Risk Factors For Diabetic Retinopathy Research Articles

90-OR: Vision-Threatening Diabetic Retinopathy (DR) Is Associated with Modifiable Risk Factors in Children with Type 1 Diabetes (T1D)

Vision-threatening DR (vtDR) is commonly defined as moderate nonproliferative or more severe DR, or the presence of diabetic macular edema (DME). Modifiable risk factors of DR and vtDR are well-established in adults. This study identified risk factors associated with DR and vtDR in a large pediatric cohort with T1D. Medical chart review was performed of baseline visits of pediatric (≤21 yrs old) patients at an academic eye center from 2005-2020 to collect demographic characteristics, medical history and DR severity. Analyses were adjusted for correlation between eyes of the same person. In total, 1735 subjects (3454 eyes) were included with mean±SD age 15.4±4.6 years, T1D duration 7.1±5.3 years, T1D onset 8.3±5.4 years, and A1c 8.4±1.3; 50.7% were female, 30.7% were overweight/obese and 4.1% had elevated/high BP. Any DR was present in 8.5% and vtDR in 2.4% of eyes. Unadjusted analyses found DR presence associated with higher A1c (p<.0001), longer T1D duration (p<.0001), younger age of T1D onset (p=0.0002), older age (p<.0001), female sex (p=0.001), higher BMI (p<.0001) and elevated/high BP (p<.0001). After backwards elimination modeling, older age (p<.0001), longer T1D duration (p=0.002) and higher A1c (p=0.01) were significantly associated with DR. In unadjusted analyses, vtDR was associated with higher A1c (p<.0001), longer T1D duration (p<.0001), younger age of T1D onset (p=0.001), older age (p<.0001), female sex (p=0.009), higher BMI (p=0.009) and elevated/high BP (p<.0001). Using backwards elimination modeling, older age (p<.0001), younger age of T1D onset (p<.0001) and elevated/high BP (p=0.0007) were significantly related to vtDR. In this pediatric cohort, DR or vtDR were present in 8.5% of eyes and were associated with modifiable risk factors of hyperglycemia and elevated BP. Future longitudinal studies can assess if early intervention to improve glycemic control and BP can reduce vtDR in youth with T1D. Disclosure C. Jacoba: None. K. Sampani: None. C. Gilbert: None. P. S. Silva: Research Support; Self; Hillrom, Optomed, Optos plc. J. Keady: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. L. P. Aiello: Consultant; Self; KalVista Pharmaceuticals, Novo Nordisk, Regeneron Pharmaceuticals Inc., Stock/Shareholder; Self; KalVista Pharmaceuticals. J. Sun: Other Relationship; Self; Novo Nordisk, Roche Pharma, Research Support; Self; Adaptive Sensory Technology, Boehringer Ingelheim Pharmaceuticals, Inc., KalVista Pharmaceuticals, Optovue, Roche Pharma.

436-P: Low Prevalence of Diabetic Retinopathy in Type 1 Diabetes Patients with a Long-Term Modernly Treated Disease and Very Good Glycaemic Control: A Retrospective Single-Center Analysis

Despite continuous progress in the therapy of type 1 diabetes (T1DM), diabetic retinopathy (DR) is still a common chronic complication. We aimed to analyse DR prevalence and its predictors in patients with T1DM lasting 10 years or more, treated with modern methods, and with excellent glycaemic control. The analysis included data from 384 (80.7% women) patients taking part in the Polish National Health Fund’s Program of Comprehensive Outpatient Specialist Care at the University Hospital in Krakow between 2014-2020. A retrospective analysis of data from medical records was applied. T1DM patients of average 34 ± 9.2 years, mean BMI of 25.0 ± 3.9 and diabetes duration of 20.5 ± 7.9 years was included. The mean HbA1c of all patients throughout the follow-up period was 6.9 ± 1 % [52 mmol/l]. The analysed group consisted of 238 (62,0%) patients treated with CSII, 99 (25.8%) treated with MDI; and 47 (12.2%) who used both methods during the observation period. All patients used short-acting analogues, 144 (98.6%) MDI users were treated with long-acting analogues. DR was confirmed in 150 (39.1%) patients, 109 (72.2 %) of them were diagnosed de novo in the analysed period. Severe DR, defined as an advanced non-proliferative DR or proliferative DR, was observed in 31 persons (8.07% of the entire study group and 20.7% of the DR group).In the multivariate logistic regression model, T1DM duration (OR 1.13; 95% CI, 1.09-1.19), HbA1c level (OR 1.41; 95% CI, 1.08-1.84), LDL level (OR 1.79; 95% CI, 1.16-2.87), and combined incidence of non-DR micro- and macrovascular chronic complications (OR 1.86; 95% CI, 1.16-3.03) were independent risk factors for DR presence. In our long-term retrospective study, the prevalences of both any stage of DR and severe DR were lower than reported in other cohorts from earlier periods. Independent risk factors for DR in this highly selected cohort did not differ from the previously reported. Disclosure P. Surowiec: None. B. Matejko: Other Relationship; Self; Ascensia Diabetes Care, Roche Diabetes Care. M. Kopka: None. A. Filemonowicz-skoczek: None. T. Klupa: Advisory Panel; Self; Dexcom, Inc., Ypsomed Group, Employee; Spouse/Partner; Ascensia Diabetes Care, Research Support; Self; Abbott Diabetes, Speaker’s Bureau; Self; Bioton S. A., Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk Inc., Sanofi-Aventis. B. A. Romanowska-dixon: None. K. Cyganek: Advisory Panel; Self; Medtronic, Speaker’s Bureau; Self; Lilly Diabetes, Novo Nordisk. M. Malecki: Advisory Panel; Self; Abbott Diabetes, Medtronic, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Merck & Co., Inc., Mundipharma International, Novo Nordisk, Sanofi-Aventis, Servier Laboratories.

Polymorphisms of vascular endothelial growth factor-2578C/A rs699947 are risk factors for diabetic retinopathy in type-2 diabetes mellitus patients in Bali, Indonesia.

BackgroundDiabetic retinopathy (DR) is one of the complications in diabetes mellitus (DM) which caused by microvascular-damage in the retina due to long termmetabolic changes in diabetes. To date, there has been much research targeted on the determinant of genetic identification in DR patients. In DR, Vascular Endothelial Growth Factor (VEGF) gene is accountable for breaking down the blood-retinal barrier and implicated in the role of neovascularization. It is thought that the polymorphism of VEGF -2578C/A (rs699947) contributed to the development of diabetic retinopathy in type 2 DM.AimTo determine whether the polymorphisms of VEGF-2578C/A are the risk factors for DR in type 2 DM patients in Bali, Indonesia.MethodsThis study is a case-control model comparing 33 cases DR patients in type-2 diabetes mellitus and 35 cases of non-DR as controls in Balinese ethnic. Polymorphisms of VEGF-2578C/A were examined by PCR analysis and DNA sequencing on rs699947 to identify any variation in A/C/T allele distribution. Chi-square test was used to analyze the data and determine the relation of polymorphism and DR.ResultsThis research showed the genetic variation existence in VEGF-2578C/A polymorphism significantly (p = 0,000) with C allele was higher in the DR group, in contrast, A and T allele were greater in the non-DR group compared to DR group. The result showed that C allele in VEGF-2578 contributed as a risk factor (OR = 13.05; 95% CI = 2.69–63.18; p = 0.001) for DR in type-2 DM (T2DM) patients in Bali, Indonesia.ConclusionPolymorphism of VEGF-2578C/A (rs699947) allele distribution can be concluded as a risk factor of DR within T2DM patients in Bali, Indonesia. This study may also be used to expand the knowledge in managing DR patients at an earlier stage to avoid further complications.

Magnitude and Determinants of Diabetic Retinopathy Among Indian Diabetic Patients Undergoing Telescreening in India.

Purpose: To determine the magnitude, determinants, and public health issues related to diabetic retinopathy (DR) in India using 2019 data from a for-profit telescreening program. Methods: Digital retinal images were captured using a nonmydriatic fundus camera and transferred via the telescreening program to a reading center. Ophthalmologists trained in DR image reading created the DR status reports. Age/sex-adjusted rates of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) were calculated and correlated with known risk factors. Results: Images of 51,760 Indian diabetic patients (103,520 eyes) were reviewed. The prevalence of DR, STDR, and DME was 19.1% (95% confidence interval [CI]: 18.9-19.5), 5.1% (95% CI: 4.9-5.3), and 3.9% (95% CI: 3.7-4.1), respectively. Based on these data, we projected 14.7 million cases of DR, 3.9 million with STDR, and 3.0 million DME cases in India. Statistically significant risk factors for DR were male gender (odds ratio [OR] = 1.19, p < 0.001), older age (χ2 = 270, df = 3, p < 0.001), history of cataract surgery (OR = 2.0, p < 0.001), longer duration of diabetes (χ2 = 1084, p < 0.001), and type 1 diabetes (OR = 3.9, p = 0.01). There was a statistically significant variation of DR by geographic zones (χ2 = 310, p < 0.001). Laser treatment coverage for STDR was 22%. Duration of diabetes (p < 0.001), cataract surgery in the past (p = 0.02), and females (p = 0.001) were predictors of STDR. Conclusion: This model of telescreening for DR provides an additional pathway for screening and preventing diabetes-related visual morbidity in India. The data from this study can be used for epidemiologic and ophthalmic health policies related to diabetes.

Obstructive sleep apnea and the retina: a review.

This review's objective was to synthesize the literature on the repercussions of obstructive sleep apnea (OSA) in the retinal vascular system. Two independent investigators conducted a search using the MEDLINE/PubMed database using the following terms: sleep apnea syndrome, obstructive sleep apnea, retina, vascular tortuosity, central serous chorioretinopathy, diabetes mellitus, and subfoveal choroidal thickness. Patients with OSA present increased vascular tortuosity compared with patients without OSA, decreased parafoveal and peripapillary vessel density, and increased retinal vein occlusion incidence. In central serous chorioretinopathy patients and patients who are poor responders to intravitreal anti-VEGF (-vascular endothelial growth factor) treatment for macular edema, OSA is more frequent. Macular choroidal thickness alterations are controversial, and OSA may worsen diabetic maculopathy, thus being a risk factor for diabetic retinopathy, proliferative diabetic retinopathy, and macular edema. OSA is a prevalent syndrome with many systemic vascular changes. The retina and choroid are the most affected ocular structures, with primarily vascular changes. New noninvasive technologies such as optical coherence tomography and optical coherence tomography angiography could help to better understand retinal structures and help clarify the ophthalmological repercussions of OSA. Nakayama LF, Tempaku PF, Bergamo VC, etal. Obstructive sleep apnea and the retina: a review. J Clin Sleep Med. 2021;17(9):1947-1952.

Diet Sugar-Free Carbonated Soda Beverage, Non-Caloric Flavors Consumption, and Diabetic Retinopathy: Any Linkage.

PurposeAssessing diabetic retinopathy (DR) risk factors and daily nutrition habits are vital for prevention. This study aims to evaluate the relationship between diet soda cans, non-nutritive sweetener consumption, and diabetic retinopathy.Patients and MethodsA cross-sectional study was conducted among 200 patients attending a diabetes center in Tabuk City, Saudi Arabia, from September 2019 to July 2020. A structured questionnaire was used to collect patients’ demographic factors, and DR risk factors including the use of diet soda, non-nutritive sweeteners, and exercise habits. Dilated fundus eye examination was done to detect any diabetic retinopathy. A blood sample was taken for measuring glycated hemoglobin to assess the degree of glycemic control.ResultsThe participant's age was 50.74 ±13.51 years, and the duration since the diagnosis of diabetes was 9.99 ±6.97 years, body mass index was 27.28 ±4.68, and HbA1c %, 8.50 ±1.61), the patients used to consume 1.31 ±1.57 diet soda cans/week, and 1.06±1.39 artificial sweeteners/sachet/day. DR was found in 33%. Diet sugar-free carbonated soda beverage was associated with poor glycemic control and retinopathy, while non-caloric flavor consumption was associated with obesity (P-value<0.05). No association was evident regarding other factors (P-value>0.05).ConclusionDiet sugar-free carbonated soda beverage was associated with higher HbA1c and retinopathy, while non-caloric flavor consumption was associated with obesity. No association was evident regarding other factors. Further larger multicenter studies are needed.

A comparison of the risk factors of diabetic retinopathy between type 2 diabetes mellitus patients with and without metabolic syndrome

IntroductionThis study was aimed at analyzing, modeling, and comparing the risk factors of diabetic retinopathy (DR) among type 2 diabetes mellitus (DM) patients with and without metabolic syndrome (MS).Material and methodsA cross-sectional study from July 2017 to July 2019 was performed by tracing type 2 DM patients who received treatment at an out-patient clinic and a mydriatic examination by an ophthalmologist in a single institute in south Taiwan. A total of 802 patients without DR were recruited and divided into two groups based on whether they had MS for this study. We analyzed the impact of DR based on the potential and related factors of these two groups.ResultsThe sample consisted of 802 patients; 282 patients did not have MS, and 520 did. A comparison of the risk factors of DR among the patients with and without MS revealed that the level of glycated hemoglobin (HbA1c) was a co-risk factor of DR. However, female sex, betel quid chewing, family history of DM, and higher total cholesterol were found to be risk factors of DR among the patients who had MS. Betel quid chewing, especially, could exacerbate the disease condition of DM and elevate the risk of DR.ConclusionsOf those risk factors, betel quid chewing may be the main reason for DM deterioration and raised risk of DR. Hence, we recommend that the chewing of betel quid should be avoided to prevent DR.

Association of serum lipid levels and social factors with diabetic retinopathy in patients with type 2 diabetes mellitus: Study from tertiary care center of Western Maharashtra

To study the prevalence of dyslipidemia and to find out the correlation between serum lipid levels and social factors like occupation, locality(urban/rural) and education status with diabetic retinopathy in patients with type 2 diabetes mellitus.200 patients with type 2 diabetes mellitus were segregated into 2 categories:- First category of patients with diabetic retinopathy and second category of patients without diabetic retinopathy. Serum lipid levels of subjects were measured and social history like occupation, locality (urban/rural) and education status was taken. Observations were compared to check association between above factors and diabetic retinopathy.The prevalence of dyslipidemia was found to be 75.50%. Mean ± SD of LDL(mg/dL) in patients with diabetic retinopathy was 118.86 ± 40.58 which was significantly higher as compared to patients without diabetic retinopathy (p value=0.006). No significant association was seen in the distribution of total cholesterol(mg/dL), HDL(mg/dL), Triglyceride(mg/dL) with diabetic retinopathy (p value&amp;#62;.05). 10% of patients with DR worked as clerks while 52% were homemakers, thus, significant association was seen in the relationship of occupation with the presence of diabetic retinopathy (p value&amp;#60;.05). Diabetic retinopathy was more prevalent among type 2 diabetics living in urban areas (p&amp;#60;0.0001). 16% of patients with DR had studied up to primary school while 28% of patients with DR had studied up to high school, thus significant association was seen between the education status of the patients and the occurrence of diabetic retinopathy (p value&amp;#60;.05).Elevated serum LDL levels were found to be a significant risk factor for diabetic retinopathy. Clerks and homemakers were more predisposed to diabetic retinopathy. Subjects who received education up to primary school and high school and subjects living in urban areas had significantly increased rates of diabetic retinopathy.

Association between serum fibroblast growth factor 21 level and sight-threatening diabetic retinopathy in Chinese patients with type 2 diabetes

IntroductionWe conducted this cross-sectional study to explore the relationship between serum fibroblast growth factor 21 (FGF21) level and sight-threatening diabetic retinopathy (STDR).Research design and methodsA total of 654 patients with...

Diabetes onset at an earlier age and high HbA1c levels as risk factors of diabetic retinopathy.

To assess the effect of age at diabetes onset and uncontrollable high HbA1c levels on the development of diabetic retinopathy (DR) among Chinese type 2 diabetes mellitus (DM) patients. This was a cross-sectional survey of diabetic patients in Subei district, China. Data covering physical measurements, fasting blood-glucose (FBG), glycosylated hemoglobin (HbA1c), blood lipid, urinary albumin/creatinine ratio (UACR), ocular fundus examination, and diabetes treatment records were collected. An independent sample t-test were used to analyze differences. A Logistic regression analysis was applied to study the independent risk factors of DR. A total of 1282 patients with type 2 DM were enrolled, and 191 cases had DR (14.9%). The age at diabetes onset, education level, alcohol consumption, HbA1c level, UACR level, and hypoglycemic drugs were independent influencing factors for DR. The older the onset of diabetes, the less likely to develop DR (OR: 0.958, 95%CI: 0.942-0.975, P=0.000). Patients were then divided in terms of age at diabetes onset as follows: <50y, 50-59y, 60-69y, and ≥70y. Compared with diabetes onset age <50y, 50-59y (OR: 0.463, 95%CI: 0.306-0.699, P=0.000), 60-69y (OR: 0.329, 95%CI: 0.203-0.535, P=0.000) and ≥70y (OR: 0.232, 95%CI: 0.094-0.577, P=0.002) were at a lower risk of DR. The prevalence of DR was highest in patients with diabetes onset age <50y (29.5%, P<0.05). The HbA1c level (8.67±1.97)% and proportion of insulin injection (52.5%) in patients with diabetes onset <40y were higher than in patients with older diabetes onset age (P<0.05). Diabetes onset at an earlier age and uncontrollable high HbA1c level could be independent risk factors for DR.

Retinal venular tortuosity and fractal dimension predict incident retinopathy in adults with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

Aims/hypothesisOur aim was to determine whether a range of prespecified retinal vessel traits were associated with incident diabetic retinopathy in adults with type 2 diabetes.MethodsIn the prospective observational cohort Edinburgh Type 2 Diabetes Study of 1066 adults with type 2 diabetes, aged 60–75 years at recruitment, 718 were free from diabetic retinopathy at baseline. Baseline retinal traits including vessel widths, tortuosity (curvature) and fractal dimensions (network complexity), were quantified using fundus camera images and semiautomated software, and analysed using logistic regression for their association with incident diabetic retinopathy over 10 years.ResultsThe incidence of diabetic retinopathy was 11.4% (n = 82) over 10 years. After adjustment for a range of vascular and diabetes-related risk factors, both increased venular tortuosity (OR 1.51; 95% CI 1.15, 1.98; p = 0.003) and decreased fractal dimension (OR 0.75; 95% CI 0.58, 0.96; p = 0.025) were associated with incident retinopathy. There was no evidence of an association with arterial tortuosity, and associations between measurements of vessel widths and retinopathy lost statistical significance after adjustment for diabetes-related factors and vascular disease. Adding venular tortuosity to a model including established risk factors for diabetic retinopathy (HbA1c, BP and kidney function) improved the discriminative ability (C statistic increased from 0.624 to 0.640, p = 0.013), but no such benefit was found with fractal dimension.Conclusions/interpretationIncreased retinal venular tortuosity and decreased fractal dimension are associated with incident diabetic retinopathy, independent of classical risk factors. There is some evidence that venular tortuosity may be a useful biomarker to improve the predictive ability of models based on established retinopathy risk factors, and its inclusion in further risk prediction modelling is warranted.Graphical abstract

Association Between ALR2 -106C>T Gene Polymorphisms And The Risk Of Diabetic Retinopathy In Diabetes Mellitus Patient: A Meta-Analysis

Introduction Diabetic retinopathy (DR) is the most common chronic complication in diabetes mellitus (DM). Aldose reductase (ALR2) gene polymorphisms has been indicated to be associated with DR in previous studies, but the results were inconclusive. This study aimed to investigate the association between ALR2 106C>T gene polymorphisms and the risk of DR in patient with DM. Method This study followed the PRISMA 2009 guidelines. The literature search was performed using databases such as PubMed and EMBASE until September 2020. Studies included in this meta- analysis were accessed using The Newcastle Ottawa Score (NOS). The association between polyol genes and the risk of DR were evaluated using pooled odds ratios (ORs) and 95% confidence intervals (CIs). Result Nine studies (4722 cases/5939 controls) were included. The results indicated that ALR2 106C>T gene polymorphisms was associated with the increased risk of DR in T1DM (C vs T, OR95%CI = 2.07 [1.32– 3.24], p = 0.001; CC vs CT + TT, OR95%CI = 2.56 [1.33 – 4.94], p = 0.005). T allele and TT genotype were determined to be a protective factor for DR in T1DM (OR95%CI = 0.48 [0.31 – 0.76], p = 0.0001; OR95%CI = 0.12 [0.04 – 0.39], p = 0.0005, respectively). No association between ALR2 106C>T gene polymorphisms and the risk of DR in T2DM patient. Conclusion In conclusion, the result showed that C allele and CC genotype may be a risk factor for DR in T1DM patient, while T allele and TT genotype may serve as protective factor for DR in T1DM patient.

The Risk Factors for Diabetic Retinopathy in a Chinese Population: A Cross-Sectional Study.

Aims Epidemiological data on diabetic retinopathy (DR) in Chinese population is still rather scarce, and risk factors for diabetic retinopathy are inconsistent because of study designs, grading standards, and population samples. Materials and Methods This hospital-based retrospective study included 1052 type 2 diabetes patients. Diabetic retinopathy was diagnosed by nonmydriatic fundus photography and/or fundus examination apparatus. Logistic regression analysis was performed to evaluate the risk of diabetic retinopathy. Results A total of 352 (33.5% prevalence) subjects were diagnosed with diabetic retinopathy based on our population. The patients in the DR group not only had significantly higher hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), urinary microalbumin-creatinine ratio (ACR), and systolic blood pressure but also had higher follicle-stimulating hormone (FSH), luteinizing hormone (LH), and sex hormone-binding globulin (SHBG) levels compared to those in the non-DR group. Moreover, we confirmed that diabetes duration and HbA1c are strongly associated with DR risk. We also found that serum LH was an independent risk factor in male diabetic retinopathy patients (OR = 1.086, 95% CI 1.024–1.152), and the levels of LH were significantly associated with diabetic retinopathy prevalence (P = 0.018). Conclusions Our study strengthens the argument that diabetes duration and HbA1c are risk factors for patients with DR. Additionally; we firstly confirmed that serum LH was an independent risk factor in male diabetic retinopathy patients.

Mapping research trends in diabetic retinopathy from 2010 to 2019

Background:Although many publications in diabetic retinopathy (DR) have been reported, there is no bibliometric analysis.Purpose:To perform a bibliometric analysis in the field of diabetic retinopathy (DR) research, to characterize the current international status of DR research, to identify the most effective factors involved in this field, and to explore research hotspots in DR research.Methods:Based on the Web of Science Core Collection (WoSCC), a bibliometric analysis was conducted to investigate the publication trends in research related to DR. Knowledge maps were constructed by VOSviewer v.1.6.10 to visualize the publications, the distribution of countries, international collaborations, author productivity, source journals, cited references and keywords, and research hotspots in this field.Results:In total, 11,839 peer-reviewed papers were retrieved on DR from 2010 to 2019, and the annual research output increased with time. The United States ranks highest among countries with the most publications. The most active institution is the University of Melbourne. Wong, TY contributed the largest number of publications in this field. Investigative Ophthalmology & Visual Science was the most prolific journal in DR research. The top-cited references mainly investigated the use of anti-vascular endothelial growth factor (VEGF) medications in the management of DR, and the keywords formed 6 clusters:1.pathogenesis of DR;2.epidemiology and risk factors for DR;3.treatments for DR;4.screening of DR;5.histopathology of DR; and6.diagnostic methods for DR.Discussion:With the improvement of living standard, DR has gradually become one of the important causes of blindness, and has become a hot spot of public health research in many countries. The application of deep learning and artificial intelligence in diabetes screening and anti-VEGF medications in the management of DR have been the research hotspots in recent 10 years.Conclusions:Based on data extracted from the WoSCC, this study provides a broad view of the current status and trends in DR research and may provide clinicians and researchers with insight into DR research and valuable information to identify potential collaborators and partner institutions and better predict their dynamic directions.

Risk Factors for Diabetic Retinopathy

Abstract&#x0D; Introduction.Diabetic retinopathy is a progressive microangiopathy characterized by damage and occlusion of small blood vessels. The earliest pathologic changes are thickening of the capillary endothelial basement membrane and a reduction in the number of pericits. Diabetic retinopathy is the main cause of vision loss in type 1 of DM patients and has various risk factors such as chronic hyperglycemia, hypertension, hypercholesterolemia, and elevated HbA1C levels.&#x0D; Methods.This research was conducted using a descriptive observational analytic method with a cross sectional approach at The Eye Polyclinic (RSUP) Dr. Mohammad Hoesin Palembang used secondary data on diabetic retinopathy patients. The sample consisted of 64 patients with a total sampling technique, there were 50 patients who met the inclusion criteria.&#x0D; Results.There was a significant relationship between HbA1C levels (p value = 0.050) with a PR value = 1.463 and total cholesterol (p value = 0.038) with a PR value = 1.667 for diabetic retinopathy.&#x0D; Conclusion.HbA1C levels and total cholesterol are significant risk factors for diabetic retinopathy.

English

BACKGROUND Dyslipidaemia has been proposed as a possible risk factor for diabetic retinopathy (DR) but results from previous studies are inconsistent. We designed this study to find the association of abnormal serum lipid levels with diabetic retinopathy and diabetic macular oedema (DME). METHODS This was a single centre observational study conducted at a tertiary care hospital, where patients with type 2 diabetes of more than five years duration were enrolled. A comprehensive ophthalmic evaluation was performed on all study subjects. Detailed fundoscopy was done after obtaining the best possible mydriasis with 1 % tropicamide and 5 % phenylephrine eye drops using direct ophthalmoscopy, indirect ophthalmoscopy with + 20 D lens and stereoscopic slit lamp biomicroscopy of the disc and macula using + 78 D Volk lens. Fundus photographs were taken in patients with any grade of diabetic retinopathy by Topcon fundus camera. DR and DME were diagnosed and classified according to the Early Treatment Diabetic Retinopathy Study (ETDRS) grading system. Fasting blood sugar (FBS), fasting lipid profile and glycated haemoglobin (HbA1c) was assessed for each patient. RESULTS A total of two hundred and twelve participants was enrolled. Mean age of the study group was 63.93 ± 9.52 and the mean duration of diabetes was 13.54 ± 6.07. DR was present in 164 (78.1 %) of whom 71 (43.3 %) had mild non proliferative diabetic retinopathy (NPDR), 42 (25.6 %) had moderate NPDR, 31 (18.9 %) had severe NPDR, and 20 (12.2 %) had proliferative diabetic retinopathy (PDR). Of those with DR, 59 (36 %) had DME. Duration of diabetes (14.62 ± 6.18 vs 9.72 ± 3.68 years, P &lt; 0.001), higher fasting blood glucose (176.79 ± 59.13 vs 138.46 ± 49.44 mg / dL, P &lt; 0.001), higher HbA1c (8.21 ± 1.38 vs. 7.48 ± 1.25 %, P = 0.002), higher total cholesterol (215.04 ± 49.78 vs 184.37 ± 30.84 mg / dL, P &lt; 0.001), higher triglyceride levels (155.23 ± 59.06 vs 125.13 ± 37.3 mg / dL, P = 0.001) and higher low density lipoprotein (LDL) cholesterol levels (139.28 ± 37.38 vs 120.85 ± 22.75 mg / dL, P = 0.002) were significantly associated with the severity of DR. Higher total cholesterol, higher triglyceride levels and higher LDL cholesterol levels were also associated with DME. CONCLUSIONS There is a significant association of abnormal serum lipid levels and hyperglycaemia with the presence and severity of DR and presence of DME. Early identification and intervention to control these modifiable risk factors, hyperglycaemia and dyslipidaemia may delay the development and progression of DR in diabetic patients. These observations also support the current management strategies for diabetes, which include control of dyslipidaemia in addition to hyperglycaemia. KEYWORDS Diabetic Retinopathy, Diabetic Macular Oedema, Dyslipidaemia

Association between Proliferative Diabetic Retinopathy and Serum Bile Acid Level in Patients with Type 2 Diabetes Mellitus.

Diabetic retinopathy (DR) is one of the diabetic microvascular complications, which is also one of the important causes of blindness in adults. To investigate the association between proliferative retinopathy and serum bile acid level in patients with type 2 diabetes mellitus (T2DM). Three hundred and thirty-six patients with T2DM were included, of which, 229 had a history of more than 10 years without diabetic retinopathy (no diabetic retinopathy, NDR) and 107 had proliferative diabetic retinopathy (PDR). The baseline characteristics of the two groups were compared. According to the level of bile acid, the patients were divided into low, medium and high bile acid groups. The ratio of proliferative retinopathy in each group was compared. The presence of retinopathy was taken as the dependent variable, and the significant variables were analyzed by logistic regression. The level of total bilirubin and bile acid in the NDR group was significantly higher than that in the PDR group, while the levels of triglyceride, cholesterol and LDL-C were significantly lower than that in the PDR group (P<0.05). With the increase of bile acid level, the proportion of proliferative retinopathy decreased. Logistic regression analysis showed that bilirubin and bile acid were protective factors of diabetic retinopathy, while SBP, LDL-C and UAER were risk factors of diabetic retinopathy. Bile acid might be a protective factor for diabetic retinopathy in T2DM, which might be a potential therapeutic role in retinal disorders.

Association of Bone Metabolism Indices and Bone Mineral Density with Diabetic Retinopathy in Elderly Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Inpatient Study in China.

Objective This study is aimed at analyzing the association between bone metabolism indices and diabetic retinopathy (DR) in elderly patients with type 2 diabetes mellitus. Methods Data of 352 men and 284 postmenopausal women, aged more than 50 years, with type 2 diabetes mellitus were retrospectively analyzed. Patients were divided into three groups based on the degree of DR: nondiabetic retinopathy (NDR) group, background diabetic retinopathy (BDR) group, and proliferative diabetic retinopathy (PDR) group. Results (1) The diabetic duration and urinary albumin to creatinine ratio (UACR) were significantly higher in the PDR and BDR groups than in the NDR group (P < 0.05). The level of beta-C-terminal telopeptide (β-CTX) in male patients was lower in the PDR and BDR groups than in the NDR group (P < 0.05). In addition, the level of procollagen 1 intact N-terminal (P1NP) in female patients was higher in the PDR and BDR groups than in the NDR group (P < 0.05). (2) For men and postmenopausal women, the proportion of vitamin deficiency was higher in the PDR and BDR groups than in the NDR group (P < 0.05). (3) The logistic regression analysis in men and postmenopausal women showed that the diabetic duration and lower levels of UACR and 25(OH)D were independent risk factors for DR (P < 0.05). (4) The diabetic duration was also an independent risk factor for PDR (P < 0.05); however, no independent correlation was found between the level of 25(OH)D and PDR (P > 0.05). Conclusions A close association was observed between 25(OH)D level and DR in the elderly male patients and postmenopausal women with type 2 diabetes mellitus. P1NP and β-CTX levels might be closely related to DR in elderly male patients and postmenopausal women with type 2 diabetes mellitus.

The Association Between HbA1c and Other Biomarkers With the Prevalence and Severity of Diabetic Retinopathy.

Introduction: Diabetes mellitus (DM) is considered to be a significant public health problem globally. According to the American Society of Retina Specialists, diabetic retinopathy (DR) is a complication of diabetes that causes damage to the blood vessels of the retina. In a Japanese study showed that HbA1c and fasting blood glucose values can be considered as predictors for the future development of DR. Thus, this study aimed to determine the prevalence and severity of DR among diabetic patients in Medina, Saudi Arabia, and to assess its relationship with HbA1c and other biomarkers.Methods: This cross-sectional study was conducted at Prince Abdulaziz Bin Majed Diabetes Center and Charitable Healthcare Society in Medina, Saudi Arabia, in July 2018. The data were collected from direct interview questionnaires that were administered to 130 randomly selected diabetic subjects. The subjects’ demographic information, eye disease history, medical backgrounds, and laboratory biomarkers were noted. Fundus examinations using a slit lamp were conducted by ophthalmic physicians to diagnose and grade DR. The data were analyzed using Statistical Package for Social Sciences (SPSS) (IBM Corp., Armonk, NY, USA).Results: All 130 diabetic patients were examined for DR. DR was prevalent among 35 (26.9%) of the participants. According to the DR severity grading, 95 (73.1%) had no apparent DR, 11 (8.5%) had mild non-proliferative diabetic retinopathy (NPDR), 11 (8.5%) had moderate NPDR, 11 (8.5%) had severe NPDR, and only two (1.5%) had proliferative diabetic retinopathy (PDR). There was a significant association between the development of DR and HbA1c levels (p = 0.040). The duration of DM was also determined to be a significant risk factor for DR (p = 0.001). No other factors were found to have a significant association with DR.Conclusion: Around one-third of the participants in our study had DR. HbA1c levels and duration of DM were established as important risk factors for DR. Screening is necessary, even in patients with good HbA1c levels, to avoid the late presentation of severe DR and to prevent blindness.

Evaluation the Role of Malondialdehyde in Occurrence and Development of Diabetic Retinopathy Patients

Case control study was carried out in Salah-Addin city in private ophthalmology clinic from 1st November of2019 to End february 2020. The study included 90 individuals including sixty diabetic patients (30 who hadretinopathy and 30 without retinopathy) and 30 healthy individuals to evaluate the level of Malondialdehyde(MDA) in diabetic patients with and without retinopathy and healthy controls. All patients were agedbetween (51-82) years, with a negative history of antioxidant supplementation consumption. Blood sampleswere collected from each patients and controls to evaluate the levels of malondialdehyde and HbA1c byusing immunofluorescence technique. The study showed that majority of diabetic retinopathy (DR) patientswere females and the highest mean of age was recorded in diabetic retinopathy patients (60.76±7.25year) compared with diabetic without retinopathy patients (58.31±9.19 year). The study displayed thatthe highest mean of MDA was recorded in DR patients as compared with diabetic without retinopathypatients (390.37±108.68 vs 336.97±94.95 ng/ml), although the result was non-significant (P: > 0.05).The study showed that the highest mean of MDA was in DR patients (390.37±108.68 ng/ml) followed bydiabetic without retinopathy patients (336.97±94.95 ng/ml) and the lowest mean was in healthy individuals(293.32±42.51 ng/ml), (P: < 0.05). The study showed that, HbA1c was elevated significantly (P<0.05) indiabetic retinopathy patients (9.26±1.54) compared with diabetic without retinopathy patients (7.84±1.02).The present study displayed that the highest mean of duration of DM was recorded in diabetic retinopathypatients (13.48±6.00) compared with Diabetic without retinopathy patients (6.34±2.78), the result wassignificant (P:<0.05). The study showed negative correlation between HbA1c and BMI in DR patients; andno correlation between HbA1c and BMI in DM patients without retinopathy, The study showed negativecorrelation between MDA and HbA1c in DR patients and no correlation in DM patients without retinopathy.Conclusion: Long duration of DM and the old age were risk factors for DR, poor control of was moredisposed to develop retinopathy and oxidative stress is still higher in diabetic patients with retinopathy thanpatients without retinopathy.