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Vasilijevic J, Kovacevic I, Polovina S, Dacic-Krnjaja B, Kalezic T, Miletic S, Al Barri L, Stanca S, Ferrari F, Jesic M. Retinal Perfusion Analysis of Children with Diabetes Mellitus Type 1 Using Optical Coherence Tomography Angiography. J Pers Med 2024; 14:696. [PMID: 39063950 PMCID: PMC11278221 DOI: 10.3390/jpm14070696] [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: 05/18/2024] [Revised: 06/11/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: This study aims to evaluate retinal perfusion by optical coherence tomography angiography (OCTA) in pediatric patients with type 1 diabetes mellitus (T1D) without diabetic retinopathy (DR). (2) Methods: Thirty-one patients affected by T1D were enrolled. All participants were evaluated using OCTA. The foveal avascular zone (FAZ) and superficial and deep macular vessel density (VD) were analyzed. The correlation of these parameters with metabolic factors such as body mass index (BMI), glycated hemoglobin (HbA1c), and the type of insulin therapy (multiple daily injections, MDI vs. continuous subcutaneous insulin infusion, CSII) was determined. (3) Results: None of the OCTA parameters were significantly different between the groups. The patients' HbA1C level did not influence any of the OCTA parameters. The use of MDI tended to reduce the parafoveal and perifoveal deep VD (p = 0.048 and p = 0.021, respectively) compared to CSII. An elevated BMI tended to increase the deep macular (p = 0.005) and perifoveal VD (p = 0.006). (4) Conclusion: VD and FAZ are normal in pubescent children with T1D without signs of DR. Treatment with CSII may be a better choice compared to MDI, as CSII may be protective against retinal microvascular damage. Our results indicate the need for new clinical parameters of glycemic control in addition to HbA1c which could assess the risk of DR.
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Affiliation(s)
- Jelena Vasilijevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.K.); (B.D.-K.); (T.K.); (M.J.)
- Clinic for Eye Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Igor Kovacevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.K.); (B.D.-K.); (T.K.); (M.J.)
- Clinic for Eye Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Snezana Polovina
- Clinic for Endocrinology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Bojana Dacic-Krnjaja
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.K.); (B.D.-K.); (T.K.); (M.J.)
- Clinic for Eye Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Tanja Kalezic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.K.); (B.D.-K.); (T.K.); (M.J.)
- Clinic for Eye Diseases, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Suzana Miletic
- Pediatric Clinic, Clinical Centre of Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia;
| | - Leila Al Barri
- Department of Ophthalmology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Simona Stanca
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | | | - Maja Jesic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.K.); (B.D.-K.); (T.K.); (M.J.)
- Department of Pediatric Endocrinology, University Children’s Hospital, 11000 Belgrade, Serbia
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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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