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Chen B, Shen C, Sun B. Current landscape and comprehensive management of glycemic variability in diabetic retinopathy. J Transl Med 2024; 22:700. [PMID: 39075573 PMCID: PMC11287919 DOI: 10.1186/s12967-024-05516-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 07/18/2024] [Indexed: 07/31/2024] Open
Abstract
Diabetic retinopathy (DR), a well-known microvascular complication of diabetes mellitus, remains the main cause of vision loss in working-age adults worldwide. Up to now, there is a shortage of information in the study regarding the contributing factors of DR in diabetes. Accumulating evidence has identified glycemic variability (GV), referred to fluctuations of blood glucose levels, as a risk factor for diabetes-related complications. Recent reports demonstrate that GV plays an important role in accounting for the susceptibility to DR development. However, its exact role in the pathogenesis of DR is still not fully understood. In this review, we highlight the current landscape and relevant mechanisms of GV in DR, as well as address the mechanism-based therapeutic strategies, aiming at better improving the quality of DR management in clinical practice.
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Affiliation(s)
- Bo Chen
- Department of Pharmacy, The Central Hospital of Yongzhou, Yongzhou, China
| | - Chaozan Shen
- Department of Clinical Pharmacy, The Second People's Hospital of Huaihua, Lulin Road, Huaihua, Hunan, 418000, China.
| | - Bao Sun
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, China.
- Institute of Clinical Pharmacy, Central South University, Changsha, China.
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Tecce N, Cennamo G, Rinaldi M, Costagliola C, Colao A. Exploring the Impact of Glycemic Control on Diabetic Retinopathy: Emerging Models and Prognostic Implications. J Clin Med 2024; 13:831. [PMID: 38337523 PMCID: PMC10856421 DOI: 10.3390/jcm13030831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
This review addresses the complexities of type 1 diabetes (T1D) and its associated complications, with a particular focus on diabetic retinopathy (DR). This review outlines the progression from non-proliferative to proliferative diabetic retinopathy and diabetic macular edema, highlighting the role of dysglycemia in the pathogenesis of these conditions. A significant portion of this review is devoted to technological advances in diabetes management, particularly the use of hybrid closed-loop systems (HCLSs) and to the potential of open-source HCLSs, which could be easily adapted to different patients' needs using big data analytics and machine learning. Personalized HCLS algorithms that integrate factors such as patient lifestyle, dietary habits, and hormonal variations are highlighted as critical to reducing the incidence of diabetes-related complications and improving patient outcomes.
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Affiliation(s)
- Nicola Tecce
- Unit of Endocrinology, Dipartimento di Medicina Clinica e Chirurgia, Federico II University Medical School of Naples, 80131 Napoli, Italy; (N.T.); (A.C.)
| | - Gilda Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy;
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80131 Naples, Italy
| | - Michele Rinaldi
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy;
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80131 Naples, Italy
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Annamaria Colao
- Unit of Endocrinology, Dipartimento di Medicina Clinica e Chirurgia, Federico II University Medical School of Naples, 80131 Napoli, Italy; (N.T.); (A.C.)
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Zhang M, Zhang C, Chen C, Liu L, Liang Y, Hong Y, Chen Y, Shi Y. The experience of diabetic retinopathy patients during hospital-to-home full-cycle care: A qualitative study. BMC Nurs 2023; 22:58. [PMID: 36869346 PMCID: PMC9983167 DOI: 10.1186/s12912-023-01206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the major blinding eye diseases worldwide. Psychological, emotional and social problems of DR patients are prominent. The aim of this study is to explore the experiences of patients with different phases of DR from hospital to home based on the "Timing It Right" framework, and to provide a reference for formulating corresponding intervention strategies. METHODS The phenomenological method and semi-structured interviews were used in this study. A total of 40 patients with DR in different phases were recruited from a tertiary eye hospital between April and August 2022. Colaizzi's analysis method was used to analyse the interview data. RESULTS Based on the "Timing It Right" framework, different experiences in five phases of DR before and after Pars Plana Vitrectomy (PPV) were extracted. The patients experienced complicated emotional reactions and inadequate coping skills during the pre-surgery phase, increased uncertainty during the post-surgery phase, insufficient confidence and the decision to change during the discharge preparation phase, eagerness for professional support and moving forward in exploration during the discharge adjustment phase, and courageous acceptance and positive integration during the discharge adaptation phase. CONCLUSION The experiences of DR patients with vitrectomy in different phases of disease are ever-changing, and medical staff should provide personalized support and guidance to help DR patients get through the hard times smoothly and enhance the quality of hospital-family holistic care.
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Affiliation(s)
- Mengyue Zhang
- grid.268099.c0000 0001 0348 3990School of Ophthalmology and Optometry, Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - ChunHua Zhang
- grid.268099.c0000 0001 0348 3990School of Ophthalmology and Optometry, Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - Chen Chen
- grid.268099.c0000 0001 0348 3990School of Ophthalmology and Optometry, Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - Linjie Liu
- grid.414701.7The Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - Youping Liang
- grid.414701.7The Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - YiRong Hong
- grid.414701.7The Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, 325027 Wenzhou, Zhejiang China
| | - Yanyan Chen
- The Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
| | - Yinghui Shi
- The Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, 325027, Wenzhou, Zhejiang, China.
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Zhai L, Lu J, Cao X, Zhang J, Yin Y, Tian H. Association Between the Variability of Glycated Hemoglobin and Retinopathy in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis. Horm Metab Res 2023; 55:103-113. [PMID: 36223803 DOI: 10.1055/a-1931-4400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Visit-to-visit variability of glycated hemoglobin (HbA1c) is a marker of long-term glycemic fluctuation, which has been related to increased risk of macrovascular complications in patients with type 2 diabetes mellitus (T2DM). The association between HbA1c variability and retinopathy in patients with T2DM, however, has been inconsistent in previous studies. In order to fully evaluate the above association, we conducted a meta-analysis. Observational studies related to the aim of the meta-analysis were identified by search of PubMed, Web of Science, and Embase databases. Studies with HbA1c variability evaluated as the standard deviation (SD) and/or the coefficients of variation (CV) of HbA1c were included. The results were analyzed using a random-effects model that incorporated potential heterogeneity between studies. Twelve observational studies involving 44 662 T2DM patients contributed to the meta-analysis. Overall, 5150 (11.5%) patients developed retinopathy. Pooled results showed that compared to patients with lower HbA1c variability, T2DM patients with higher HbA1c-SD (relative risk [RR]: 1.48, 95% confidence interval [CI]: 1.24 to 1.78, p<0.001, I2=34%) and higher HbA1c-CV (RR: 1.29, 95% CI: 1.05 to 1.59, p=0.02, I2=0%) were both associated with higher risk of DR. For studies with HbA1c-SD, the association was not significantly affected by study characteristics such as country, study design, mean age, disease duration, adjustment of mean HbA1c, or quality scores (p for subgroup difference all>0.05). In conclusion, higher HbA1c variability may be associated with an increased risk of retinopathy in patients with T2DM.
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Affiliation(s)
- Liping Zhai
- Department of Endocrinology, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Jun Lu
- Department of Ophthalmology, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Xinjian Cao
- Department of Clinical Medicine, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Jun Zhang
- Department of Clinical Medicine, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Yong Yin
- Department of Clinical Medicine, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Hu Tian
- Department of Clinical Medicine, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, China
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Ke J, Li K, Cao B. A Nomogram for Predicting Vision-Threatening Diabetic Retinopathy Among Mild Diabetic Retinopathy Patients: A Case-Control and Prospective Study of Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:275-283. [PMID: 36760600 PMCID: PMC9888403 DOI: 10.2147/dmso.s394607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
AIM This study aims to develop a nomogram for predicting vision-threatening diabetic retinopathy (VTDR) in type 2 diabetes mellitus (T2DM) with mild non-proliferative diabetic retinopathy (NPDR) patients. MATERIALS AND METHODS In case-control analysis, 440 patients with mild NPDR or VTDR were enrolled to identify predictors and develop a nomogram. In the prospective cohort, 120 T2DM patients with mild NPDR were enrolled for external validation. Sensitivity, specificity, and area under the receiver operating characteristic (AUC) were calculated to evaluate the predictive performance of the nomogram. RESULTS In case-control analysis, 2-h C-peptide (OR = 0.85, 95% CI: 0.75 to 0.95, p = 0.006), sural nerve conduction impaired (SNCI) (mildly: OR = 2.18, 95% CI: 1.10 to 4.33, p = 0.026; moderately/severely: 3.66, 95% CI: 1.74 to 7.70, p < 0.001) and UACR (microalbuminuria: OR = 2.37, 95% CI: 1.25 to 4.48, p = 0.008; macroalbuminuria: 4.02, 95% CI: 1.61 to 10.06, p = 0.003) were identified as independent predictors. The concordance index of the prediction nomogram was 0.76 in the training set. In the test set, sensitivity, specificity, and AUC were 84.8%, 60.6%, and 0.73, respectively. In the prospective cohort, median follow-up period was 42 months, and 15 patients (12.5%) developed VTDR. Sensitivity, specificity, and AUC of prediction were 66.7%, 89.5%, and 0.75, respectively. CONCLUSION Introducing 2-h C-peptide, UACR, and SNCI, the nomogram demonstrated a good discriminatory power for predicting risk of VTDR in mild NPDR individuals.
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Affiliation(s)
- Jing Ke
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| | - Kun Li
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| | - Bin Cao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
- Correspondence: Bin Cao, Tel +86-10-6954-3901, Email
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Hill S, Mullins P, Murphy R, Schmiedel O, Vaghefi E, Ramke J, Squirrell D. Risk Factors for Progression to Referable Diabetic Eye Disease in People With Diabetes Mellitus in Auckland, New Zealand: A 12-Year Retrospective Cohort Analysis. Asia Pac J Ophthalmol (Phila) 2021; 10:579-589. [PMID: 34905518 DOI: 10.1097/apo.0000000000000464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To evaluate the prevalence and risk factors for the development of any and referable diabetic eye disease in a multi-ethnic New Zealand population with diabetes mellitus attending a regional retinal screening service. METHODS Retrospective observational cohort study of people living with diabetes who attended the Auckland Regional Diabetic Retinal Screening Programme 2006-2018 inclusive (n = 41,786). RESULTS Any retinopathy/maculopathy was present at first screening for 48.2% [95% confidence interval (CI): 45.8%-50.6%] / 37.8% (95% CI: 35.5%- 40.1%) of people with Type 1 and 25% (95% CI: 24.6%-25.4%) / 21.9% (95% CI: 21.5%-22.3%) with Type 2 diabetes. Referable retinopathy at baseline screening was 4.4% (95% CI: 3.6%-5.3%) and 1.6% (95% CI: 1.5%-1.7%) among people with Type 1 and Type 2 diabetes mellitus, respectively. After 4 years, cumulative incidence for referable retinopathy /referable maculopathy was 12/36 per 1000 people with Type 1 and 2.4/16 per 1000 people with Type 2 diabetes. Independent hazards for disease progression varied for the diabetes cohort types but baseline grade, duration of diabetes, and HbA1c were common to all. CONCLUSIONS Referable diabetic eye disease at the first screening and after 4 years of follow-up is uncommon. Lengthening of the screening intervals for people with no or mild diabetic eye disease at first screening assessment could be considered.
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Affiliation(s)
- Sophie Hill
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
- Ophthalmology Department, University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Peter Mullins
- Department of Statistics, University of Auckland, Faculty of Science, Science Centre 3030, Auckland 1010, New Zealand
| | - Rinki Murphy
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
- Department of Medicine, University of Auckland, Building 507, Grafton, Auckland 1023, New Zealand
| | - Ole Schmiedel
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
| | - Ehsan Vaghefi
- School of Optometry and Vision Science, University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Jacqueline Ramke
- School of Optometry and Vision Science, University of Auckland, Grafton, Auckland 1023, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - David Squirrell
- Ophthalmology Department, Auckland District Health Board, 214 Green Lane West, One Tree Hill, Epsom, Auckland 105, New Zealand
- Ophthalmology Department, University of Auckland, Grafton, Auckland 1023, New Zealand
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Dhatariya K, Humberstone A, Hasnat A, Wright R, Lujan M, Nunney I. The Association Between Mean Glycated Haemoglobin or Glycaemic Variability and the Development of Retinopathy in People with Diabetes: A Retrospective Observational Cohort Study. Diabetes Ther 2021; 12:2755-2766. [PMID: 34491530 PMCID: PMC8479058 DOI: 10.1007/s13300-021-01146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/24/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION To determine the association between mean glycated haemoglobin (HbA1c) or glycaemic variability and the development of diabetic retinopathy (DR) in people with diabetes. METHODS An observational cohort study with people registered with a DR eye screening service between October 2012 and October 2017. Those who had no DR at the start of the study were followed for a maximum of 5 years. HbA1c measures were used to calculate HbA1c variability and mean HbA1c to assess any relationship between these and the risk of developing new onset DR. RESULTS A total of 2511 individuals were followed up for up to 5 years. Of these, 542 (21.6%) developed DR. After adjustment, HbA1c variability was not significantly associated with the development of DR (p = 0.3435). However, the mean HbA1c was (p < 0.0001). Those with type 1 diabetes had an odds of 1.63 (95% CI 1.11-2.40) of a retinopathy diagnosis compared to those with type 2 diabetes. CONCLUSIONS We have shown that mean HbA1c is associated with an increased risk of developing diabetic retinopathy. However, after adjustment for sex, age, diabetes type and the mean, the HbA1c variability no longer remained significant. Our data suggest that optimizing long-term glycaemic control remains paramount.
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Affiliation(s)
- Ketan Dhatariya
- Norwich Medical School, University of East Anglia, Medical Building, Norwich, Norfolk, NR4 7TJ, UK.
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
| | - Alexander Humberstone
- Norwich Medical School, University of East Anglia, Medical Building, Norwich, Norfolk, NR4 7TJ, UK
| | - Abul Hasnat
- Norwich Medical School, University of East Anglia, Medical Building, Norwich, Norfolk, NR4 7TJ, UK
| | - Rebecca Wright
- Norwich Medical School, University of East Anglia, Medical Building, Norwich, Norfolk, NR4 7TJ, UK
| | - Morgan Lujan
- Norwich Medical School, University of East Anglia, Medical Building, Norwich, Norfolk, NR4 7TJ, UK
| | - Ian Nunney
- Department of Medical Statistics, Norwich Medical School, Norwich, Norfolk, UK
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Hsing SC, Lin C, Chen JT, Chen YH, Fang WH. Glycemic Gap as a Useful Surrogate Marker for Glucose Variability and Progression of Diabetic Retinopathy. J Pers Med 2021; 11:jpm11080799. [PMID: 34442443 PMCID: PMC8401120 DOI: 10.3390/jpm11080799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 12/22/2022] Open
Abstract
(1) Background: Recent studies have reported that the glucose variability (GV), irrespective of glycosylated hemoglobin (HbA1c), could be an additional risk factor for the development of diabetic retinopathy (DR). However, measurements for GV, such as continuous glucose monitoring (CGM) and fasting plasma glucose (FPG) variability, are expensive and time consuming. (2) Methods: This present study aims to explore the correlation between the glycemic gap as a measurement of GV, and DR. In total, 2565 patients were included in this study. We evaluated the effect of the different types of glycemic gaps on DR progression. (3) Results: We found that the area under the curve (AUC) values of both the glycemic gap and negative glycemic gap showed an association with DR progression. (4) Conclusions: On eliminating the possible influences of chronic blood glucose controls, the results show that GV has deleterious effects that are associated with the progression of DR. The glycemic gap is a simple measurement of GV, and the predictive value of the negative glycemic gap in DR progression shows that GV and treatment-related hypoglycemia may cause the development of DR. Individual treatment goals with a reasonable HbA1c and minimal glucose fluctuations may help in preventing DR.
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Affiliation(s)
- Shi-Chue Hsing
- National Defense Medical Center, Department of Internal Medicine, Tri-Service General Hospital, Taipei 11490, Taiwan;
| | - Chin Lin
- National Defense Medical Center, Graduate Institute of Life Sciences, Taipei 11490, Taiwan;
- National Defense Medical Center, School of Medicine, Taipei 11490, Taiwan
- National Defense Medical Center, School of Public Health, Taipei 11490, Taiwan
| | - Jiann-Torng Chen
- National Defense Medical Center, Department of Ophthalmology, Tri-Service General Hospital, Taipei 11490, Taiwan; (J.-T.C.); (Y.-H.C.)
| | - Yi-Hao Chen
- National Defense Medical Center, Department of Ophthalmology, Tri-Service General Hospital, Taipei 11490, Taiwan; (J.-T.C.); (Y.-H.C.)
| | - Wen-Hui Fang
- National Defense Medical Center, Department of Family and Community Medicine, Tri-Service General Hospital, No.161, Min-Chun E. Rd., Sec. 6, Neihu, Taipei 11490, Taiwan
- Correspondence: ; Tel.: +886-2-87923311 (ext. 12322); Fax: +886-2-66012632
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