluate the changes in fundus microcirculation in non-diabetic retinopathy (NDR) and mild non-proliferative diabetic retinopathy (NPDR) in patients with type 2 diabetic mellitus (T2DM) using widefield swept-source optical coherence tomography angiography (WSSOCTA), and to investigate the correlation with laboratory indices of T2DM. Eighty nine, 58 and 28 eyes were included in the NDR, NPDR and Control groups, respectively, were enrolled in this study. The 12mm×12mm fundus images obtained by WSS-OCTA were divided into 9 regions (supratemporal, ST; temporal, T; inferotemporal, IT; superior, S; central macular area, C; inferior, I; supranasal, SN; nasal, N; inferonasal, IN) to evaluate changes in vessel density (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris, and mid-large choroidal vessel (MLCV), as well as changes in inner retinal thickness (IRT), outer retinal thickness (ORT), and choroidal thickness (CT). Results: Compared with control group, MLCV VD (I, N, IN) was significantly decreased in NDR group, SCP VD (IT, C, I) and DCP VD (T, IT, I) were significantly decreased in NPDR group. In NPDR group, DCP VD (IT) was significantly decreased compared with that in NDR group. Compared with control group, CT (ST, T, IT, S, SN, IN) was significantly declined in NDR group, and IRT (ST, IT) and ORT (ST, N) were significantly increased in NPDR group. In NPDR group, IRT (ST) and ORT (T, S) were significantly increased compared with NDR group. Correlation analysis showed that age, body mass index, fasting blood glucose, fasting insulin, fasting C-peptide, and estimated glomerular filtration rate in T2DM patients were statistically correlated with retinal and choroidal thickness/VD. Structural and blood flow changes in the choroid occur before the onset of DR and precede changes in the retinal microcirculation, and MLCV thickness/VD is a more sensitive imaging biomarker for the clinical detection of DR. WSS-OCTA enables large-scale non-invasive visual screening and follow-up of the retinal and choroidal vasculature in DR patients, providing a new strategy for the prevention and monitoring of DR in patients with T2DM.

Association between high-density lipoprotein cholesterol to apolipoprotein A ratio and diabetic retinopathy: A cross-sectional study

AimsOur study is aimed to investigate the relationship between high-density lipoprotein cholesterol to apolipoprotein A ratio (HDL-C/ApoA) and diabetic retinopathy (DR) in subjects with type 2 diabetes mellitus (T2DM). MethodsWe retrospect the consecutive medical files of 1058 subjects with T2DM and recorded their clinical information and laboratory findings. Subjects with T2DM were divided into DR group (n = 522) and non-DR group (n = 536). We compared the lipids values of the two groups. Meanwhile we also observed the prevalence of DR at different HDL-C/ApoA levels. Binary logistic regression was used to correct confounding factors. Smooth curve fitting model and subgroup analysis were used to determine the correlation, non-linear relationship and threshold effect between HDL/ApoA and DR. ResultsHDL-C/ApoA value of DR group was significantly higher than non-DR group (0.88 ± 0.17 vs 0.84 ± 0.13, P < 0.05). The prevalence of DR significantly increased as HDL-C/ApoA level increased. There was association between HDL/ApoA levels and DR in the adjusted models (OR 1.55, 95%CI 0.60 to 4.02). After full adjustments for other relevant clinical covariates, patients with HDL/ApoA values in quartile 3 (Q3) had 1.50 times (95 % CI 1.00 to 2.17) and in Q4 had 2.39 times (95%CI 1.65 to 3.47) as high as the risk of DR compared with patients in Q1. HDL/ApoA showed a non-linear relationship with DR, with an inflection point value of 0.759. When HDL/ApoA>0.759, HDL/ApoA was significantly positively associated with DR (HR = 26.508, 95 % CI 7.623–92.174; P < 0.0001). Compared to patients with age < 60, HDL/ApoA was obviously associated with DR when age ≥ 60 (OR = 38.05, 95 % CI 8.06–179.69; P < 0.001). ConclusionsHDL-C/ApoA was found to be associated with the incidence of DR in patients with T2DM. After adjusting potential related factors HDL-C/ApoA OR value was 1.55 (95%CI 0.60 to 4.02). A non-linear association between HDL/ApoA and DR was observed in T2DM. Subgroup analysis showed that age could alter the relationship between HDL/ApoA and DR.

Evaluation of the lamina cribrosa in different stages of diabetic retinopathy.

To evaluate the relationship of the peripapillary retina nerve fiber layer (RNFL) and lamina cribrosa (LC) with diabetic retinopathy (DR) in type 2 diabetes mellitus (DM) cases. Prospective comparative study. This study included 50 non-DR (Group 1), 55 non-proliferative diabetic retinopathy (NPDR) (Group 2), 28 DM cases with proliferative diabetic retinopathy (PDR) (Group 3) and 45 healthy volunteers (Group 4). All participants were evaluated with visual acuity, intraocular pressure (IOP) with Goldman applanation tonometry, anterior segment biomicroscopy, 24 - 2 visual field testing, and dilated fundus examination. Retinal nerve fiber layer (RNFL) thickness, lamina cribrosa thickness (LCT) and anterior lamina cribrosa depth (ALCD) were examined by spectral-domain optical coherence tomography (OCT). There was no difference between the groups in terms of age and gender. Visual acuity (p < 0.001) was significantly different between the groups, while IOP (p = 0.068) was similar. Mean (p = 0.010), superior-temporal (p = 0.024), and superior-nasal (p = 0.011) RNFL thickness decreased significantly in correlation with the stage of DR. LCT decreased significantly as the stage of DR progressed in both vertical and horizontal radial OCT scans (p < 0.001). ALCD was not different between groups (p = 0.954 for horizontal scan, p = 0.867 for vertical scan). Peripapillary RNFL and LCT significantly decreases as the DR stage progresses. The biomechanical effects of the LC may also be responsible for diabetes-induced neurodegeneration.

Analysis of independent risk factors for progression of different degrees of diabetic retinopathy as well as non-diabetic retinopathy among type 2 diabetic patients.

To study the independent risk factors for development of different degrees of diabetic retinopathy (DR) as well as non-DR (NDR) among type 2 diabetic patients. This cross-sectional study included 218 patients with type 2 diabetes between January 2022 and June 2022. All the patients were divided into two groups: the DR group and the NDR group. The DR group was subdivided into the mild, moderate and severe non-proliferative DR (NPDR) group and the proliferative DR (PDR) group. Data recorded for all patients included age, gender, duration of diabetes, blood pressure, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), blood lipids, best corrected visual acuity (BCVA), intraocular pressure (IOP), axial length (AL), anterior chamber depth (ACD), and renal function. Logistic regression methods were used to analyze the risk factors for DR. The prevalence of DR in type 2 diabetes was 28.44%. The duration of diabetes, age, mean arterial pressure (MAP), HbA1c, FBG, urinary albumin/creatinine ratio (UACR), BCVA, AL, and ACD were significantly different between the DR and the NDR groups (p < 0.05). Multivariate logistic regression analysis identified age, FBG, UACR, and AL as the independent risk factors for DR (OR = 0.843, 2.376, 1.049, 0.005; p = 0.034, 0.014, 0.016, p < 0.001). Young age, short AL, higher levels of FBG and UACR were the independent risk factors for the progression of DR in type 2 diabetes.

Serum metabolomic profiles and semaphorin-3A as biomarkers of diabetic retinopathy progression

Diabetic retinopathy (DR) is a typical microvascular complication of diabetes mellitus (DM) and it remains one of the leading causes of vision loss worldwide. Studies postulated that a distinct metabolic signature of DR exists and can be resolved from that of diabetes alone. Serum Semaphorin3A (Sema3A) levels have also been found to be correlated with the phenotypes of diabetic retinopathy. We aimed to analyze and identify serum metabolites and serum Sema3A levels that could be useful biomarkers of DR progression. This cross-sectional study included 45 type 2 diabetes (T2D) patients. Diabetic patients were divided into three groups based on the status of their complications: non-DR (NDR, n=15), non-proliferative DR (NPDR, n=15), and proliferative DR (PDR, n=15) groups. Serum metabolomic profiles of these patients were determined by using high-performance liquid chromatography-mass spectrometry (HPLC-MS), and serum Sema3A levels measured by ELISA. Metabolomics analysis revealed a set of metabolites that were altered in the serum of PDR patients as compared with NPDR and NDR groups. Among these metabolites total asymmetric dimethylarginine (ADMA) and Kynurenine were potential predictors of PDR patients. Significantly higher serum levels of Sema3A in PDR patients as compared with NPDR and NDR groups (p < 0.001), their serum levels were positively correlated with the central macular thickness (r= 0.952, p < 0.001) and negatively correlated with the superficial macular density (r=-0.952, p < 0.001). In conclusion, the metabolite signatures identified in this study and serum Sema3A levels could be proposed as biomarkers for DR development and progression in T2D patients. However, Sema3A was superior to metabolomics in the prediction of the severity of DR.

An Association Between the Intestinal Permeability Biomarker Zonulin and the Development of Diabetic Retinopathy in Type II Diabetes Mellitus.

Increased intestinal permeability (IP) and gut microbiota dysbiosis have been implicated in low-grade chronic inflammation, which is an important factor in the pathogenesis of diabetic retinopathy (DR). This study aims to demonstrate the relationship between the IP biomarker zonulin and DR in patients with type 2 diabetes mellitus (T2DM). This study was conducted with a total of 89 T2DM patients, including 33 non-DR, 28 with non-proliferative DR (NPDR), and 28 with proliferative DR (PDR), and 32 healthy controls. Zonulin levels were determined from blood samples using an enzyme-linked immunosorbent assay kit. There was no difference between the four groups in terms of age (p=0.236), gender (p=0.952), and body mass index (p=0.134) of the participants. Zonulin levels were significantly higher in the PDR group compared to the other three groups, as well as in the non-DR and NPDR groups compared to the control group. In multivariate logistic regression analysis, zonulin was found to be an independent predictor of DR (odds ratio: 1,781, 95% confidence interval: 1,122-2,829, p=0.014). Our study showed that elevated zonulin levels may play a significant role in the development of DR, particularly during the transition to the proliferative stage. This suggests that regulation of IP could be one of the targets of DR treatment. More studies are needed to determine whether a eubiotic gut microbiota and IP have a direct relationship with DR.

Relationship Between Estimated Glucose Disposal Rate and Type 2 Diabetic Retinopathy.

To investigate the association between diabetic retinopathy (DR), DR intensity, and estimated glucose disposal rate (eGDR) in individuals with type2diabetes mellitus (T2DM). This study comprised 1762 T2DM patients who were admitted between January and December, 2021. Overall, the DR was identified in 430 patients. Based on the eGDR, the participants were divided into four study groups. One-way analysis of variance was used to compare the groups. The correlations between eGDR and DR risk, eGDR, and DR severity were analyzed using regression analysis. Furthermore, these relationships were analyzed in different sex groups. Patients with T2DM had a 19.75% (348/1762) DR detection rate, whereas those with DR had a 22.41% (78/348) proliferative DR detection rate. The DR group had substantially reducedlevels of eGDR compared with the non-DR group. Multivariate logistic regression analysis demonstrated that reduced eGDR was an independent risk factor for DR, after adjusting forconfounding variables. eGDR correlated significantly with proliferative DR in women but not in men. In Chinese individuals with T2DM, lower eGDR was independently associated with a higher risk of DR.

Are VEGF and SCUBE1 gene expressions increased in diabetic retinopathy?

Abstract Objectives In the current study, we synergistically evaluated vascular endothelial growth factor (VEGF) gene expression levels and signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) gene expression levels in diabetic patients without retinopathy, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). Methods 94 blood samples from 26 healthy controls, 29 non-DR, 22 NPDR, and 17 PDR patients were collected in sterile EDTA tubes. Total RNA was obtained from these samples without waiting and then converted to cDNA. The expression levels of the VEGF and SCUBE1 genes were determined by quantitative real-time polymerase chain reaction (qPCR). Results SCUBE1 gene expression levels were 2.15 (p=0.015), 1.75 (p=0.799), 2.37 (p=0.037) times higher, and VEGF gene expression levels were 1.71 (p=0.023), 1.75 (p=0.012), 1.85 (p=0.031) times higher in the non-DR, NPDR, and PDR groups compared to the control group, respectively. VEGF gene expression levels were significantly higher in participants with HbA1c levels ≥5.7% compared to those with &lt;5.7. SCUBE1 and VEGF gene expression levels were significantly higher in participants with fasting plasma glucose (FPG) levels ≥126 mg/dL than those with &lt;126 mg/dL. Conclusions As a result, SCUBE1 gene expression levels are higher than VEGF gene expression levels, especially in the PDR group. Therefore, SCUBE1 may contribute to the pathology of DR just like VEGF by generating angiogenesis. However, we believe there is a need for experimental animal model studies with DR examining SCUBE1 gene expression levels in tissue samples.

Association between Age at Type 2 Diabetes Onset and Diabetic Retinopathy: A Double-Center Retrospective Study.

With the decreasing age of type 2 diabetes mellitus (T2DM) onset, the incidence of diabetic complications is gradually increasing. We evaluated the independent effect of age at diabetes onset on diabetic retinopathy (DR) development. A total of 7472 patients with T2DM were enrolled in the National Metabolic Management Center from September 2017 to May 2022. Anthropometry data, laboratory reports, and medical history were collected. The independent association of DR with age at diabetes onset was analyzed using multivariable logistic regression models. In addition, a stratified analysis was performed to determine the effect of confounding variables. Of the 7472 patients recruited, 1642 (21.98%) had DR. Patients with DR had considerably younger ages of diabetes onset than those without DR (45 (38-53) years vs. 50 (43-57) years, P < 0.001). The proportion of patients with T2DM onset at a younger age was higher in the DR group than that in the non-DR group. Participants were divided into four groups according to their age at diabetes onset, namely, ≥60, <40, 40-49, and 50-59 years. Compared with patients with diabetes onset at age ≥ 60 years, those with diabetes onset at <40 years (odds ratio (OR): 5.56, 95% confidence interval (CI): 3.731-8.285, P < 0.001), 40-49 years (OR: 2.751, 95% CI: 2.047-3.695, P < 0.001), and 50-59 years (OR: 1.606, 95% CI: 1.263-2.042, P < 0.001) were at an increased risk of DR after adjusting for potential confounding factors. Furthermore, stratification analyses demonstrated that young age at diabetes onset is an independent risk factor for DR. Compared with diabetes onset at an older age, diabetes onset at a younger age is associated with a significantly increased DR risk.

Evaluation of Serum ANGPTL8/Betatrophin and Cartonectin/CTRP3 Levels in Diabetic and Non-Diabetic Retinopathy.

To determine serum betatrophin and cartonectin levels and their relationship with biochemical parameters in diabetic and non-diabetic retinopathy. Descriptive study. Department of Internal Medicine and Ophthalmology, School of Medicine, Firat University, Turkey, from April to November 2020. Patients with diabetic retinopathy (DR), non-diabetic retinopathy (non-DR), type 2 diabetes mellitus without retinopathy, and healthy controls, were enrolled from April to November 2020. Demographic, metabolic, and biochemical parameters were evaluated. Serum betatrophin, cartonectin, IL-6, and TNFα levels were assayed by ELISA methods. One-Way Anova or Kruskal Wallis tests were applied to find out statistical significance among different variables between four groups. A total of 84 participants (DR= 21 patients; non-DR= 21 patients; 21 diabetic patients without retinopathy and 21 healthy controls) were enrolled in the study. TNF-α level was significantly higher in both DR and non-DR than in controls (p<0.001). IL-6 level was higher in DR group than T2DM and controls (p=0.013). Serum betatrophin level was significantly higher in DR group than in non-DR and T2DM groups (p=0.002). Cartonectin level was decreased in DR, non-DR, and T2DM groups compared to non-diabetic healthy controls (p=0.002). Serum betatrophin levels are higher in DR, whereas cartonectin levels are lower in both DR and non-DR groups. Serum betatrophins and cartonectin estimation may be helpful in early diagnosis and differential diagnosis in cases of diabetic and non-diabetic retinopathy. Angiopoietin-like protein 8, Cartonectin/CTRP3, Diabetic retinopathy, Diabetes mellitus, Type 2, Diagnosis, Differential, Betatrophin.

PS-C15-10: ASSOCIATION OF BODY MASS INDEX, WAIST-TO-HEIGHT RATIO AND DURATION OF TYPE 2 DIABETES MELLITUS WITH DIABETIC RETINOPATHY IN WOMEN

Objective: Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus (DM). It is a leading cause of visual impairment and blindness worldwide, reducing the quality of life of patients. Clear evidence of association between anthropometric measurements and DR risk is lacking in Nigerian females with type 2 DM (T2DM). Design and Methods: A cross-sectional study of 57 female participants with physician-diagnosed T2DM with or without systemic hypertension. Anthropometric measurements were taken. Fasting blood samples were drawn for laboratory analysis. All patients underwent dilated fundoscopy by a single Ophthalmologist and diabetic retinopathy was graded based on the worse eye. Results: The mean age of the participants was 60.8 ± 11.0 years with no significant age difference between the DR and Non-DR groups. Of the 57 participants, 36 had varying degrees of DR while 21 had no features of DR. Among the patients with DR, 26 were hypertensive diabetic while 10 were only diabetic. The hypertensive diabetic were older than the diabetic. The mean weight and body mass index (BMI) were higher in the non-DR group compared to the DR group. The DR group had significantly longer disease duration for both diabetes and hypertension. The hypertensive diabetic had significantly higher systolic blood pressure (SBP), pulse pressure (PP), total cholesterol-high density lipid ratio (TC:HDL) and serum triglyceride (TG) than the diabetic. BMI was negatively correlated with presence of DR, while weight, TyG-BMI, weight-height ratio (WHt), hip circumference (HC) and DM duration were positively correlated. BMI, WHt and TyG-BMI were negatively correlated with severity of DR while DM duration showed positive correlation. Linear regression showed that the independent determinant of the presence of DR in hypertensive diabetic were WHt and DM duration, while for severity of DR, DM duration, neutrophil-lymphocyte ratio (NLR) and HbA1c status were predictors. When adjusted for DM duration, presence of DR was predicted by WHt while severity was predicted by BMI. The curve of the receiver operating characteristic was also plotted to establish the relevance of each of the factors predicting DR and their area under the curve (AUC) was compared. The results showed that DM duration, HbA1c status, NLR, HTN duration, BMI, WHt were predictors. Conclusions: BMI, waist-to-height ratio and DM duration and neutrophil-to-lymphocyte ratio are associated with the occurrence and severity of DR in female hypertensive diabetic.

Macular Vascular Complexity Analysis of Diabetes Mellitus by Swept-Source Optical Coherence Tomographic Angiography

Purpose: This study was designed to evaluate the associations between retinal vascular complexity features, including fractal dimension (FD) and blood vessel tortuosity (BVT), and the severity of diabetic retinopathy (DR) by using optical coherence tomographic angiography (OCTA). Methods: In this prospective cross-sectional study, 1,282 ocular-treatment-naive patients with type 2 diabetes mellitus (DM) (1,059 without DR and 223 with DR) registered in the community of Guangzhou, China, were enrolled. OCTA was used to measure FD and BVT in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). Univariate and multivariate linear regression analyses were performed to analyze the correlation of FD and BVT in different layers with DR severity. Results: In this study, 1,282 patients with DM (1,282 eyes), with a mean age of 64.2 ± 7.8 years, were included. FD in the DCP decreased and BVT in the DCP increased in patients with DR compared with those in patients without DR, even after adjusting for confounding factors (p < 0.05). Trend analysis showed a significant decrease in the FD values as the DR progressed, whereas the BVT progressively increased with worsening DR severity (p < 0.01). The FD in DCP had a statistically significant positive correlation with FD in SCP and a negative correlation with BVT in SCP and BVT in DCP in all of the participants, including the non-DR group, moderate DR group, and severe DR group (p < 0.01). Conclusions: FD and BVT determined using OCTA might be useful parameters for objectively distinguishing DR from non-DR and indicating DR progression.

Rates of choroidal loss and ganglion cell–inner plexiform layer thinning in type 2 diabetes mellitus and healthy individuals: a 2-year prospective study

AimsTo investigate longitudinal choroid and ganglion cell–inner plexiform layer (GCIPL) changes in type 2 diabetes mellitus (T2DM) patients and healthy populations across 2 years.MethodsThis prospective cohort study included T2DM patients...

LBODP058 Evaluation Of Factors Associated With The Development Of Diabetic Retinopathy Based On A Case-control Study

Abstract Objectives Diabetic Retinopathy (DR) is a microvascular complication of diabetes mellitus (DM) and one of the leading causes of irreversible vision loss, particularly in the most productive age group. Several epidemiological studies have found that diabetics worldwide and in India have a high prevalence of DR. Risk estimation of various factors has been performed earlier however there is dearth of case control studies among the diabetics who developed DR and those who were unaffected. This study was planned to identify the sociodemographic, disease related and lifestyle related risk factors for development of DR among diabetics which could broadly be categorized under modifiable and non-modifiable factors. Findings from the study could help clinicians develop predictors and risk-based screening programs for early detection of DR. Material &amp; Methods In this age and gender matched case control study, total 256 diabetes mellitus patients (96% type 2) were recruited equally in groups with diabetic retinopathy (DR) and without it. Diagnosis of DR was done by fundal examination as per the Early Treatment for Diabetic Retinopathy Study (ETDRS) standard. Adherence to diabetes medications was measured using four items in vernacular language adapted from the MMAS-4 (Morisky Medication Adherence Scale). Univariate and multivariate binary logistics regression was performed to find the independent risk (Odd's ratio) and modified Odd's ratio respectively. Results There was parity between cases and controls in terms of gender distribution and age. Mean age of DR and non-DR group was 63.7 ± 9.5 and 63.3 ± 10.4 years respectively. Independent risk factors for development of DR were presently on insulin therapy (OR=2.87,p=0. 0001), smoking (OR=1.92,p=0. 02), alcoholism(OR=2.62,p=0. 03), sedentary lifestyle(OR=2.72,p=0. 0008), non-adherence to diabetes medications (OR=14. 08,p=0. 0001), non-adherence to dietary advice (OR=4.41,p=0. 0001), presence of other microvascular complications (OR=3.79,p=0. 0001), dyslipidemia (OR=1.85,p=0. 02) and hypertension (OR=5.91,p=0. 0001). On multivariate logistics regression analysis, non-adherence to medicine (Exp(B)=7.89,p=0. 0001) and hypertension (Exp(B)=1.16,p=0. 0001) were predictors of development of DR . Type of occupation, education, socioeconomic status and type of diabetes did not have any correlation with development of DR among diabetics. Conclusion Diabetics under insulin therapy and with hypertension have a seriously increased risk of developing DR. Smoking, alcohol abuse, sedentary lifestyle, failure to take diabetes medications, and failure to follow dietary advice are independent risk factors for developing DR that can be modified through lifestyle changes in diabetics. DR should be monitored more closely in patients with other microvascular complications and dyslipidemia. Presentation: No date and time listed

Tortuosity of branch retinal artery is more associated with the genesis and progress of diabetic retinopathy.

ObjectiveThe purpose of this study is to investigate the potential of using the tortuosity of branch retinal artery as a more promising indicator for early detection and accurate assessment of diabetic retinopathy (DR).Design and methodThe diagnoses, consisting of whether DR or not as well as DR severity, were given by ophthalmologists upon the assessment of those fundus images from 495 diabetic patients. Meanwhile, benefiting from those good contrast and high optical resolution fundus images taken by confocal scanning laser ophthalmoscope, the branch arteries, branch veins, main arteries and main veins in retina can be segmented independently, and the tortuosity values of them were further extracted to investigate their potential correlations with DR genesis and progress based on one-way ANOVA test.ResultsFor both two comparisons, i.e., between non-DR group and DR group as well as among groups with different DR severity levels, larger tortuosity increments were always observed in retinal arteries and the increments in branch retinal vessels were even larger. Furthermore, it was newly found that branch arterial tortuosity was significantly associated with both DR genesis (p=0.030) and DR progress (p<0.001).ConclusionBased on this cohort study of 495 diabetic patients without DR and with different DR severity, the branch arterial tortuosity has been found to be more closely associated with DR genesis as well as DR progress. Therefore, the branch arterial tortuosity is expected to be a more direct and specific indicator for early detection of DR as well as accurate assessment of DR severity, which can further guide timely and rational management of DR to prevent from visual impairment or even blindness resulting from DR.