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Wang S, Jia B, Niu S, Chen S. Relationship Between the Hemoglobin, Albumin, Lymphocyte Count, Platelet Count (HALP) Score and Type 2 Diabetes Retinopathy. Diabetes Metab Syndr Obes 2024; 17:2693-2706. [PMID: 39007156 PMCID: PMC11246656 DOI: 10.2147/dmso.s467799] [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: 05/01/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To explore the correlation between hemoglobin, albumin, lymphocyte count, platelet count (HALP) score and type 2 diabetic retinopathy (DR). Methods The study was conducted on 674 patients with type 2 diabetes (T2DM). According to the results of the fundus examination, they were divided into non-diabetic retinopathy group (NDR, n=388) and diabetic retinopathy group (DR, n=286). Collected patients baseline data, calculated HALP score, analyzed the correlation between HALP score and DR. Results In all patients, male patients and female patients, the HALP score of the DR group was lower than that of the NDR group (P<0.001), and the HALP score was negatively correlated with the incidence of DR (P<0.05). HALP score was independent risk factors for DR, regardless of gender. In male patients, HALP score and DR had a linear relationship, but in female patients, HALP score and DR showed a nonlinear relationship, and HALP score was more sensitive to the onset of DR in male patients. The combined diagnostic model of HALP score, course of disease, SBP and BUN was used to diagnose DR, and it was found that the diagnostic value was the highest among male patients, with AUC of 0.761, sensitivity of 58.3% and specificity of 80.3%. Conclusion HALP score was an independent risk factor for DR, attention should be paid to monitoring HALP score, especially in male T2DM patients. The accuracy of HALP score, disease course, SBP and BUN combined model diagnosis of DR was high, which can become a biological indicator for early screening of DR.
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Affiliation(s)
- Shuqi Wang
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, People's Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Boying Jia
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, People's Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Sifan Niu
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
- Department of Internal Medicine, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Shuchun Chen
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, People's Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
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2
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Tang J, Huang P. The association in diabetic retinopathy and stroke finding from NHANES evidence. Int Ophthalmol 2024; 44:170. [PMID: 38587685 DOI: 10.1007/s10792-024-03098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/24/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Diabetic retinopathy and stroke are both vascular pathologies, and this study intends to investigate the relationship between diabetic retinopathy and stroke. METHODS The NHANES database was used to find the relationship between diabetic retinopathy and stroke with 1948 individuals aged 40 years or older. The sensitivity of the data was verified by multiple interpolation, further analysis was done by subgroup analyses, and possible links were investigated with mediation studies. RESULTS Diabetes retinopathy was found to be closely associated with stroke, with the PDR group having a higher stroke incidence than the NPDR group. After controlling for covariates, there were still substantial differences in the risk of stroke among patients with NPDR and PDR. Overall, subgroup analysis revealed DR group showed an important distinction, compared to the non-DR (OR = 1.76, 95% CI 1.15-2.64). The results of the mediation research indicated that the connection between DR and stroke was mediated by the frailty index and hypertension. CONCLUSION This study demonstrated a statistically significant correlation between DR and stroke, which persisted even after DR staging and was more prevalent in PDR patients than in NPDR patients. Stroke prevention may benefit from DR health management.
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Affiliation(s)
- Jing Tang
- Pharmacy Department, Liyuan Hospital, Huazhong University of Science and Technology, Wuhan, 430077, People's Republic of China
| | - Ping Huang
- Department of Ophthalmology, Liyuan Hospital, Huazhong University of Science and Technology, Wuhan, 430077, People's Republic of China.
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3
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Mezzetto L, Mastrorilli D, Zanetti E, Scoccia E, Pecoraro B, Sboarina A, Mantovani A, Veraldi GF. Clinical risk factors and features on computed tomography angiography in high-risk carotid artery plaque in patients with type 2 diabetes. INT ANGIOL 2024; 43:280-289. [PMID: 38470152 DOI: 10.23736/s0392-9590.24.05154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND High-risk carotid artery plaque (HPR) is associated with a markedly increased risk of ischemic stroke. The aims of this study were: 1) to examine the prevalence of HRP in a cohort of asymptomatic adults with type 2 diabetes (T2D); 2) to investigate the relationship between HRP, established cardiovascular risk factors and computed tomography angiography (CTA) profile; and 3) to assess whether the presence of HRP is associated with an increased risk of major adverse cardiovascular events (MACE). METHODS This was a retrospective cohort study of T2D asymptomatic patients who underwent carotid endarterectomy (CEA) from January 2018 to July 2021. The carotid atherosclerotic plaque (CAP) was assessed for the presence of ulceration, the presence of lipids, fibrosis, thrombotic deposits, hemorrhage, neovascularization, and inflammation. A CAP presenting at least five of these histological features was defined as a HRP (Group A); in all other cases it was defined as a mild to moderate heterogeneous plaque and no-HRP (Group B). CTA features included the presence of rim sign consisting of thin peripheral adventitial calcification (<2 mm) and internal soft plaque (≥2 mm), NASCET percent diameter stenosis, maximum plaque thickness, ulceration, calcification, and intraluminal thrombus were recorded. Binary logistic regression with Uni- and Multivariate was used to evaluate possible predictors for HRP while multivariable Cox Proportional Hazards was used to assess independent predictors for MACE. RESULTS One hundred eighty-five asymptomatic patients (mean age 73±8 years, 131 men), undergoing carotid endarterectomy, were included. Of these, 124 (67%) had HRP, and the 61 (33%) did not. Diabetic complications (OR 2.4, 95% CI: 1.1-5.1, P=0.01), NASCET stenosis ≥75% (OR 2.4, 95% CI: 1.2-3.7, P=0.02) and carotid RIM sign (OR 4.3, 95% CI: 3.9-7.3, P<0.001) were independently associated with HRP. However, HRP was not associated with a higher risk of MACE (freedom from MACE at 5 years: HRP 83.4% vs. non HRP 87.8%, P=0.72) or a reduction of survival (5-year survival estimates: HRP 96.4% vs. non HRP: 94.6%, P=0.76). CONCLUSIONS A high prevalence of HRP (67%) was observed in asymptomatic and elderly T2D patients. Independent predictors of HRP were diabetic complications, NASCET stenosis ≥75% and carotid RIM sign (OR 4.3, 95% CI: 3.9-7.3, P<0.001). HRP was not associated with an increased risk of MACE during a mean follow-up of 39±24 years.
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Affiliation(s)
- Luca Mezzetto
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, Verona, Italy
| | - Davide Mastrorilli
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, Verona, Italy -
| | - Elisa Zanetti
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, Verona, Italy
| | - Enrico Scoccia
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Barbara Pecoraro
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Andrea Sboarina
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Gian F Veraldi
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, Verona, Italy
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Hanhart J, Jeon S, Tuuminen R. Should patient enrollment criteria for anti-VEGF phase III trials be reconsidered. J Diabetes 2023; 15:911-912. [PMID: 37731062 PMCID: PMC10590675 DOI: 10.1111/1753-0407.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Joel Hanhart
- Department of Ophthalmology, Shaare Zedek Medical CenterJerusalemIsrael
- Hebrew University of JerusalemJerusalemIsrael
| | - Sohee Jeon
- Vitreoretinal ServiceKeye Eye CenterSeoulSouth Korea
| | - Raimo Tuuminen
- Department of OphthalmologyKymenlaakso Central HospitalKotkaFinland
- Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- Helsinki Retina Research Group, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
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Gui SY, Wang XC, Qiao JC, Lin SY, Wang QQ, Zhang MY, Xu YY, Huang ZH, Tao LM, Hu CY, Tao FB, Jiang ZX, Liu DW. Association of retinopathy with risk of all-cause and specific-cause mortality in the National Health and Nutrition Examination Survey, 2005 to 2008. Front Public Health 2023; 11:1200925. [PMID: 37680275 PMCID: PMC10482412 DOI: 10.3389/fpubh.2023.1200925] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
Objective This study aimed to elucidate the relationship between retinopathy status or severity and the all-cause and specific-cause mortality risk based on the updated National Health and Nutrition Examination Survey (NHANES) database and 2019 Public Access Link mortality file. Methods In this prospective cohort study, a total of 6,797 participants aged over 40 years based on NHANES 2005-2008 were analyzed. The severity of retinopathy was classified into 4 grades-no retinopathy, mild non-proliferative retinopathy (NPR), moderate to severe NPR, and proliferative retinopathy (PR). Multiple covariate-adjusted Cox proportional hazards regression models and Fine and Gray competing risk regression models were used to assess the all-cause and cause-specific mortality risks, respectively. The propensity score matching (PSM) approach was also applied additionally to adequately balance between-group covariates to validate our findings. Results A final total of 4,808 participants representing 18,282,772 United States (US) non-hospitalized participants were included for analysis, 50.27% were male (n = 2,417), 55.32% were non-hispanic white (n = 2,660), and mean [SE] age, 56.10 [0.40] years. After a median follow-up of 12.24 years (interquartile range, 11.16-13.49 years), 1,164 participants died of all-cause mortality, of which 941 (80.84%) died without retinopathy and 223 (19.16%) died with retinopathy at baseline. The presence of retinopathy was associated with increased all-cause mortality, cardiovascular disease (CVD), and diabetes mellitus (DM)-specific mortality, and the results remain consistent after PSM. Severity analysis showed that only mild NPR was associated with an increased all-cause mortality risk (hazard ratio (HR) = 2.01; 95% confidence interval (CI), 1.00-4.03), while increased CVD and DM-specific mortality risk were associated with all grades of retinopathy and were exponentially greater with increasing retinopathy severity, and the trend test was also significant (P for trend 0.004 and 0.04, respectively). Discussion Our findings suggest that the diagnosis of retinopathy is an independent risk factor for all-cause mortality in people over 40 years old. Retinopathy grading is significantly associated with the survival risk of patients with CVD or DM, it can be a valuable predictor in the stratified management and risk warning of CVD or DM patients, as well as in the monitoring of systemic vasculopathy status.
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Affiliation(s)
- Si-Yu Gui
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin-Chen Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jian-Chao Qiao
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Si-Yu Lin
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qian-Qian Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Meng-Yue Zhang
- Department of Clinical Medicine, The First School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Yue-Yang Xu
- Department of Clinical Medicine, The First School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Zhi-Hao Huang
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Li-Ming Tao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cheng-Yang Hu
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, Hefei, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Zheng-Xuan Jiang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dong-Wei Liu
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Feng S, Guo L, Wang S, Chen L, Chang H, Hang B, Mao J, Snijders AM, Lu Y, Ding D. Association of Serum Bile Acid and Unsaturated Fatty Acid Profiles with the Risk of Diabetic Retinopathy in Type 2 Diabetic Patients. Diabetes Metab Syndr Obes 2023; 16:2117-2128. [PMID: 37465650 PMCID: PMC10351529 DOI: 10.2147/dmso.s411522] [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: 03/28/2023] [Accepted: 06/10/2023] [Indexed: 07/20/2023] Open
Abstract
Aim We aimed to identify the ability of serum bile acids (BAs) and unsaturated fatty acids (UFAs) profiles to predict the development of diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) patients. Methods We first used univariate and multivariate analysis to compare 15 serum BA and 11 UFA levels in healthy control (HC) group (n = 82), T2DM patients with DR (n = 58) and T2DM patients without DR (n = 60). Forty T2DM patients were considered for validation. Then, the receiver operating characteristic curve (ROC) and decision curve analysis were used to assess the diagnostic value and clinical benefit of serum biomarkers alone, clinical variables alone or in combination, and the area under the curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were used to further assess whether the addition of biomarkers significantly improved the predictive ability of the model. Results Orthogonal partial least squares-discriminant analysis (OPLS-DA) of serum BAs and UFAs separated the three cohorts including HC, T2DM patients with or without DR. The difference in serum BA and UFA profiles of T2DM patients with or without DR was mainly manifested in the three metabolites of taurolithocholic acid (TLCA), tauroursodeoxycholic acid (TUDCA) and arachidonic acid (AA). Together, they had an AUC of 0.785 (0.918 for validation cohort) for predicting DR in T2DM patients. After adjusting for numerous confounding factors, TLCA, TUDCA, and AA were independent predictors that differentiated T2DM with or without DR. The results of AUC, IDI, and NRI demonstrated that adding these three biomarkers to a model with clinical variables statistically increased their predictive value and were replicated in our independent validation cohort. Conclusion These findings highlight the association of three metabolites, TLCA, TUDCA and AA, with DR and may indicate their potential value in the pathogenesis of DR.
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Affiliation(s)
- Susu Feng
- Department of Endocrinology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Lin Guo
- Department of Endocrinology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Sijing Wang
- Department of Endocrinology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Lijuan Chen
- Department of Endocrinology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Hang Chang
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Bo Hang
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
- Department of Biomaterials, Berkeley-Nanjing Research Center, Nanjing, People's Republic of China
| | - Jianhua Mao
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Antoine M Snijders
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Yibing Lu
- Department of Endocrinology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Dafa Ding
- Department of Endocrinology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
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Baget-Bernaldiz M, Romero-Aroca P, Mira-Puerto A, Bautista-Perez A, Roca-Borrut I, Vizcarro M, Navarro-Gil R, Llagostera-Serra M. Risk Factors for Recurrent Vitreous Hemorrhage in Type 2 Diabetes Mellitus Patients after Posterior Vitrectomy. J Clin Med 2023; 12:jcm12082989. [PMID: 37109325 PMCID: PMC10143377 DOI: 10.3390/jcm12082989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
(Background) The aim of this study was to determine the factors related to recurrent vitreous hemorrhage (RVH) in a sample of proliferative diabetic retinopathy (PDR) patients. (Methods) This was a retrospective, review-based study. We studied 183 eyes from 121 type 2 diabetes patients with PDR. We recorded the duration of diabetes, history of hypertension, retinal photocoagulation status, posterior vitreous status, mean HbA1c and hemoglobin levels, renal function, and systemic complications associated with diabetes. We also recorded surgical variables-the presence of tractional retinal detachment, the application of segmentation and diathermy on fibrovascular proliferative tissue, and the use of silicone oil-to study which independent variables were significantly related to the presence of RVH. (Results) The duration of diabetes (p = 0.028), hemoglobin level (p = 0.02), status of the posterior vitreous (p = 0.03), retinal photocoagulation status (p = 0.002), and the presence of tractional retinal detachment (p = 0.03) were significantly associated with the presence of RVH. On the other hand, the use of diathermy was associated with fewer RVH events (p < 0.005). In addition, patients with diabetic polyneuropathy, myocardial infarction, and ischemia in the lower limbs exhibited more vitreous hemorrhage events (p < 0.001). (Conclusions) Patients with PDR and a longer diabetes duration, anemia, attached posterior vitreous, deficient retinal photocoagulation, and prior cardiovascular events were more prone to RVH.
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Affiliation(s)
- Marc Baget-Bernaldiz
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), 43204 Reus, Spain
| | - Pedro Romero-Aroca
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), 43204 Reus, Spain
| | | | - Angel Bautista-Perez
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
| | | | - Montse Vizcarro
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
| | - Raul Navarro-Gil
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), 43204 Reus, Spain
| | - Monica Llagostera-Serra
- Ophthalmology Service, Hospital Universitario Sant Joan de Reus, 43204 Reus, Spain
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
- Pere Virgili Institute for Health Research (IISPV), 43204 Reus, Spain
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Orsi E, Solini A, Bonora E, Vitale M, Garofolo M, Fondelli C, Trevisan R, Vedovato M, Cavalot F, Zerbini G, Nicolucci A, Pugliese G. Retinopathy as an independent predictor of all-cause mortality in individuals with type 2 diabetes. DIABETES & METABOLISM 2023; 49:101413. [PMID: 36460217 DOI: 10.1016/j.diabet.2022.101413] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022]
Abstract
AIMS To assess whether the presence and grade of diabetic retinopathy (DR) predict all-cause mortality, independent of risk factors for cardiovascular disease (CVD) and other complications, including diabetes-related kidney disease (DKD) and CVD, in individuals with type 2 diabetes mellitus. METHODS Prospective cohort study that enroled 15,773 patients in 19 Italian centers in 2006-2008. DR ascertained by fundoscopy, DKD by albuminuria and estimated glomerular filtration rate, and prior CVD by hospital discharge records. All-cause mortality retrieved for 15,656 patients on 31 October 2015. RESULTS The adjusted risk of death was increased in patients with any DR (hazard ratio, 1.136 [95% confidence interval, 1.054;1.224] P < 0.0001), advanced DR, including severe non-proliferative and proliferative DR and diabetic macula edema (1.213 [1.097;1.340] P < 0.0001), and especially proliferative DR alone (1.381 [1.207;1.580] P < 0.0001), compared with those without DR. The impact of DR was more evident in patients without than in those with DKD or CVD. Mortality risk was increased in participants with DR alone, though much less than in those with DKD or CVD alone and particularly in those with both DR and DKD or CVD. DR grade was related to mortality in individuals without DKD or CVD, whereas it conferred no additional risk to those with albuminuric or nonalbuminuric DKD or established CVD. CONCLUSIONS In patients with type 2 diabetes mellitus, the excess mortality risk conferred by DR is relatively small and higher in those without DKD and CVD, suggesting that it may be mediated by the concurrent presence of these complications, even at a subclinical level.
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Affiliation(s)
- Emanuela Orsi
- Diabetes Unit, IRCCS "Cà Granda - Ospedale Maggiore Policlinico" Foundation, Milan, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Martina Vitale
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Via di Grottarossa, Rome 00189 , Italy
| | - Monia Garofolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Roberto Trevisan
- Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Vedovato
- Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy
| | - Franco Cavalot
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Gianpaolo Zerbini
- Complications of Diabetes Unit, Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Nicolucci
- Centre for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Via di Grottarossa, Rome 00189 , Italy.
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Trott M, Driscoll R, Pardhan S. Associations between diabetic retinopathy, mortality, disease, and mental health: an umbrella review of observational meta-analyses. BMC Endocr Disord 2022; 22:311. [PMID: 36494641 PMCID: PMC9733253 DOI: 10.1186/s12902-022-01236-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic retinopathy is a complication of diabetes affecting the eyes and can lead to blindless if left untreated. Several significant risk factors have been reported for DR, of which several can be classified as some form of disease. Furthermore, several systematic reviews have reported associations between several types of mortality and DR. Numerous meta-analyses have pooled the data on these factors, however, a systematic evaluation of these meta-analytic relationships is lacking. In this study, therefore, we performed an umbrella review of systematic reviews of meta-analyses for mortality, diseases and DR, grading the credibility of evidence. METHODS A comprehensive database search for observational meta-analyses was conducted from inception until 29/04/2022 against pre-published inclusion criteria. For each meta-analytic outcome, a random-effects meta-analysis was re-conducted, stratifying by study design (and type of DR where possible) of included studies. Several statistical variables, including publication bias, heterogeneity, excess significance bias, and prediction intervals were used to grade the credibility of significant evidence from I to IV, using the recommendations from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. RESULTS Of the 1,834 initial results, 11 systematic reviews with meta-analyses were included covering 16 independent outcomes (total participants = 299,655; median participants per outcome: 7,266; median individual studies per outcome = 5). Overall, 10/16 outcomes (62.5%) yielded significant results, most of which were graded as 'highly suggestive' (Grade II) evidence. DR was associated with all-cause and cardio-vascular mortality, obstructive sleep apnoea, depression eating disorders, and several forms of cognitive impairment. CONCLUSIONS Results show highly suggestive evidence for associations between health outcomes and/or conditions and DR. Public health professionals and practitioners should note these findings when developing and/or reviewing public health polices.
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Affiliation(s)
- Mike Trott
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge, CB1 2LZ, UK.
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | - Robin Driscoll
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge, CB1 2LZ, UK
| | - Shahina Pardhan
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge, CB1 2LZ, UK
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Castelblanco E, Granado-Casas M, Hernández M, Pinyol M, Correig E, Julve J, Rojo-López MI, Alonso N, Avogaro A, Ortega E, Mauricio D. Diabetic retinopathy predicts cardiovascular disease independently of subclinical atherosclerosis in individuals with type 2 diabetes: A prospective cohort study. Front Cardiovasc Med 2022; 9:945421. [PMID: 36407461 PMCID: PMC9668891 DOI: 10.3389/fcvm.2022.945421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/19/2022] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) and preclinical atherosclerosis are associated with higher cardiovascular risk. However, no studies have investigated the predictive role of DR and preclinical atherosclerosis jointly on cardiovascular events in subjects with type 2 diabetes (T2D). We aimed to assess the contribution of DR and subclinical atherosclerosis on the risk of adverse cardiovascular events in subjects with T2D without previous cardiovascular disease (CVD). METHODS We included two prospective cohorts of subjects with T2D from the same geographical area. Assessment of subclinical atherosclerosis was performed by carotid ultrasound. An ophthalmologist classified DR according to standard criteria. Cardiovascular outcomes considered for analysis were the following: ischemic heart disease, stroke, heart failure, peripheral artery disease, revascularization procedures, and cardiovascular mortality. Bivariable and multivariable predictive models were performed. RESULTS From a total of 374 subjects with T2D 44 developed cardiovascular events during the 7.1 years of follow-up. Diabetes duration, total cholesterol, and glycated hemoglobin (HbA1c) at baseline were higher in subjects who developed cardiovascular outcomes (p < 0.001, p = 0.026, and p = 0.040, respectively). Compared with subjects without events, those developing cardiovascular events had higher prevalence of retinopathy (65.9% vs. 38.8%, p = 0.001; respectively) and more than mild retinopathy (43.2% vs. 31.8%, p = 0.002; respectively). Furthermore, all-cause mortality was higher in subjects with MACE than those without events (13.6% vs. 3.3%, p = 0.009; respectively). The multivariable analyses showed that HbA1c and the presence of DR at baseline were predictive of cardiovascular outcomes (p = 0.045 and p = 0.023, respectively). However, the burden of subclinical atherosclerosis was not (p = 0.783 and p = 0.071, respectively). CONCLUSION DR is a strong predictor of cardiovascular events in T2D individuals at primary CVD prevention, even after accounting for the presence of preclinical carotid atherosclerosis. These results may help to individualize CVD prevention strategies in T2D.
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Affiliation(s)
- Esmeralda Castelblanco
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Minerva Granado-Casas
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau and Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Marta Hernández
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRBLleida, University of Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Montserrat Pinyol
- Consorcio de Atención Primaria del Eixample (CAPSE), Grup Transversal de Recerca en Atenció Primària, Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eudald Correig
- Department of Biostatistics, Universitat Rovira i Virgili, Reus, Spain
| | - Josep Julve
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau and Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Marina Idalia Rojo-López
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau and Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Núria Alonso
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Hospital and Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Angelo Avogaro
- Department of Medicine, Università di Padova, Padua, Italy
| | - Emilio Ortega
- Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clínic de Barcelona, Barcelona, Spain
- Center for Biomedical Research on Pathophysiology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Didac Mauricio
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau and Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- Faculty of Medicine, University of Vic (UVic-UCC), Barcelona, Spain
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11
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Chinese expert consensus on the risk assessment and management of panvascular disease inpatients with type 2 diabetes mellitus (2022 edition). CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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12
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Barrot J, Real J, Vlacho B, Romero-Aroca P, Simó R, Mauricio D, Mata-Cases M, Castelblanco E, Mundet-Tuduri X, Franch-Nadal J. Diabetic retinopathy as a predictor of cardiovascular morbidity and mortality in subjects with type 2 diabetes. Front Med (Lausanne) 2022; 9:945245. [PMID: 36052329 PMCID: PMC9424917 DOI: 10.3389/fmed.2022.945245] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/26/2022] [Indexed: 12/30/2022] Open
Abstract
This study aimed to evaluate the predictive value of diabetic retinopathy (DR) and its stages with the incidence of major cardiovascular events and all-cause mortality in type 2 diabetes mellitus (T2DM) persons in our large primary healthcare database from Catalonia (Spain). A retrospective cohort study with pseudo-anonymized routinely collected health data from SIDIAP was conducted from 2008 to 2016. We calculated incidence rates of major cardiovascular events [coronary heart disease (CHD), stroke, or both—macrovascular events] and all-cause mortality for subjects with and without DR and for different stages of DR. The proportional hazards regression analysis was done to assess the probability of occurrence between DR and the study events. About 22,402 T2DM subjects with DR were identified in the database and 196,983 subjects without DR. During the follow-up period among the subjects with DR, we observed the highest incidence of all-cause mortally. In the second place were the macrovascular events among the subjects with DR. In the multivariable analysis, fully adjusted for DR, sex, age, body mass index (BMI), tobacco, duration of T2DM, an antiplatelet or antihypertensive drug, and HbA1c, we observed that subjects with any stage of DR had higher risks for all of the study events, except for stroke. We observed the highest probability of all-cause death events (adjusted hazard ratios, AHRs: 1.34, 95% CI: 1.28; 1.41). In conclusion, our results show that DR is related to CHD, macrovascular events, and all-cause mortality among persons with T2DM.
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Affiliation(s)
- Joan Barrot
- Primary Health Care Center Dr. Jordi Nadal i Fàbregas (Salt), Gerència d’Atenció Primària, Institut Català de la Salut, Girona, Spain
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGOL), Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Real
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGOL), Barcelona, Spain
| | - Bogdan Vlacho
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- *Correspondence: Bogdan Vlacho,
| | - Pedro Romero-Aroca
- Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili (IISPV), University of Rovira and Virgili, Reus, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Department of Endocrinology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Didac Mauricio
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Medicine, University of Vic—Central University of Catalonia, Vic, Spain
| | - Manel Mata-Cases
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Centre d’Atenció Primària La Mina, Gerència d’Àmbit d’Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Esmeralda Castelblanco
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Division of Endocrinology, Metabolism and Lipid Research, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Xavier Mundet-Tuduri
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Xavier Mundet-Tuduri,
| | - Josep Franch-Nadal
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Àmbit d’Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
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Wang Z, Cao D, Zhuang X, Yao J, Chen R, Chen Y, Zheng K, Lu P, Zhang L. Diabetic Retinopathy May Be a Predictor of Stroke in Patients With Diabetes Mellitus. J Endocr Soc 2022; 6:bvac097. [PMID: 35795810 PMCID: PMC9250809 DOI: 10.1210/jendso/bvac097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is unclear whether diabetic retinopathy (DR) can be a predictor of stroke. In this research context, the objective of our study was to investigate whether there is a significant association between DR and stroke in diabetic patients by meta-analysis. METHODS After a systematic search of studies in electronic databases, we screened all studies reporting the risk of DR status and stroke incidence and calculated their odds ratios (ORs) and hazard ratios (HRs). The effects of type of diabetes and severity of DR were also considered for subgroup analysis. RESULTS We included 19 studies involving 45 495 patients. A pooled HR = 1.62 (1.28-2.06) were found for the risk of DR and stroke in diabetic patients. In a subgroup analysis performed on the type of diabetes, the results showed a significant association between stroke incidence and DR status in patients with type 2 diabetes (T2D) (OR: 1.78; 95% CI, 1.53-2.08), but this association was not conclusive in type 1 diabetes (T1D) (OR: 1.77; 95% CI, 0.48-6.61). The results of the subgroup analysis with diabetes severity showed that both mild and moderate nonproliferative diabetic retinopathy (NPDR) status and severe NPDR and worse status significantly increased the risk of stroke with HRs of 2.01 (1.45-2.78) and 2.27 (1.52-3.39), respectively. CONCLUSION DR status in diabetic patients is associated with an increased risk of stroke. This correlation was robust in patients with T2D, but uncertain in T1D. Based on this result, we have perhaps found the new factor for stroke management, so we analyzed the necessity and advantages of considering DR as a factor for stroke screening and risk management in our studies.
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Affiliation(s)
- Zicheng Wang
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510000, China
- Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Dan Cao
- Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Cardiovascular Institute, Guangzhou, Guangdong, 510000, China
| | - Xuenan Zhuang
- Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, 515000, China
| | - Jie Yao
- Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, 515000, China
| | - Ruoyu Chen
- Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Southern Medical University, Guangzhou, 510000, China
| | - Yesheng Chen
- Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Cardiovascular Institute, Guangzhou, Guangdong, 510000, China
| | - Kangyan Zheng
- Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, 515000, China
| | - Peiyao Lu
- Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Cardiovascular Institute, Guangzhou, Guangdong, 510000, China
| | - Liang Zhang
- Correspondence: Liang Zhang, MD, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510000, China; Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
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14
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Yalim Z, Alan Yalim S, Eroğul Ö, Doğan M. The role of heart rate variability and heart rate turbulence in diabetic retinopathy. Minerva Endocrinol (Torino) 2022; 47:172-180. [PMID: 35142481 DOI: 10.23736/s2724-6507.20.03346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS The aim of this study was to evaluate the cardiac autonomic functions of individuals with asymptomatic diabetic retinopathy (DR) and no obvious heart disease by heart rate turbulence (HRT) and heart rate variability (HRV) analysis. METHODS A total of 72 patients with Type II Diabetes Mellitus: 20 non-retinopathic (NRDM), 26 non-proliferative retinopathic patients (NPDR) and 26 proliferative retinopathic patients (PDR) were enrolled in this cross-sectional study. RESULTS The HRV parameters of Standard deviation of NN intervals (SDNN) (119.8±11.7, 101.1±20.2, 100.6±17.04), Standard deviation of the average NN intervals (SDANN) (108.3±10.8, 91.2±17.5, 93.6±18.4), SDNN Index (49.5±5.1, 40.1±13.4, 38.6±12.7), Root mean square of successive RR interval differences (RMSSD) (28.3±5.1, 22.3±7.5, 26±9.2) and Triangular index (34.4±4.3, 29.7±8.8, 27.3±6.7) were significantly lower in the NPDR and PDR groups than in the NRDM group (for all p<0.05). Also, there was a statistically significant higher Turbulence Onset (-1.80±0.7, -1.1±0.9, -0.43±0.81) and lower Turbulence Slope (8.05±2.59, 5.82±3.39, 4.53±2.07) in HRT parameters in patients in the NPDR and PDR groups than in the NRDM group (respectively, NRDM, NPDM, PDM, for all p<0.001). CONCLUSIONS We found that HRV and HRT parameters had a significant deterioration in retinopathic individuals compared to the group without retinopathy. We think that HRV and HRT analysis can have an important role in the evaluation of these patients.
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Affiliation(s)
- Zafer Yalim
- Department of Cardiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey -
| | - Sümeyra Alan Yalim
- Department of İnternal Medicine, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Özgür Eroğul
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Mustafa Doğan
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
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Trott M, Smith L, Veronese N, Pizzol D, Barnett Y, Gorely T, Pardhan S. Eye disease and mortality, cognition, disease, and modifiable risk factors: an umbrella review of meta-analyses of observational studies. Eye (Lond) 2022; 36:369-378. [PMID: 34272511 PMCID: PMC8807837 DOI: 10.1038/s41433-021-01684-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 06/22/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
Globally, 2.2 billion people live with some form of vision impairment and/or eye disease. To date, most systematic reviews examining associations have focused on a single eye disease and there is no systematic evaluation of the relationships between eye diseases and diverse physical and mental health outcomes. Moreover, the strength and reliability of the literature is unclear. We performed an umbrella review of observational studies with meta analyses for any physical and/or mental comorbidities associated with eye disease. For each association, random-effects summary effect size, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals were calculated, and used to grade significant evidence from convincing to weak. 34 studies were included covering 58 outcomes. No outcomes yielded convincing evidence, six outcomes yielded highly suggestive results (cataract positively associated with type 2 diabetes, open-angled glaucoma positively associated with myopia and diabetes, diabetic retinopathy positively associated with cardiovascular disease and cardiovascular mortality, and retinopathy of prematurity positively associated with chorioamnionitis), eight outcomes yielded suggestive results (diabetic retinopathy positively associated with all-cause mortality and depression, diabetic macular oedema positively associated with dyslipidaemia, cataract positively associated with gout, nuclear sclerosis positively associated with all-cause mortality, open angled glaucoma positively associated with migraine and hypertension, and age-related macular degeneration positively associated with diabetes), and 18 outcomes yielded weak evidence. Results show highly suggestive or suggestive evidence for associations between several types of eye diseases with several comorbid outcomes. Practitioners and public health policies should note these findings when developing healthcare policies.
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Affiliation(s)
- Mike Trott
- grid.5115.00000 0001 2299 5510Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, UK ,grid.5115.00000 0001 2299 5510The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- grid.5115.00000 0001 2299 5510The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Nicola Veronese
- grid.418879.b0000 0004 1758 9800National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy ,grid.10776.370000 0004 1762 5517University of Palermo, Department of Geriatrics, Palermo, Italy
| | - Damiano Pizzol
- Italian Agency for Development Cooperation (Khartoum), Khartoum, Sudan
| | - Yvonne Barnett
- grid.5115.00000 0001 2299 5510School of Life Sciences, Anglia Ruskin University, Cambridge, UK
| | - Trish Gorely
- grid.23378.3d0000 0001 2189 1357Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Sciences, Inverness, UK
| | - Shahina Pardhan
- grid.5115.00000 0001 2299 5510Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, UK
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Eid M, Mounir A, El Etriby S, Al Taher A, Ezzat MAW. Diabetic Retinopathy as a Predictor of Angiographic Coronary Atherosclerosis Severity in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:1485-1494. [PMID: 35591908 PMCID: PMC9113458 DOI: 10.2147/dmso.s363406] [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: 03/05/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the most prevalent consequences of diabetes mellitus (DM). Much emphasis has been focused on the link between DR and cardiovascular disorders in patients with type 2 diabetes (T2DM). However, there is little information about the relation between the degree of DR and coronary atherosclerosis severity in Egyptian patients. AIM To assess the correlation between the degree of DR and the coronary atherosclerosis severity in T2DM. PATIENTS AND METHODS This work included 140 diabetic patients with T2DM who underwent diagnostic coronary angiography because of suspected coronary artery disease (CAD). All participants were evaluated by history, fundus assessment, laboratory tests (lipid profile and glycated hemoglobin [HbA1c]), and selective coronary angiography. The severity of coronary artery lesion was detected by Gensini score and vessel score. RESULTS Patients with DR had a significantly higher Gensini score (67.86± 44.56 versus 5.93± 9.02, P < 0.001) and a vessel score (2.29± 0.86 versus 0.50± 0.66, P < 0.001). There was a significant relation between the degree of DR, Gensini score (P < 0.001), and vessel score (P < 0.001), as both scores increased according to the severity of DR. The presence and degree of retinopathy were the only independent factors linked to the severity score in multivariate linear regression analyses (P < 0.001). CONCLUSION The presence and degree of DR are independent predictors of severe coronary atherosclerosis. Therefore, when evaluating whether a patient with T2DM is at high risk for CAD, the DR degree should be taken into consideration.
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Affiliation(s)
- Mohamed Eid
- Department of Internal Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt
| | - Amr Mounir
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
- Correspondence: Amr Mounir, Email
| | - Shehab El Etriby
- Department of Cardiology, Ain Shams Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ali Al Taher
- Department of Internal Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt
| | - Mohamed A W Ezzat
- Department of Internal Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt
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Babiuch AS, Wykoff CC, Yordi S, Yu H, Srivastava SK, Hu M, Le TK, Lunasco L, Reese J, Nittala MG, Sadda SR, Ehlers JP. The 2-Year Leakage Index and Quantitative Microaneurysm Results of the RECOVERY Study: Quantitative Ultra-Widefield Findings in Proliferative Diabetic Retinopathy Treated with Intravitreal Aflibercept. J Pers Med 2021; 11:1126. [PMID: 34834478 PMCID: PMC8619795 DOI: 10.3390/jpm11111126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/20/2022] Open
Abstract
Eyes with proliferative diabetic retinopathy (PDR) have been shown to improve in the leakage index and microaneurysm (MA) count after intravitreal aflibercept (IAI) treatment. The authors investigated these changes via automatic segmentation on ultra-widefield fluorescein angiography (UWFA). Forty subjects with PDR were randomized to receive either 2 mg IAI every 4 weeks (Arm 1) or every 12 weeks (Arm 2) through Year 1. After Year 1, Arm 1 switched to quarterly IAI and Arm 2 to monthly IAI through Year 2. By Year 2, the Arm 1 leakage index decreased by 43% from Baseline (p = 0.03) but increased by 59% from Year 1 (p = 0.04). Arm 2 decreased by 61% from Baseline (p = 0.008) and by 31% from Year 1 (p = 0.12). Both cohorts exhibited a significant decline in MAs from Baseline to Year 2 (871 to 410; p < 0.001; 776 to 207; p < 0.001, respectively). Subjects with an improved leakage and MA count showed a more significant improvement in the Diabetic Retinopathy Severity Scale (DRSS) score. Moreover, central subfield thickness (CST) was positively associated with changes in the leakage index. In conclusion, the leakage index and MA counts significantly improved from Baseline following IAI treatment, and monthly injections provided a more rapid and sustained reduction in these parameters compared with quarterly injections.
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Affiliation(s)
- Amy S. Babiuch
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (A.S.B.); (S.K.S.); (J.R.)
- The Tony and Leona Campane Center for Excellence for Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (S.Y.); (M.H.); (T.K.L.); (L.L.)
| | - Charles C. Wykoff
- Retina Consultants of Texas, Kingwood, TX 77339, USA; (C.C.W.); (H.Y.)
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Sari Yordi
- The Tony and Leona Campane Center for Excellence for Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (S.Y.); (M.H.); (T.K.L.); (L.L.)
| | - Hannah Yu
- Retina Consultants of Texas, Kingwood, TX 77339, USA; (C.C.W.); (H.Y.)
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Sunil K. Srivastava
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (A.S.B.); (S.K.S.); (J.R.)
- The Tony and Leona Campane Center for Excellence for Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (S.Y.); (M.H.); (T.K.L.); (L.L.)
| | - Ming Hu
- The Tony and Leona Campane Center for Excellence for Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (S.Y.); (M.H.); (T.K.L.); (L.L.)
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Thuy K. Le
- The Tony and Leona Campane Center for Excellence for Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (S.Y.); (M.H.); (T.K.L.); (L.L.)
| | - Leina Lunasco
- The Tony and Leona Campane Center for Excellence for Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (S.Y.); (M.H.); (T.K.L.); (L.L.)
| | - Jamie Reese
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (A.S.B.); (S.K.S.); (J.R.)
- The Tony and Leona Campane Center for Excellence for Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (S.Y.); (M.H.); (T.K.L.); (L.L.)
| | | | - SriniVas R. Sadda
- Doheny Eye Institute, Los Angeles, CA 90033, USA; (M.G.N.); (S.R.S.)
| | - Justis P. Ehlers
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (A.S.B.); (S.K.S.); (J.R.)
- The Tony and Leona Campane Center for Excellence for Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44106, USA; (S.Y.); (M.H.); (T.K.L.); (L.L.)
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The Association of Diabetic Retinopathy and Cardiovascular Disease: A 13-Year Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158106. [PMID: 34360398 PMCID: PMC8345672 DOI: 10.3390/ijerph18158106] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/18/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Previous studies have demonstrated that patients with diabetic retinopathy (DR) have a higher prevalence of risk factors known to be associated with cardiovascular disease (CVD). We hypothesized that patients with more severe DR could have a higher relative risk of CVD. METHODS To test this hypothesis, we used the National Health Insurance Research Database (NHIRD) to evaluate whether associations exist between DR and CVD. The data for this nationwide population-based retrospective cohort study were obtained from the NHIRD in Taiwan from 2001 to 2013. The assessed study outcome used was the incidence and other statistical analyses of CVD in patients with DR during a 13-year follow-up period. RESULTS Our findings obtained from 2001 to 2013 suggest that the incidence rates of CVD are 2.026 times that of diabetes mellitus (DM) without DR (95% C.I. = 1.876-2.187) and 2.75 times that of DM with DR (95% C.I. = 2.487-3.04) compared with the Non-DM group. CONCLUSION The relative risk of CVD in DR was greater than that in the Non-DM group for both men and women. Targeted monitoring of DM, especially the co-existence of diabetic retinopathy, is of utmost importance in the clinical care of the DM population.
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Kloecker DE, Khunti K, Davies MJ, Pitocco D, Zaccardi F. Microvascular Disease and Risk of Cardiovascular Events and Death From Intensive Treatment in Type 2 Diabetes: The ACCORDION Study. Mayo Clin Proc 2021; 96:1458-1469. [PMID: 33952397 DOI: 10.1016/j.mayocp.2020.08.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether the presence of microvascular complications modifies the effect of intensive glucose reduction on long-term outcomes in patients with type 2 diabetes. PATIENTS AND METHODS Using ACCORD and ACCORDION study data, we investigated the risk of the primary outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) or death in relation to the prerandomization type and extent of microvascular complications. Interaction terms were fitted in survival models to estimate the risk of both outcomes across levels of an overall microvascular disease score (range 0 to 100) and its individual components: diabetic nephropathy, retinopathy, and neuropathy. RESULTS During a mean follow-up of 7.7 years, 1685 primary outcomes and 1806 deaths occurred in 9405 participants. The outcome-specific microvascular score was ≤30 in 97.9% of subjects for the primary outcome and in 98.5% for death. For participants with scores of 0 and 30, respectively, the 10-year absolute risk difference between intensive glucose control and standard treatment ranged from -0.8% (95% CI, -2.6, 1.1) to -3.0% -7.1, 1.1) for the primary outcome and from -0.5% (-2.1, 1.1) to 0.7% (-4.2, 5.6) for mortality. Retinopathy was associated with the largest effects, with a 10-year absolute risk difference of -6.5% (-11.1 to -2.0) for the primary outcome and -3.9% (-7.8 to 0.1) for mortality. CONCLUSION This hypothesis-generating study identifies diabetic retinopathy as predictor of the beneficial effect of intensive glucose control on the risk of cardiovascular disease and possibly death. Further long-term studies are required to confirm these findings.
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Affiliation(s)
- David E Kloecker
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom.
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom
| | - Dario Pitocco
- Diabetes Care Unit, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, United Kingdom
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20
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Gao L, Zhao W, Yang JK, Qin MZ. Proliferative diabetic retinopathy in patients with type 2 diabetes correlates with the presence of atherosclerosis cardiovascular disease. Diabetol Metab Syndr 2021; 13:48. [PMID: 33902673 PMCID: PMC8077820 DOI: 10.1186/s13098-021-00666-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atherosclerosis cardiovascular disease (ASCVD) is the main cause of morbidity and mortality in type 2 diabetes mellitus (T2DM). As most diabetic patients with ASCVD are asymptomatic, it is most neglected in clinical practice. For this reason, identifying high-risk ASCVD population with intensified treatment is very important. In recent years, the relationship between diabetic retinopathy (DR) and ASCVD has caused much academic concern, but the results are inconsistent. Moreover, whether all grades of DR increase the risk of ASCVD remains controversial. Most importantly, very few data can be found in China. OBJECTIVE Our aim is to discuss whether all grades of DR increase the risk of ASCVD after adjustment for the traditional cardiovascular risk factors and to assess the independent contribution of DR to cardiovascular events in patients with T2DM, hoping to provide more evidence for early identification of ASCVD. RESEARCH DESIGN AND METHODS A total of 425 T2DM patients with complete physical and biochemical data were included in the study. The grade of DR was assessed with two 45 color digital retinal images. Based on the presence of history of ASCVD, 425 T2DM patients were divided into 2 groups: ASCVD group and non-ASCVD group. RESULTS ASCVD patients were older and had a significantly higher fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) and proportion of history of ASCVD. At the same time, they were more likely to be females, and had lower level of alcohol and calculated glomerular filtration rate (eGFR) than non-ASCVD patients. Their trend to develop DR with ASCVD was significantly higher than patients with non-ASCVD (χ2 = 5.805, P = 0.016). DR was an independent statistical indicator of the presence of ASCVD [odds ratio (OR) (95% CI): 2.321 (1.152-4.678), P = 0.018]. Furthermore, when DR was divided into non-proliferative retinopathy (NPDR) and proliferative retinopathy (PDR) according to its severity, only PDR was significantly associated with incident ASCVD [OR (95% CI): 8.333 (1.813-38.304), P = 0.006]. After adjusting for traditional ASCVD risk factors, such an association still existed [OR (95% CI): 7.466 (1.355-41.137), P = 0.021]. CONCLUSION DR associates strongly with ASCVD in the Chinese population with T2DM. With the increasing severity of DR, the risk of ASCVD also increases. After adjustment for traditional risk factors, PDR is still an independent risk marker for ASCVD.
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Affiliation(s)
- Lu Gao
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wei Zhao
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ming-Zhao Qin
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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21
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Lahoti S, Nashawi M, Sheikh O, Massop D, Mir M, Chilton R. Sodium-glucose co-transporter 2 inhibitors and diabetic retinopathy: insights into preservation of sight and looking beyond. Cardiovasc Endocrinol Metab 2021; 10:3-13. [PMID: 33634250 PMCID: PMC7901818 DOI: 10.1097/xce.0000000000000209] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/05/2020] [Indexed: 01/05/2023]
Abstract
Sodium-glucose co-transporter 2 Inhibitors (SGLT2i) were initially developed as therapeutic options for patients with type 2 diabetes mellitus (T2DM). Recently, randomized clinical trials have investigated their effects in cardiorenal protection through major adverse cardiovascular event reduction and reductions in diabetic nephropathy. While multiple mechanisms are proposed for this protection, microvascular protection is the primary component of their efficacy. While not primarily emphasized in clinical trials, evidence in other studies suggests that SGLT2i may confer retinoprotective effects via some of the same mechanisms in the aforementioned cardiorenal trials. Diabetic patients are susceptible to vision loss with chronic hyperglycemia promoting inflammation, edema, and retinal pathological changes. Targeting these pathways via SGLT2i may represent opportunities for providers to decrease retinopathy in high-risk T2DM patients, reduce disease progression, and lower drug burden in diabetic retinopathy patients. Further comprehensive clinical trials investigating these associations are needed to establish the potential retinoprotective effects of SGLT2i.
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Affiliation(s)
- Sejal Lahoti
- Department of Ophthalmology, Long School of Medicine, University of Texas Health San Antonio
| | - Mouhamed Nashawi
- Division of Medicine-Cardiology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Omar Sheikh
- Division of Medicine-Cardiology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - David Massop
- Department of Ophthalmology, Long School of Medicine, University of Texas Health San Antonio
| | - Mahnoor Mir
- Division of Medicine-Cardiology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Robert Chilton
- Division of Medicine-Cardiology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
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22
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Huang X, Wen Z, Qi CX, Tong Y, Shen Y. Dynamic Changes of Amplitude of Low-Frequency Fluctuations in Patients With Diabetic Retinopathy. Front Neurol 2021; 12:611702. [PMID: 33643197 PMCID: PMC7905082 DOI: 10.3389/fneur.2021.611702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/18/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Growing evidence demonstrate that diabetic retinopathy (DR) patients have a high risk of cognitive decline and exhibit abnormal brain activity. However, neuroimaging studies thus far have focused on static cerebral activity changes in DR patients. The characteristics of dynamic cerebral activity in patients with DR are poorly understood. Purpose: The purpose of the study was to investigate the dynamic cerebral activity changes in patients with DR using the dynamic amplitude of low-frequency fluctuation (dALFF) method. Materials and methods: Thirty-four DR patients (18 men and 16 women) and 38 healthy controls (HCs) (18 males and 20 females) closely matched in age, sex, and education were enrolled in this study. The dALFF method was used to investigate dynamic intrinsic brain activity differences between the DR and HC groups. Results: Compared with HCs, DR patients exhibited increased dALFF variability in the right brainstem, left cerebellum_8, left cerebellum_9, and left parahippocampal gyrus. In contrast, DR patients exhibited decreased dALFF variability in the left middle occipital gyrus and right middle occipital gyrus. Conclusion: Our study highlighted that DR patients showed abnormal variability of dALFF in the visual cortices, cerebellum, and parahippocampal gyrus. These findings suggest impaired visual and motor and memory function in DR individuals. Thus, abnormal dynamic spontaneous brain activity might be involved in the pathophysiology of DR.
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Affiliation(s)
- Xin Huang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Ophthalmology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chen-Xing Qi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Tong
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yin Shen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China.,Medical Research Institute, Wuhan University, Wuhan, China
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23
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Modjtahedi BS, Wu J, Luong TQ, Gandhi NK, Fong DS, Chen W. Severity of Diabetic Retinopathy and the Risk of Future Cerebrovascular Disease, Cardiovascular Disease, and All-Cause Mortality. Ophthalmology 2020; 128:1169-1179. [PMID: 33359888 DOI: 10.1016/j.ophtha.2020.12.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/01/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To determine the relationship between the severity of diabetic retinopathy and the future risk of cerebrovascular accident (CVA), myocardial infarction (MI), congestive heart failure (CHF), and all-cause mortality in patients with type 2 diabetes mellitus. DESIGN Retrospective cohort study. PARTICIPANTS Patients with type 2 diabetes who underwent diabetic retinopathy screening via fundus photography. METHODS The relationship between retinopathy status and the 5-year risk of first-time CVA, MI, CHF, and all-cause mortality was investigated using multivariate Cox proportional hazards regressions that controlled for age, gender, race or ethnicity, hemoglobin A1c, duration of diabetes, high-density lipoprotein level, low-density lipoprotein level, history of hypertension, systolic blood pressure, diastolic blood pressure, tobacco use, statin use, body mass index, urine microalbumin-to-creatinine ratio, and estimated glomerular filtration rate. MAIN OUTCOME MEASURES Five-year risk of first-time CVA, MI, CHF, and all-cause mortality. RESULTS Seventy-seven thousand three hundred seventy-six patients were included in this study. The average age was 59.8 years with 53.6% male, 31.2% non-Hispanic White, and 41.4% Hispanic patients. Diabetic retinopathy was significantly associated with all outcomes on multivariate analysis. Compared with patients with no retinopathy, those with minimal nonproliferative diabetic retinopathy (NPDR) had a higher risk of CVA (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.18-1.46), MI (HR, 1.30; 95% CI, 1.15-1.46), CHF (HR, 1.29; 95% CI, 1.19-1.40), and death (HR, 1.15; 95% CI, 1.05-1.25). Similarly, patients with moderate to severe NPDR had a higher risk of each outcome (CVA: HR, 1.56; 95% CI, 1.29-1.89; MI: HR, 1.92; 95% CI, 1.57-2.34; CHF: HR, 1.90; 95% CI, 1.66-2.18, and death: HR, 1.55; 95% CI, 1.32-1.82), as did patients with proliferative diabetic retinopathy (CVA: HR, 2.53; 95% CI, 1.84-3.48; MI: HR, 1.89; 95% CI, 1.26-2.83; CHF: HR, 1.96; 95% CI, 1.47-2.59; and death: HR, 1.87; 95% CI, 1.36-2.56). CONCLUSIONS Diabetic retinopathy is significantly associated with future risk of CVA, MI, CHF, and death, with higher degrees of retinopathy appearing to carry a heightened risk for each outcome. Retinal information may provide valuable insights into patients' risk of future vascular disease and death.
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Affiliation(s)
- Bobeck S Modjtahedi
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California; Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California; Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California.
| | - Jun Wu
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Tiffany Q Luong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Nainesh K Gandhi
- Department of Cardiology, Southern California Permanente Medical Group, San Bernardino County, California
| | - Donald S Fong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California; Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California; Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California
| | - Wansu Chen
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
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24
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Takao T, Suka M, Yanagisawa H, Kasuga M. Combined effect of diabetic retinopathy and diabetic kidney disease on all-cause, cancer, vascular and non-cancer non-vascular mortality in patients with type 2 diabetes: A real-world longitudinal study. J Diabetes Investig 2020; 11:1170-1180. [PMID: 32267626 PMCID: PMC7477514 DOI: 10.1111/jdi.13265] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/16/2020] [Accepted: 03/29/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS/INTRODUCTION We assessed the relationship between diabetic retinopathy (DR) and/or diabetic kidney disease (DKD) according to their severity and all-cause, cancer, vascular and non-cancer non-vascular mortality in real-world patients with type 2 diabetes. MATERIALS AND METHODS A total of 1,902 patients with type 2 diabetes were enrolled from 1995 to 1999 and followed to 2017. At baseline, DR was diagnosed in 374 patients, DKD in 529, vision-threatening DR in 123 and advanced DKD in 287. Patients were classified by the status of DR and DKD. Multivariate Cox regression analysis was carried out. RESULTS There were 266 deaths during a median follow-up period of 18.6 years. Among these, 92 were from cancer, 78 were from vascular causes and 82 were from non-cancer non-vascular causes. DR and/or DKD predicted all-cause, vascular and non-cancer non-vascular mortality, but not cancer mortality. Similarly, vision-threatening DR and/or advanced DKD predicted all-cause, vascular and non-cancer non-vascular mortality, but not cancer mortality. Hazard ratios for all-cause, vascular and non-cancer non-vascular mortality were highest in the DR(+)DKD(+) group, and higher in the DR(-)DKD(+) and the DR(+)DKD(-) groups than in the DR(-)DKD(-) group. The results for vision-threatening DR and advanced DKD were similar. The interaction for non-cancer non-vascular mortality, but not all-cause and vascular mortality, between DR and DKD and between vision-threatening DR and advanced DKD might be significant. CONCLUSIONS DR and DKD may be jointly and independently associated with all-cause, vascular and non-cancer non-vascular mortality, but not cancer mortality, according to their severity in real-world patients with type 2 diabetes.
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Affiliation(s)
- Toshiko Takao
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan
| | - Machi Suka
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yanagisawa
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masato Kasuga
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan
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25
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Loss to Follow-Up Among Patients With Proliferative Diabetic Retinopathy in Clinical Practice. Am J Ophthalmol 2020; 215:66-71. [PMID: 32209344 DOI: 10.1016/j.ajo.2020.03.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the proportion of patients with proliferative diabetic retinopathy (PDR) who were counted as loss to follow-up (LTFU) patients and to investigate predictive factors. DESIGN Retrospective cohort study. METHODS Information was collected for 4,423 patients with PDR between April 30, 2012, and April 30, 2017. Two definitions of LTFU were used. Complete LTFU referred to the population who never returned to care within the study period. Interval LTFU referred to the population who did not adhere to clinical recommendations and missed scheduled appointments, resulting in intervals longer than 6 months or 1 year between 2 appointments. Age, average gross income, and insurance were assessed as potential predictors of interval LTFU. RESULTS Among 4,423 patients with PDR, 2,407 (54.4%) and 2,320 (52.4%) were complete LTFU at 6 months and 1 year, respectively; 782 (17.7%) and 468 (10.6%) patients were interval LTFU for 6 months and 1 year, respectively. Age and average gross income were not found to be significant predictors of interval LTFU. Compared to self-pay, government and private insurance patients were more likely to be interval LTFU at 6 months (government, P = .035; private, P = .005). Private insurance patients were also more likely to be interval LTFU at 1 year (P = .003). CONCLUSIONS The identified complete LTFU rates were notably high and warrant further study. More than 1 of 6 patients were interval LTFU for at least 6 months, and 1 of 10 patients was interval LTFU for more than 1 year. Insurance status was significant in determining interval LTFU status. Consistent with other analyses, these results indicate that compliance with clinical appointments among patients with PDR is a substantial clinical challenge.
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Drinkwater JJ, Davis TME, Davis WA. The relationship between carotid disease and retinopathy in diabetes: a systematic review. Cardiovasc Diabetol 2020; 19:54. [PMID: 32375803 PMCID: PMC7201797 DOI: 10.1186/s12933-020-01023-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since studies of the relationship between carotid disease and diabetic retinopathy (DR) have shown apparent inconsistencies, the aim of this study was to conduct a systematic review of available published data. METHODS Electronic databases were searched independently by two reviewers, according to an iterative protocol, for relevant articles. The search term used was "diabetes AND (carotid disease OR intima-media OR carotid plaque OR carotid stenosis OR carotid arterial disease OR carotid artery disease OR carotid atherosclerosis) AND (retinopathy OR diabetic retinopathy)". RESULTS From 477 publications, 14 studies were included. There were differences in the variables used as markers of carotid disease and DR across the included studies. Ten studies used carotid disease as the dependent variable, and the remainder used DR. All but one study involved cross-sectional data. Most studies reported a statistically significant association between at least one parameter of carotid disease as assessed by ultrasound and DR presence or severity. Only four studies reported no significant association. A common limitation was the use of convenience participant sampling. CONCLUSIONS There appears to be an increased likelihood of DR when there is ultrasonographic evidence of carotid disease, and vice versa. The available studies suggest that there may be a direct relationship between DR and carotid macrovascular disease and/or that these complications co-exist due to shared risk factors. If carotid disease is detected, retinal assessment should be performed. If DR is identified, intensive cardiovascular disease risk management should be considered. Additional longitudinal studies are needed to assess the directionality of the association.
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Affiliation(s)
- Jocelyn J Drinkwater
- Medical School, The University of Western Australia, Fremantle Hospital, P. O. Box 480, Fremantle, WA, 6959, Australia
| | - Timothy M E Davis
- Medical School, The University of Western Australia, Fremantle Hospital, P. O. Box 480, Fremantle, WA, 6959, Australia.
| | - Wendy A Davis
- Medical School, The University of Western Australia, Fremantle Hospital, P. O. Box 480, Fremantle, WA, 6959, Australia
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27
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Bandello F, Toni D, Porta M, Varano M. Diabetic retinopathy, diabetic macular edema, and cardiovascular risk: the importance of a long-term perspective and a multidisciplinary approach to optimal intravitreal therapy. Acta Diabetol 2020; 57:513-526. [PMID: 31749046 DOI: 10.1007/s00592-019-01453-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/05/2019] [Indexed: 12/17/2022]
Abstract
Diabetic retinopathy (DR), diabetic macular edema (DME), and cardiovascular disease (CVD) resulting from vascular damage from persistently elevated blood glucose levels are among the serious secondary pathologies associated with long-standing diabetes mellitus. The established link between DR and CVD suggests the need for appropriate and early management of patients with diabetes to minimize CV risk. This is of particular importance in patients with recent, or a history of, major CV events. Early management of DR is a complex task that requires comprehensive evaluation and a multidisciplinary approach to manage complications, risk factors, and interactions between different aspects of the disease. Anti-vascular endothelial growth factor (VEGF) agents have become an important therapeutic modality in ophthalmology. However, their use is contraindicated in patients with DR and/or DME with a CV event in the previous 3 months. In patients with DME, corticosteroids target the multifaceted inflammatory pathways involved in the pathogenesis of DR, with a broader spectrum of action than anti-VEGF agents. In this context, recent guidelines suggest the use of corticosteroids, and in particular dexamethasone intravitreal implant, as a well-tolerated and efficacious first-line treatment in patients with high CV risk, such as a history of or recent major CV events. This review focuses on the subset of diabetic patients with a prior CV event, DR, and DME and discusses the need for a holistic approach in evaluating the optimal therapeutic choice for the care of the individual patient, supported by real-world clinical experience on long-term dexamethasone intravitreal implant therapy.
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Affiliation(s)
- Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina Milano, 58, 20132, Milan, Italy.
| | - Danilo Toni
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
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28
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Drinkwater JJ, Davis TME, Hellbusch V, Turner AW, Bruce DG, Davis WA. Retinopathy predicts stroke but not myocardial infarction in type 2 diabetes: the Fremantle Diabetes Study Phase II. Cardiovasc Diabetol 2020; 19:43. [PMID: 32234054 PMCID: PMC7110810 DOI: 10.1186/s12933-020-01018-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/19/2020] [Indexed: 12/22/2022] Open
Abstract
Background Microangiopathy in type 2 diabetes (T2D) is associated with cardiovascular disease (CVD), but most relevant studies were performed > 10 years ago. CVD risk factor management has since improved. The aim of this study was to determine whether diabetic retinopathy (DR) and its severity increases stroke and myocardial infarction (MI) risk in a contemporary cohort. Methods Fremantle Diabetes Study Phase II participants with T2D had DR graded from fundus photography at baseline between 2008 and 2011. Subsequent hospitalizations and mortality for MI or stroke were ascertained through validated data linkage to end-2016. Cox regression modelling identified predictors of first stroke and MI including DR presence and severity. Results The 1521 participants with T2D and known DR status (mean age 65.6 years, 52.1% males, median diabetes duration 9.0 years) were followed for a mean of 6.6 years. After excluding those with prior MI/stroke, there were 126 incident MIs among 1393 eligible participants and 53 incident strokes in 1473 eligible participants, respectively. Moderate non-proliferative DR (NPDR) or worse was significantly and independently associated with an increased risk of incident stroke (adjusted hazard ratio 2.55 (95% CI 1.19, 5.47), p = 0.016). Retinopathy presence and severity increased the risk of incident MI in unadjusted models (p ≤ 0.001), but these associations were no longer statistically significant after adjusting for other risk factors. Conclusions Moderate NPDR or worse was associated with an increased risk of first stroke in Australians with T2D. Intensified CVD risk factor management should be considered for patients with at least moderate NPDR.
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Affiliation(s)
- Jocelyn J Drinkwater
- Medical School, The University of Western Australia, Fremantle Hospital, P. O. Box 480, Fremantle, WA, 6959, Australia
| | - Timothy M E Davis
- Medical School, The University of Western Australia, Fremantle Hospital, P. O. Box 480, Fremantle, WA, 6959, Australia.
| | - Valentina Hellbusch
- Medical School, The University of Western Australia, Fremantle Hospital, P. O. Box 480, Fremantle, WA, 6959, Australia
| | - Angus W Turner
- Lions Eye Institute, Nedlands, WA, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Crawley, WA, Australia
| | - David G Bruce
- Medical School, The University of Western Australia, Fremantle Hospital, P. O. Box 480, Fremantle, WA, 6959, Australia
| | - Wendy A Davis
- Medical School, The University of Western Australia, Fremantle Hospital, P. O. Box 480, Fremantle, WA, 6959, Australia
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Porta M, Striglia E. Intravitreal anti-VEGF agents and cardiovascular risk. Intern Emerg Med 2020; 15:199-210. [PMID: 31848994 DOI: 10.1007/s11739-019-02253-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022]
Abstract
Antagonists of Vascular Endothelial Growth Factor (Anti-VEGF) are widely administered by intravitreal injection for the treatment of ocular pathologies such as Age-related Macular Degeneration, Diabetic Macular Edema, Proliferative Diabetic Retinopathy and occlusion of retinal vessels. Anti-VEGF agents, in particular bevacizumab, were introduced in oncology to inhibit tumor-induced angiogenesis feeding neoplastic tissues. Subsequently, other specific agents were developed for intraocular administration. Whereas systemic administration of anti-VEGF agents in oncology is burdened by increased risk of arterial hypertension and embolism, agents administered for ophthalmic indications are delivered locally into the eye globe in much smaller quantities. Nevertheless, clinical observations have raised the possibility that, even in these conditions, anti-VEGF agents may increase cardiovascular risk in patients who, being elderly and/or diabetic, are intrinsically prone to such events. This paper aims at reviewing the current knowledge on VEGF and its pharmacologic antagonists from mechanistic and side effect points of view, with specific reference to patients with sight-threatening conditions. Internists should be aware of the need to collaborate with ophthalmologists and pharmacovigilance operators to define as best as possible the risk/benefit balance of intravitreal agents in patients who might lose their sight if left untreated, or increase their risk of suffering a cardiovascular event if treated.
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Affiliation(s)
- Massimo Porta
- Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126, Turin, Italy.
| | - Elio Striglia
- Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126, Turin, Italy
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30
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Cicinelli MV, Cavalleri M, Lattanzio R, Bandello F. The current role of steroids in diabetic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1729743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Maria Vittoria Cicinelli
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Michele Cavalleri
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
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31
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Aliyari R, Hajizadeh E, Aminorroaya A, Sharifi F, Kazemi I, Baghestani AR. Multistate Models to Predict Development of Late Complications of Type 2 Diabetes in an Open Cohort Study. Diabetes Metab Syndr Obes 2020; 13:1863-1872. [PMID: 32547148 PMCID: PMC7266524 DOI: 10.2147/dmso.s234563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Increase in the prevalence of type 2 diabetic mellitus (T2DM) as a complex disease, its complications, and spread has become a dominant global health threat in recent decades. OBJECTIVE The aim of the current study was to investigate the impact of risk factors and transition probability on the development and progression of the late complications of T2DM. METHODS This study was an open cohort one which was conducted at Isfahan Endocrine and Metabolism Research Center (IEMRC). The data were collected from 1993 to 2018. The sample size consisted of 2519 adults diagnosed with type 2 diabetes. We applied the homogeneous multistate models including no complication, retinopathy alone, coronary artery disease (CAD), microalbuminuria, retinopathy and CAD, and the final absorbing mortality states. RESULTS Based on our results, time-varying hypertension strongly intensified the hazard of transition to mortality in CAD, no complication, CAD and retinopathy, and retinopathy patients by 4.99, 4.09, 3.42, and 2.65 times, respectively. Hypertension seemed to be a potential factor for the transition of microalbuminuria to no complication in diabetic patients. One-unit increase in LDL increased the hazard ratio of transition from CAD, and retinopathy and CAD to mortality by 1.8% and 2.4%, respectively. Moreover, one level increase in time-varying HbA1c increased the hazard ratio of transition to retinopathy and mortality among no complication diabetic patients by 30% and 67%, respectively. One level increase in time-varying HbA1c also intensified the hazard ratio of transition from retinopathy to mortality by 45%. The same level of increase in time-varying HbA1c also intensified the hazard ratio of transition from CAD alone to CAD and retinopathy, and microalbuminuria to retinopathy by 26% and 50%, respectively. CONCLUSION In addition to glycemic control, our study indicates that controlling hypertension and hyperlipidemia is more effective in reducing mortality and the diabetic macro- and microvascular complications.
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Affiliation(s)
- Roqayeh Aliyari
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ebrahim Hajizadeh
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
- Correspondence: Ebrahim Hajizadeh Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran1411713116, IranTel +982182883810Fax +982182884510 Email
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Ashraf Aminorroaya Isfahan Endocrine and Metabolism Research, Isfahan University of Medical Sciences, Isfahan, IranTel +98 313 335 9933Fax +98 313 337 3733 Email
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Kazemi
- Department of Statistics, Faculty of Sciences, University of Isfahan, Isfahan, Iran
| | - Ahmad-Reza Baghestani
- Department of Biostatistics, Physiotherapy Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhou JB, Yuan J, Tang XY, Zhao W, Luo FQ, Bai L, Li B, Cong J, Qi L, Yang JK. Is central obesity associated with diabetic retinopathy in Chinese individuals? An exploratory study. J Int Med Res 2019; 47:5601-5612. [PMID: 31547740 PMCID: PMC6862893 DOI: 10.1177/0300060519874909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective To our knowledge, the independent association between central obesity, defined by waist circumference (WC) or waist-to-hip ratio (WHR), and diabetic retinopathy (DR) remains unknown in Chinese individuals. Method The study was conducted in two stages. First, the relationship between WC or WHR and DR was estimated in a case-control set (DR vs. non-DR) for the whole population before and after propensity score matching. Subsequently, a systematic review and meta-analysis was performed on evidence from the literature to validate the relationship. Results Of 511 eligible patients, DR (N = 156) and non-DR (N = 156) patients with similar propensity scores were included in the propensity score matching analyses. Central obesity (defined by WC) was associated with risk of DR (odds ratio [OR] 1.07, 95% confidence interval [95% CI] (1.03–1.10). The meta-analysis showed that central obesity significantly increased the risk of DR by 12% (OR 1.12, 95% CI 1.02–1.22). Analysis of data from 18 studies showed a significant association between continuous body mass index and risk of proliferative DR (OR 0.95, 95% CI 0.93–0.98; I2 = 50%). Conclusion Central obesity, particularly as defined by WC, is associated with the risk of DR in the Chinese population.
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Affiliation(s)
- Jian-Bo Zhou
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Jing Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | | | - Wei Zhao
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | | | - Lu Bai
- Department of Geriatrics, Beijing Haidian Hospital, Beijing, China
| | - Bei Li
- Department of Digestive, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jia Cong
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
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Zhao L, Wang L, Lu M, Hu W, Xiu S. Hyperglycemia is associated with poor in-hospital outcome in elderly patients with acute ischemic stroke. Medicine (Baltimore) 2019; 98:e16723. [PMID: 31374068 PMCID: PMC6709290 DOI: 10.1097/md.0000000000016723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Fasting hyperglycemia is associated with poor neurologic outcome in acute ischemic stroke (AIS), but its relationship with in-hospital outcome in elderly patients remains largely unknown. To assess the association of in-hospital outcome with fasting plasma glucose (FPG) levels at admission in individuals with AIS.This retrospective propensity score-matched case-control study included patients aged over 60 years suffering from AIS and who were admitted to the emergency department from November 2013 to October 2016. Subjects were grouped into the poor-outcome and good-outcome groups based on mortality and intensive care unit (ICU) admission.The poor- and good-outcome groups comprised 74 and 1927 cases, respectively, before propensity score matching (PSM), and 74 and 296 cases, respectively, after PSM. Univariable logistic regression analysis showed that initial FPG after admission was associated with poor in-hospital outcome. Multivariable logistic regression analysis showed that initial FPG after admission was an independent predictor of poor in-hospital outcome (odds ratio = 1.11, 95% confidence interval: 1.037-1.188, P = .003).This study used PSM and strongly suggests that FPG is an independent predictive factor of poor in-hospital outcome in elderly patients with AIS. High initial FPG levels after admission may predict poor in-hospital outcome. Prospective studies are needed to confirm these findings.
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Kuper H, Mathenge W, Macleod D, Foster A, Gichangi M, Rono H, Wing K, Weiss HA, Bastawrous A, Burton M. Mortality during 6 years of follow-up in relation to visual impairment and eye disease: results from a population-based cohort study of people aged 50 years and above in Nakuru, Kenya. BMJ Open 2019; 9:e029700. [PMID: 31182456 PMCID: PMC6561440 DOI: 10.1136/bmjopen-2019-029700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/04/2019] [Accepted: 05/15/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To estimate the association between (1) visual impairment (VI) and (2) eye disease and 6-year mortality risk within a cohort of elderly Kenyan people. DESIGN, SETTING AND PARTICIPANTS The baseline of the Nakuru Posterior Segment Eye Disease Study was formed from a population-based survey of 4318 participants aged ≥50 years, enrolled in 2007-2008. Ophthalmic and anthropometric examinations were undertaken on all participants at baseline, and a questionnaire was administered, including medical and ophthalmic history. Participants were retraced in 2013-2014 for a second examination. Vital status was recorded for all participants through information from community members. Cumulative incidence of mortality, and its relationship with baseline VI and types of eye disease was estimated. Inverse probability weighting was used to adjust for non-participation. PRIMARY OUTCOME MEASURES Cumulative incidence of mortality in relation to VI level at baseline. RESULTS Of the baseline sample, 2170 (50%) were re-examined at follow-up and 407 (10%) were known to have died (adjusted risk of 11.9% over 6 years). Compared to those with normal vision (visual acuity (VA) ≥6/12, risk=9.7%), the 6-year mortality risk was higher among people with VI (<6/18 to ≥6/60; risk=28.3%; risk ratio (RR) 1.75, 95% CI 1.28 to 2.40) or severe VI (SVI)/blindness (<6/60; risk=34.9%; RR 1.98, 95% CI 1.04 to 3.80). These associations remained after adjustment for non-communicable disease (NCD) risk factors (mortality: RR 1.56, 95% CI 1.14 to 2.15; SVI/blind: RR 1.46, 95% CI 0.80 to 2.68). Mortality risk was also associated with presence of diabetic retinopathy at baseline (RR 3.18, 95% CI 1.98 to 5.09), cataract (RR 1.26, 95% CI 0.95 to 1.66) and presence of both cataract and VI (RR 1.57, 95% CI 1.24 to 1.98). Mortality risk was higher among people with age-related macular degeneration at baseline (with or without VI), compared with those without (RR 1.42, 95% CI 0.91 to 2.22 and RR 1.34, 95% CI 0.99 to 1.81, respectively). CONCLUSIONS Visual acuity was related to 6-year mortality risk in this cohort of elderly Kenyan people, potentially because both VI and mortality are related to ageing and risk factors for NCD.
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Affiliation(s)
- Hannah Kuper
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology and Dr. Agarwal’s Eye Hospital, Kigali, Rwanda
| | - David Macleod
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Hillary Rono
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Kitale Eye Unit, Ministry of Health Trans Nzoia County, Kitale, Kenya
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Anne Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Burton
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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Coney JM. Fluocinolone acetonide 0.19 mg intravitreal implant improves foveal thickness and reduces treatment burden for up to 1 year in eyes with persistent diabetic macular edema. Int Med Case Rep J 2019; 12:161-169. [PMID: 31213929 PMCID: PMC6549741 DOI: 10.2147/imcrj.s192524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/28/2019] [Indexed: 12/20/2022] Open
Abstract
Objective: To assess the effectiveness, safety, and treatment burden in eyes with persistent diabetic macular edema (DME) for up to 1 year after administration of 0.19 mg fluocinolone acetonide (FAc) implant (Iluvien®). Methods: This retrospective study at one private practice in the US included 40 eyes from 33 patients treated with an FAc implant. Eyes had previously been treated with VEGF antagonists, dexamethasone, or focal laser. The primary outcome was change in central foveal thickness from baseline. Data were also collected on demographics, visual acuity, intraocular pressure (IOP), use of IOP-lowering drugs for elevated IOP, lens clarity, and treatment burden before and after the implant. Results: Average duration of diabetes and DME at baseline was 19 and 5 years, respectively, and average glycated hemoglobin was 7.21%. Severity of diabetic retinopathy before the implant had a slight bimodal distribution: moderate nonproliferative diabetic retinopathy (35%) and proliferative diabetic retinopathy (40%). Improvements in central foveal thickness from baseline were evident at 3 months (mean change –74.2 µm, P<0.001) and sustained through 12 months (–55.3 µm; P=0.005) for most eyes. Mean visual acuity remained stable (66.2 letters at baseline versus 67.2 letters at 12 months, roughly equivalent to 20/50 vision; P=0.855). On average, eyes required one anti-VEGF injection every 1.9 months before and one every 6.6 months after the implant, while 60% of eyes did not require additional anti-VEGF injections. Small but significant increases in IOP at months 3, 6, and 9 were not sustained to month 12, and mean IOP was normal throughout follow-up. Conclusion: In patients with DME previously treated with a steroid, and treated according to licensed indications in the US, an FAc implant not only reduces the burden of disease in the real-world setting, but also the burden of injections and office visits for patients.
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Zhou JB, Zhu XR, Zhao W, Yin L, Li HB, Qi L, Yang JK. Prediction of Proliferative Diabetic Retinopathy to Asymptomatic Obstructive Coronary Artery Disease in Chinese Type 2 Diabetes Individuals: An Exploratory Study. Metab Syndr Relat Disord 2019; 17:367-373. [PMID: 31145036 PMCID: PMC6708263 DOI: 10.1089/met.2018.0140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Patients with type 2 diabetes are prone to the asymptomatic obstructive coronary artery disease (AO-CAD). The association of proliferative diabetic retinopathy (PDR) with AO-CAD is unknown. The aim of the study is to explore the specific relationship of PDR with AO-CAD. Methods: We performed coronary angiography and retinal photographs in 1332 participants with unknown CAD status in a retrospective discovery set and 252 patients with non-CAD enrolled in a prospective validation cohort. Main outcome measures are prediction of PDR to AO-CAD. Results: In the case–control retrospective discovery set, investigation included 211 nondiabetic retinopathy (NDR) and 140 PDR. Individuals with PDR had a 2.16 times higher risk of AO-CAD compared with individuals without diabetic retinopathy (P < 0.01). Relative risk between individuals with PDR and the risk of AO-CAD varied by different adjusted covariates, 2.53 (1.48–4.32) by age and gender; 2.16 (1.10–4.31) by additionally other covariates. In the prospective validation set, after adjustment for covariates, the cumulative risk of AO-CAD was significantly higher in the PDR group compared with NDR group, followed up for a median of 4.3 years (hazard ratio = 3.07, 95% confidence interval 1.81–5.21, P < 0.001). Conclusions: PDR showed superior identification performance over traditional risk factors in screening for AO-CAD. PDR may predict persons at high risk of AO-CAD.
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Affiliation(s)
- Jian-Bo Zhou
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Xiao-Rong Zhu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Zhao
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Bing Li
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
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Xiao-Rong Z, Hui-Rong Z, Mei L, Zhen Z, Wei L, Jing L, Guang-Ran Y, Jian-Bo Z, Jin-Kui Y. Risk of silent myocardial ischemia detected by single photon emission computed tomography (SPECT) among asymptomatic Chinese patients with type 2 diabetes. Medicine (Baltimore) 2019; 98:e15618. [PMID: 31096471 PMCID: PMC6531126 DOI: 10.1097/md.0000000000015618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To explore the prevalence and risk factors of silent myocardial ischemia (SMI) detected by using single photon emission computed tomography (SPECT) in Chinese asymptomatic patients with type 2 diabetes (T2D).In this hospital-based retrospective study, 821 T2D patients who were screened for SMI detected by stress myocardial perfusion imaging using SPECT between June 2014 and July 2016 were investigated. Clinical indicators were compared between the patients with SMI and controls without SMI. Risk factors for SMI were evaluated by univariate and multivariate analysis.In this study, there were 131 patients with SMI in asymptomatic diabetes and the prevalence of SMI was 21.3% of 614 individuals. Logistic regression analysis indicated that diabetic retinopathy (OR = 1.474, 95%CI: 1.113-1.951, P = .007), male gender (OR = 1.805, 95%CI: 1.183-2.747, P = .006), and low-density lipoprotein (LDL) cholesterol (OR = 1.298, 95%CI: 1.042-1.615, P = .02) were risk factors associated with SMI. Besides, the prevalence of SMI increased in associated with the progression of retinopathy (P = .041). The percentage of SMI diagnosed in patients with no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) were 18.5% (75/405), 25.2% (37/147), and 30.6% (19/62), respectively. The percentage of SMI in male (24.5%, 85/347) was higher than that in female (17.2%, 46/267), P = .029.Physicians should be aware of these conditions when examining male patients with type 2 diabetes, especially with DR and/or high level of low-density lipoprotein cholesterol (LDL cholesterol), even if otherwise asymptomatic. A routine screening for SMI may thus be considered advisable in these patients.
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Affiliation(s)
- Zhu Xiao-Rong
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Zhang Hui-Rong
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Li Mei
- Department of Nuclear Medicine Department, Beijing Tongren Hospital
| | - Zhou Zhen
- Department of Mathematics, School of Biomedical Engineering, Capital Medical University, Beijing
| | - Liu Wei
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Lu Jing
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
- Beijing Key Laboratory of Diabetes Research and Care
| | - Yang Guang-Ran
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Zhou Jian-Bo
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Yang Jin-Kui
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
- Beijing Key Laboratory of Diabetes Research and Care
- Beijing Diabetes Institute, China
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Bjerg L, Hulman A, Carstensen B, Charles M, Witte DR, Jørgensen ME. Effect of duration and burden of microvascular complications on mortality rate in type 1 diabetes: an observational clinical cohort study. Diabetologia 2019; 62:633-643. [PMID: 30649599 DOI: 10.1007/s00125-019-4812-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
AIMS/HYPOTHESIS The role of burden and duration of multiple microvascular complications on mortality rate has not been explored in detail in type 1 diabetes. Taking complication burden and time-updated duration into account we aimed to quantify mortality rate in individuals with and without microvascular complications. METHODS This observational clinical cohort included 3828 individuals with type 1 diabetes attending the Steno Diabetes Center Copenhagen in 2001-2013. We used information on mortality and detailed clinical measures of microvascular complications from electronic patient records. Poisson models were used to model mortality rates according to complication burden. RESULTS During 26,665 person-years of follow-up, 503 deaths occurred. Compared with individuals without microvascular complications, the mortality rate ratio was 2.20 (95% CI 1.79, 2.69) for individuals with diabetic kidney disease, 1.72 (95% CI 1.39, 2.12) for individuals with neuropathy and 1.02 (95% CI 0.77, 1.37) for individuals with retinopathy, all adjusted for calendar time (year/month/day), age, duration of diabetes, sex, HbA1c, LDL-cholesterol, BMI, smoking status, systolic blood pressure, use of antihypertensive and lipid-lowering medication, and cardiovascular disease status. In individuals with two complications or more, the risk of mortality did not exceed the combined risk from each individual complication. Mortality rate ratios increased immediately after diagnosis of neuropathy and diabetic kidney disease. Mortality rate ratios were independent of the duration of neuropathy and retinopathy, while the mortality rate associated with diabetic kidney disease reached a stable level after approximately 3 years. CONCLUSIONS/INTERPRETATION Neuropathy and diabetic kidney disease are strong and independent risk markers of mortality in type 1 diabetes, whereas no evidence of higher mortality rate was found for retinopathy. We found no indication that the mortality risk with multiple complications exceeds the risk conferred by each complication separately. The duration spent with microvascular complications had only a marginal effect on mortality.
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Affiliation(s)
- Lasse Bjerg
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark.
- Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus C, Denmark.
- Danish Diabetes Academy, Odense, Denmark.
| | - Adam Hulman
- Danish Diabetes Academy, Odense, Denmark
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Morten Charles
- Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus C, Denmark
| | - Daniel R Witte
- Danish Diabetes Academy, Odense, Denmark
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Marit E Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
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39
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Pearce I, Simó R, Lövestam‐Adrian M, Wong DT, Evans M. Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review. Diabetes Obes Metab 2019; 21:467-478. [PMID: 30280465 PMCID: PMC6667892 DOI: 10.1111/dom.13550] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 02/06/2023]
Abstract
The aim of this systematic review was to examine the associations between diabetic retinopathy (DR) and the common micro- and macrovascular complications of diabetes mellitus, and how these could potentially affect clinical practice. A structured search of the PubMed database identified studies of patients with diabetes that assessed the presence or development of DR in conjunction with other vascular complications of diabetes. From 70 included studies, we found that DR is consistently associated with other complications of diabetes, with the severity of DR linked to a higher risk of the presence of, or of developing, other micro- and macrovascular complications. In particular, DR increases the likelihood of having or developing nephropathy and is also a strong predictor of stroke and cardiovascular disease, and progression of DR significantly increases this risk. Proliferative DR is a strong risk factor for peripheral arterial disease, which carries a risk of lower extremity ulceration and amputation. Additionally, our findings suggest that a patient with DR has an overall worse prognosis than a patient without DR. In conclusion, this analysis highlights the need for a coordinated and collaborative approach to patient management. Given the widespread use of DR screening programmes that can be performed outside of an ophthalmology office, and the overall cost-effectiveness of DR screening, the presence and severity of DR can be a means of identifying patients at increased risk for micro- and macrovascular complications, enabling earlier detection, referral and intervention with the aim of reducing morbidity and mortality among patients with diabetes. Healthcare professionals involved in the management of diabetes should encourage regular DR screening.
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Affiliation(s)
- Ian Pearce
- St Paul's Eye UnitRoyal Liverpool University HospitalLiverpoolUK
| | - Rafael Simó
- Vall d'Hebron Research Institute (VHIR) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)BarcelonaSpain
| | | | - David T. Wong
- St. Michael's Hospital, University of TorontoTorontoCanada
| | - Marc Evans
- University Hospital Llandough, LlandoughWalesUK
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40
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Sabanayagam C, Chee ML, Banu R, Cheng CY, Lim SC, Tai ES, Coffman T, Wong TY. Association of Diabetic Retinopathy and Diabetic Kidney Disease With All-Cause and Cardiovascular Mortality in a Multiethnic Asian Population. JAMA Netw Open 2019; 2:e191540. [PMID: 30924904 PMCID: PMC6450319 DOI: 10.1001/jamanetworkopen.2019.1540] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE The association of diabetic microvascular complications such as diabetic retinopathy (DR) and diabetic kidney disease (DKD) with mortality in populations is not clear. OBJECTIVE To examine the association of DR and DKD separately and jointly with all-cause and cardiovascular disease (CVD) mortality in a multiethnic Asian population. DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study was conducted including 2964 adults between the ages of 40 and 80 years with diabetes who participated in the Singapore Epidemiology of Eye Diseases study (baseline, 2004-2011). Data analysis was performed from January to May 2018. EXPOSURES Diabetic retinopathy ascertained from retinal photographs and DKD from estimated glomerular filtration rate. MAIN OUTCOMES AND MEASURES All-cause and CVD mortality obtained by linkage with the National Registry of Births and Deaths until May 2017. RESULTS Of the 2964 adults (mean [SD] age, 61.8 [10.0] years; 1464 [49.4%] female; 592 Chinese, 1052 Malay, and 1320 Indian), 29.9% of the participants had DR, while 20.7% had DKD. Over a median (interquartile range) follow-up of 8.8 (7.2-11.0) years, 610 deaths occurred (20.6%), of which 267 (9.0%) were due to CVD. In separate models, the multivariable hazard ratios for all-cause and CVD mortality were 1.54 (95% CI, 1.24-1.91) and 1.74 (95% CI, 1.27-2.40), respectively, for DR and 2.04 (95% CI, 1.64-2.56) and 2.29 (95% CI, 1.64-3.19), respectively, for DKD. In models including both DR and DKD, the subgroup with DKD alone (27.1% and 12.6%) followed by DR alone (6.5% and 5.2%) contributed substantially to the excess risk of all-cause and CVD mortality. Compared with those with no DR and DKD, the hazard ratios of all-cause and CVD mortality were 1.89 (95% CI, 1.40-2.57) and 2.26 (95% CI, 1.42-3.61), respectively, for DKD alone and 1.38 (95% CI, 1.03-1.86) and 1.64 (95% CI, 1.06-2.56), respectively, for DR alone. Hazard ratios for all-cause and CVD mortality were 2.76 (95% CI, 2.05-3.72) and 3.41 (95% CI, 2.19-5.32), respectively, for those with both DKD and DR. The relative excess risk associated with the interaction was 0.49 (95% CI, -0.29 to 1.27; P = .20) for all-cause mortality and 0.51 (95% CI, -0.83 to 1.85; P = .50) for CVD mortality. CONCLUSIONS AND RELEVANCE These results suggest that risks of all-cause and CVD mortality were significantly higher in those with DKD and DR, but DKD was more strongly associated with excess risk. The findings underscore the importance of early identification and close monitoring and management of patients with DR and DKD to reduce the risk of death.
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Affiliation(s)
- Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Miao Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Riswana Banu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | | | - E. Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, National University of Singapore, Singapore
| | - Thomas Coffman
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore
| | - Tien Y. Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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41
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Liu E, Estevez J, Kaidonis G, Hassall M, Phillips R, Raymond G, Saha N, Wong GHC, Gilhotra J, Burdon K, Landers J, Henderson T, Newland H, Lake S, Craig JE. Long-term survival rates of patients undergoing vitrectomy for diabetic retinopathy in an Australian population: a population-based audit. Clin Exp Ophthalmol 2019; 47:598-604. [PMID: 30663192 DOI: 10.1111/ceo.13466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Five-year survival rates in patients undergoing vitrectomy for diabetic retinopathy (DR) vary from 68% to 95%. No study has been conducted in an Australian population. BACKGROUND We aimed to determine the survival rates of patients undergoing diabetic vitrectomy in an Australian population. DESIGN Retrospective audit, tertiary centre hospitals and private practices. PARTICIPANTS All individuals in South Australia and the Northern Territory who underwent their first vitrectomy for diabetic complications between January 1, 2007 and December 31, 2011. METHODS An audit of all eligible participants has been completed previously. Survival status as of July 6, 2018 and cause of death were obtained using SA/NT DataLink. Kaplan-Meier survival curves and multivariate cox-regressions were used to analyse survival rates and identify risk factors for mortality. MAIN OUTCOME MEASURES Five-, seven- and nine-year survival rates. RESULTS The 5-, 7- and 9-year survival rates were 84.4%, 77.9% and 74.7%, respectively. The most common cause of death was cardiovascular disease. Associated with increased mortality independent of age were Indigenous ethnicity (HR = 2.04, 95% confidence interval [CI]: 1.17-3.57, P = 0.012), chronic renal failure (HR = 1.76, 95% CI: 1.07-2.89, P = 0.026) and renal failure requiring dialysis (HR = 2.32, 95% CI: 1.25-4.32, P = 0.008). CONCLUSIONS AND RELEVANCE Long-term survival rates after diabetic vitrectomy in Australia are similar to rates reported in other populations. Indigenous ethnicity and chronic renal failure were the most significant factors associated with long-term mortality. This information can guide allocation of future resources to improve the prognosis of these high risk groups.
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Affiliation(s)
- Ebony Liu
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Jose Estevez
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Georgia Kaidonis
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Mark Hassall
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Russell Phillips
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.,Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Grant Raymond
- Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Niladri Saha
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.,Eyemedics, Wayville, South Australia, Australia
| | - George H C Wong
- Marion Road Eye Clinic, Adelaide, South Australia, Australia
| | - Jagjit Gilhotra
- Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia.,Department of Ophthalmology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Kathryn Burdon
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.,Department of Cancer, Genetics and Immunology, Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - John Landers
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Tim Henderson
- Department of Ophthalmology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Henry Newland
- Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Stewart Lake
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.,Eyemedics, Wayville, South Australia, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.,Eyemedics, Wayville, South Australia, Australia
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Shani M, Eviatar T, Komaneshter D, Vinker S. Diabetic Retinopathy -Incidence And Risk Factors In A Community Setting- A Longitudinal Study. Scand J Prim Health Care 2018; 36:237-241. [PMID: 29947279 PMCID: PMC6381535 DOI: 10.1080/02813432.2018.1487524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
AIM To evaluate the natural history of diabetic retinopathy (DR) in diabetic patients and to assess long term risk for other chronic diseases associated with DR. METHODS Retrospective, community-based study. Diabetics who underwent their first fundoscopic examination during 2000-2002, and had at least one follow- up examination by the end of 2007 were included. The primary outcome was the development of DR (proliferative diabetic retinopathy (PDR), non PDR (NPDR) or macular edema. Patients were followed for another 9 years for documentation of new diagnosis of related diseases. RESULTS 516 patients' (1,032 eyes) records were included and were followed first for an average of 4.15 ± 1.27 years. During follow-up, 28 (2.7%) of the total 1,032 eyes examined were diagnosed with PDR. An additional 194 (18.8%) eyes were diagnosed with new NPDR. The cumulative incidence of NPDR was 310/1,032 (30.0%). All the patients who developed PDR had prior NDPR. By the end of the 9 years extended follow up, patients with NPDR had a greater risk for developing chronic renal failure HR = 1.71 (1.14-2.56), ischemic heart disease HR = 1.57 (1.17-2.09), and had an increased mortality rate HR = 1.26 (1.02-1.57) Conclusion: DR is associated with a higher rate of diabetes complications. Patients with DR should be followed more closely. Key points During a mean follow-up of 4.5 years, the cumulative incidence of diabetic retinopathy in a community cohort was 18.8%. NDPR (non-proliferative diabetic retinopathy) is a predictor of PDR (proliferative diabetic retinopathy). In a real life setting NPDR is a marker of a poorer prognosis. Patients with NDPR should be monitored more closely.
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Affiliation(s)
- Michal Shani
- Department of Family Medicine, Clalit Health Services, Central District, Rehovot, Israel;
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
- Chief physician office, Clalit Health Service, Tel Aviv, Israel
- CONTACT Dr. Michal Shani 101 Arlozorov st. Tel Aviv, Israel
| | - Tali Eviatar
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | | | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
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