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Vujosevic S, Limoli C, Piccoli G, Costanzo E, Marenzi E, Torti E, Giannini D, Polito MS, Luzi L, Nucci P, Parravano M. A gender-based analysis of retinal microvascular alterations in patients with diabetes mellitus using OCT angiography. J Diabetes Complications 2024; 38:108852. [PMID: 39213716 DOI: 10.1016/j.jdiacomp.2024.108852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To assess the difference in microvascular changes between males and females with diabetes mellitus (DM) without diabetic retinopathy (NoDR) and with mild-to-moderate non-proliferative diabetic retinopathy (NPDR) using Optical Coherence Tomography Angiography (OCT-A). DESIGN Retrospective cross-sectional study. METHODS 267 DM patients, 133 females (49.81 %), 111 with NoDR (41.57 %) and 156 NPDR (58.43 %) were included. Foveal-centered 3 × 3 mm OCT-A images corresponding to the superficial (SCP), intermediate (ICP) and deep capillary plexus (DCP), and full retinal (RET) slab were used for analysis. For each slab, FAZ area, perimeter, and circularity index (CI) were determined, following manual delineation of the FAZ; perfusion (PD) and vessel density (VD), fractal dimension (FD), vessel length density (VLD), geometric perfusion deficits (GPD) were also computed. Flow voids (FV) were determined in the choriocapillaris plexus; and perfused capillary density (PCD) in the RET slab. RESULTS Females showed larger FAZ CI in SCP and greater FAZ area and perimeter than males in NPDR group. Males had higher central macular thickness than females in NPDR group. All density metrics at the level of ICP and DCP were affected in the NPDR group with no gender differences. Of note, the same significant findings were found in type 1 DM patients, and not in type 2 DM patients. CONCLUSIONS Our OCT-A findings suggest significant microvascular changes in females with NPDR compared to males, but no such differences in patients without DR. Therefore, gender-related vascular alterations might be present in early stages of DR with potential role.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy.
| | | | | | | | - Elisa Marenzi
- Laboratory of Custom Computing and Programmable Systems, Department of Electrical, Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | - Emanuele Torti
- Laboratory of Custom Computing and Programmable Systems, Department of Electrical, Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Lombardia, Italy
| | | | | | - Livio Luzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Chauhan MZ, Elhusseiny AM, Sallam AB. The Association of Sickle-Cell Disorders With Diabetic Retinopathy: A Large Database Study. OPHTHALMOLOGY SCIENCE 2024; 4:100490. [PMID: 38694493 PMCID: PMC11061721 DOI: 10.1016/j.xops.2024.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 05/04/2024]
Abstract
Purpose To evaluate the association of sickle-cell disease (SCD) and sickle-cell trait (SCT) disease with diabetic retinopathy (DR) in patients with diabetes mellitus (DM). Design Population-based, retrospective cohort study utilizing data from the TriNetX Research Network, including 119 million patients across 80 health care organizations worldwide. Participants Diabetes mellitus patients (type 1 [T1DM] or 2 [T2DM]), with or without SCD and SCT, were included. Three cohorts were analyzed, including (1) DM patients without SCD, SCT, or sickle-cell/hemoglobin-C; (2) DM with SCD; and (3) DM with SCT. Methods All patients with DM were categorized into 3 cohorts based on the presence of SCD and SCT. Each cohort underwent 1:1 propensity score matching for demographics, blood glucose levels, hemoglobin A1C, and other relevant comorbidities. Main Outcome Measures Risk of DR in DM patients with and without SCD or SCT. Results There was no significant difference in the risk of any T1DR between those with and without SCD. However, for those with SCT, there was a notable twofold increased risk for T1-proliferative DR (PDR) (relative risk [RR]: 2.03; 95% confidence interval [CI]: 1.33-3.01). In contrast, there was an elevated risk for any T2DR in patients with SCD (RR: 1.50; 95% CI: 1.19-1.88), particularly due to higher PDR risks in T2DM patients (RR: 1.83; 95% CI: 1.29-2.60). The risk of mild to moderate T2DM non-PDR was also found to be higher in patients with SCT. Conclusions The risk of any DR was increased in T2DM patients with SCD or SCT, with increased risks for PDR in patients with SCT and T1DM. This indicates there may be a potential role of sickle-cell disorders in diabetic eye disease progression. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Muhammad Z. Chauhan
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Abdelrahman M. Elhusseiny
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ahmed B. Sallam
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Mellor J, Jeyam A, Beulens JW, Bhandari S, Broadhead G, Chew E, Fickweiler W, van der Heijden A, Gordin D, Simó R, Snell-Bergeon J, Tynjälä A, Colhoun H. Role of Systemic Factors in Improving the Prognosis of Diabetic Retinal Disease and Predicting Response to Diabetic Retinopathy Treatment. OPHTHALMOLOGY SCIENCE 2024; 4:100494. [PMID: 38694495 PMCID: PMC11061755 DOI: 10.1016/j.xops.2024.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 05/04/2024]
Abstract
Topic To review clinical evidence on systemic factors that might be relevant to update diabetic retinal disease (DRD) staging systems, including prediction of DRD onset, progression, and response to treatment. Clinical relevance Systemic factors may improve new staging systems for DRD to better assess risk of disease worsening and predict response to therapy. Methods The Systemic Health Working Group of the Mary Tyler Moore Vision Initiative reviewed systemic factors individually and in multivariate models for prediction of DRD onset or progression (i.e., prognosis) or response to treatments (prediction). Results There was consistent evidence for associations of longer diabetes duration, higher glycosylated hemoglobin (HbA1c), and male sex with DRD onset and progression. There is strong trial evidence for the effect of reducing HbA1c and reducing DRD progression. There is strong evidence that higher blood pressure (BP) is a risk factor for DRD incidence and for progression. Pregnancy has been consistently reported to be associated with worsening of DRD but recent studies reflecting modern care standards are lacking. In studies examining multivariate prognostic models of DRD onset, HbA1c and diabetes duration were consistently retained as significant predictors of DRD onset. There was evidence of associations of BP and sex with DRD onset. In multivariate prognostic models examining DRD progression, retinal measures were consistently found to be a significant predictor of DRD with little evidence of any useful marginal increment in prognostic information with the inclusion of systemic risk factor data apart from retinal image data in multivariate models. For predicting the impact of treatment, although there are small studies that quantify prognostic information based on imaging data alone or systemic factors alone, there are currently no large studies that quantify marginal prognostic information within a multivariate model, including both imaging and systemic factors. Conclusion With standard imaging techniques and ways of processing images rapidly evolving, an international network of centers is needed to routinely capture systemic health factors simultaneously to retinal images so that gains in prediction increment may be precisely quantified to determine the usefulness of various health factors in the prognosis of DRD and prediction of response to treatment. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Joe Mellor
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Anita Jeyam
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Crewe Road, Edinburgh, Scotland
| | - Joline W.J. Beulens
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Sanjeeb Bhandari
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Geoffrey Broadhead
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Ward Fickweiler
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Amber van der Heijden
- Department of General Practice, Amsterdam Public Health Institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Department of Nephrology, Helsinki University Hospital, University of Helsinki, Finland
| | - Rafael Simó
- Endocrinology & Nutrition, Institut de Recerca Hospital Universitari Vall d’Hebron (VHIR), Barcelona, Spain
| | - Janet Snell-Bergeon
- Clinical Epidemiology Division, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Colorado
| | - Anniina Tynjälä
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Department of Nephrology, Helsinki University Hospital, University of Helsinki, Finland
| | - Helen Colhoun
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Crewe Road, Edinburgh, Scotland
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Cen Y, Feng D, Kowsar R, Cheng Z, Luo Y, Xiao Q. Sex-Specific Variations in the mRNA Levels of Candidate Genes in Peripheral Blood Mononuclear Cells from Patients with Diabetes: A Multistep Study. Endocr Res 2024; 49:59-74. [PMID: 37947760 DOI: 10.1080/07435800.2023.2280571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is one of the most prevalent diseases that also show sexual dimorphism in many different aspects. OBJECTIVES This study aimed to distinguish the mRNA expression of genes in peripheral blood mononuclear cells (PBMCs) in men or women with T2D using a multistep analysis. METHODS A total of 95 patients with T2D were compared based on their sex in terms of clinical variables and mRNA expression in their PBMCs. RESULTS Men with T2D had lower LDLC, HDLC, and HbA1c values in their blood, but greater creatinine levels. In men with T2D, TLR4, CCR2, NOX2, and p67phox mRNA expression was greater, but IL6 and NF-κB mRNA expression was lesser in PBMCs. There was a link between fasting plasma glucose (FPG), triglycerides, and hs-CRP, as well as COX1 mRNA in men with T2D. In women with T2D, FPG was associated with the mRNA expression of THBS1 and p67phox, as well as triglycerides and HDLC levels. We found the exclusive effect of FPG on HDLC, HbA1c, as well as p67phox mRNA in PBMCs of women with T2D. Analysis revealed the exclusive effect of FPG on hs-CRP and PAFR mRNA in PBMCs of men with T2D. FPG was shown to be associated with body mass index, hs-CRP, triglycerides, and COX1 mRNA in men with T2D, and with serum triglycerides, THSB1, and p67phox mRNA in women with T2D, according to network analysis. HbA1c was linked with NF-κB mRNA in women with T2D. CONCLUSIONS Using a multistep analysis, it was shown that network analysis outperformed traditional analytic techniques in identifying sex-specific alterations in mRNA gene expression in PBMCs of T2D patients. The development of sex-specific therapeutic approaches may result from an understanding of these disparities.
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Affiliation(s)
- Yuzhen Cen
- Department of Blood Transfusion, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dana Feng
- Department of Blood Transfusion, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rasoul Kowsar
- Department of Animal Science, College of Agriculture, Isfahan University of Technology, Isfahan, Iran
| | - Zhen Cheng
- Guantian Community Healthcare Center, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, China
| | - Yu Luo
- Guantian Community Healthcare Center, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, China
| | - Qingyu Xiao
- Department of Blood Transfusion, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, China
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Yan J, Li B, Chen Y, Gu C, Dai G, Zhang Q, Zheng Z, Luo D, Zhao S, Zhou C. Prevalence and predictors of developing vision-threatening diabetic retinopathy within the first three years of type 2 diabetes. Front Endocrinol (Lausanne) 2023; 14:1305378. [PMID: 38192422 PMCID: PMC10773727 DOI: 10.3389/fendo.2023.1305378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/03/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose To investigate the prevalence of diabetic retinopathy (DR) and vision-threatening DR (VTDR) in patients with type 2 diabetes mellitus (T2DM) stratified by the duration of diabetes and to identify the clinical variations and risk factors for VTDR occurring at different stages of T2DM. Methods This was a retrospective comparative study. Patients were divided into short- (≤3 years), intermediate- (3-7 years), and long-duration (>7 years) groups. All patients were followed-up for DR and VTDR development. Risk factors were explored using logistic regression analysis. Results A total of,2961 patients were included; among them, 1,036 (35.0%) patients developed DR, and 293 (9.9%) had VTDR. The frequency of VTDR in patients who developed DR in the short-duration group was significantly higher than that in the intermediate-duration group (25.7% vs. 15.0%; p = 0.019), but comparable with that of the long-duration group (25.7% vs. 31.8%; p = 0.138). Patients who developed VTDR within the first 3 years of T2DM were more likely to have a family history of diabetes (p = 0.024), had higher glycated hemoglobin (p = 0.025), were males (p = 0.042), and were notably older at the onset of diabetes (p <0.001) but younger when diagnosed with DR (p <0.001). Moreover, higher glycated hemoglobin (OR = 1.14; 95% CI: 1.00-1.29; p = 0.043) and diabetic nephropathy (DN) (OR = 2.31; 95% CI: 1.08-4.91; p = 0.030) were independent risk factors for developing VTDR during the first 3 years of T2DM. Conclusion The risk of DR is not high in persons with ≤3 years' duration of T2DM, however, if afflicted, the risk of VTDR should never be neglected. More frequent retinal screening is warranted in patients with newly diagnosed T2DM.
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Affiliation(s)
- Jia Yan
- Department of Ophthalmology, Taizhou Zhangqin Eye Hospital, Taizhou, China
| | - Bo Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Ye Chen
- Surgical Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chufeng Gu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Guosheng Dai
- Department of Ophthalmology, Taizhou Zhangqin Eye Hospital, Taizhou, China
| | - Qin Zhang
- Department of Ophthalmology, Taizhou Zhangqin Eye Hospital, Taizhou, China
| | - Zhi Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Dawei Luo
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Shuzhi Zhao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Chuandi Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
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Sikka R, Raina P, Soni R, Gupta H, Bhanwer AJS. Genomic profile of diabetic retinopathy in a north indian cohort. Mol Biol Rep 2023; 50:9769-9778. [PMID: 37700140 DOI: 10.1007/s11033-023-08772-z] [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: 04/20/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Diabetic Retinopathy (DR) is one of the major microvascular complications of diabetes. Being a complex disease, it is important to delineate the genetic and environmental factors that influence the susceptibility to DR in a population. Therefore, the present study was designed to investigate the role of genetic and lifestyle risk factors associated with DR susceptibility in a North-Indian population. METHODS A total of 848 subjects were enrolled, comprising of DR cases (n = 414) and healthy controls (n = 434). The Sequenom MassARRAY technology was used to perform target genome analysis of 111 SNPs across 57 candidate genes and 14 intergenic region SNPs that are involved in the metabolic pathways associated with type 2 diabetes (T2D) and DR. Allele, genotype and haplotype frequencies were determined and compared among cases and controls. Logistic regression models were used to determine genotype-phenotype and phenotype-phenotype correlations. RESULTS The strongest association was observed with TCF7L2 rs12255372 T allele [p < 0.0001; odds ratio (OR) = 1.81 (1.44-2.27)] and rs11196205 C allele [p < 0.0008; OR = 1.62 (1.32-1.99)]. Genotype-phenotype and phenotype-phenotype correlations were found in the present study. CONCLUSION Our study provides strong evidence of association between the TCF7L2 variants and DR susceptibility.
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Affiliation(s)
- Ruhi Sikka
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, India.
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, Mathura, UP, India.
| | - Priyanka Raina
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, India
- Mosaic Therapeutics, Wellcome Genome Campus, Cambridge, UK
| | | | - Himanshu Gupta
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, Mathura, UP, India
| | - A J S Bhanwer
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, India
- Department of Genetics, Guru Ram Das University of Health Sciences, Amritsar, Punjab, India
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Albuminuria as a biomarker of severity in diabetic retinopathy and in the response to intravitreal treatment in diabetic macular edema. Int Ophthalmol 2022; 43:2049-2056. [DOI: 10.1007/s10792-022-02604-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
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Zhou YY, Zhou TC, Chen N, Zhou GZ, Zhou HJ, Li XD, Wang JR, Bai CF, Long R, Xiong YX, Yang Y. Risk factor analysis and clinical decision tree model construction for diabetic retinopathy in Western China. World J Diabetes 2022; 13:986-1000. [PMID: 36437866 PMCID: PMC9693737 DOI: 10.4239/wjd.v13.i11.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/20/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is the driving force of blindness in patients with type 2 diabetes mellitus (T2DM). DR has a high prevalence and lacks effective therapeutic strategies, underscoring the need for early prevention and treatment. Yunnan province, located in the southwest plateau of China, has a high pre-valence of DR and an underdeveloped economy.
AIM To build a clinical prediction model that will enable early prevention and treatment of DR.
METHODS In this cross-sectional study, 1654 Han population with T2DM were divided into groups without (n = 826) and with DR (n = 828) based on fundus photography. The DR group was further subdivided into non-proliferative DR (n = 403) and proliferative DR (n = 425) groups. A univariate analysis and logistic regression analysis were conducted and a clinical decision tree model was constructed.
RESULTS Diabetes duration ≥ 10 years, female sex, standing- or supine systolic blood pressure (SBP) ≥ 140 mmHg, and cholesterol ≥ 6.22 mmol/L were risk factors for DR in logistic regression analysis (odds ratio = 2.118, 1.520, 1.417, 1.881, and 1.591, respectively). A greater severity of chronic kidney disease (CKD) or hemoglobin A 1c increased the risk of DR in patients with T2DM. In the decision tree model, diabetes duration was the primary risk factor affecting the occurrence of DR in patients with T2DM, followed by CKD stage, supine SBP, standing SBP, and body mass index (BMI). DR classification outcomes were obtained by evaluating standing SBP or BMI according to the CKD stage for diabetes duration < 10 years and by evaluating CKD stage according to the supine SBP for diabetes duration ≥ 10 years.
CONCLUSION Based on the simple and intuitive decision tree model constructed in this study, DR classification outcomes were easily obtained by evaluating diabetes duration, CKD stage, supine or standing SBP, and BMI.
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Affiliation(s)
- Yuan-Yuan Zhou
- Department of Endocrinology and Metabolism, The Sixth Affiliated Hospital of Kunming Medical University, The People’s Hospital of Yuxi City, Yuxi 653100, Yunnan Province, China
| | - Tai-Cheng Zhou
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Nan Chen
- Department of Endocrinology and Metabolism, The Frist People’s Hospital of Anning City, Anning City 650300, Yunnan Province, China
| | - Guo-Zhong Zhou
- Department of Endocrinology and Metabolism, The Frist People’s Hospital of Anning City, Anning City 650300, Yunnan Province, China
| | - Hong-Jian Zhou
- Department of Endocrinology and Metabolism, The Sixth Affiliated Hospital of Kunming Medical University, The People’s Hospital of Yuxi City, Yuxi 653100, Yunnan Province, China
| | - Xing-Dong Li
- Department of Endocrinology and Metabolism, The Sixth Affiliated Hospital of Kunming Medical University, The People’s Hospital of Yuxi City, Yuxi 653100, Yunnan Province, China
| | - Jin-Rui Wang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Chao-Fang Bai
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Rong Long
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Yu-Xin Xiong
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Ying Yang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
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CA J, Kumar Pinnelli VB, Nikethan D, Ramachandran V, Ganaraja VH, S SA, P SS, Dandu S, Sarkar D. Disease Progression and Associations of Microvascular Complications in Diabetic Patients: A Study From South India. Cureus 2022; 14:e30201. [DOI: 10.7759/cureus.30201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
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Chauhan MZ, Rather PA, Samarah SM, Elhusseiny AM, Sallam AB. Current and Novel Therapeutic Approaches for Treatment of Diabetic Macular Edema. Cells 2022; 11:1950. [PMID: 35741079 PMCID: PMC9221813 DOI: 10.3390/cells11121950] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/13/2022] Open
Abstract
Diabetic macular edema (DME) is a major ocular complication of diabetes mellitus (DM), leading to significant visual impairment. DME's pathogenesis is multifactorial. Focal edema tends to occur when primary metabolic abnormalities lead to a persistent hyperglycemic state, causing the development of microaneurysms, often with extravascular lipoprotein in a circinate pattern around the focal leakage. On the other hand, diffusion edema is due to a generalized breakdown of the inner blood-retinal barrier, leading to profuse early leakage from the entire capillary bed of the posterior pole with the subsequent extravasation of fluid into the extracellular space. The pathogenesis of DME occurs through the interaction of multiple molecular mediators, including the overexpression of several growth factors, including vascular endothelial growth factor (VEGF), insulin-like growth factor-1, angiopoietin-1, and -2, stromal-derived factor-1, fibroblast growth factor-2, and tumor necrosis factor. Synergistically, these growth factors mediate angiogenesis, protease production, endothelial cell proliferation, and migration. Treatment for DME generally involves primary management of DM, laser photocoagulation, and pharmacotherapeutics targeting mediators, namely, the anti-VEGF pathway. The emergence of anti-VEGF therapies has resulted in significant clinical improvements compared to laser therapy alone. However, multiple factors influencing the visual outcome after anti-VEGF treatment and the presence of anti-VEGF non-responders have necessitated the development of new pharmacotherapies. In this review, we explore the pathophysiology of DME and current management strategies. In addition, we provide a comprehensive analysis of emerging therapeutic approaches to the treatment of DME.
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Affiliation(s)
- Muhammad Z. Chauhan
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.Z.C.); (P.A.R.); (S.M.S.); (A.M.E.)
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Peyton A. Rather
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.Z.C.); (P.A.R.); (S.M.S.); (A.M.E.)
| | - Sajida M. Samarah
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.Z.C.); (P.A.R.); (S.M.S.); (A.M.E.)
| | - Abdelrahman M. Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.Z.C.); (P.A.R.); (S.M.S.); (A.M.E.)
| | - Ahmed B. Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.Z.C.); (P.A.R.); (S.M.S.); (A.M.E.)
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11
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Hamati JN, Das AV, Prashanthi GS, Behera UC, Narayanan R, Rani PK. Factors protecting against diabetic retinopathy in a geriatric Indian cohort. Indian J Ophthalmol 2021; 69:3167-3172. [PMID: 34708765 PMCID: PMC8725154 DOI: 10.4103/ijo.ijo_1495_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: Diabetic retinopathy (DR) is a potentially sight-threatening complication of diabetes mellitus. The majority of cases are in older adults. This study aims to evaluate modifiable and nonmodifiable protective factors against DR in a geriatric Indian population. Methods: This retrospective observational study uses data from a multitiered ophthalmology network to evaluate several demographic and clinical variables against diabetic retinopathy and visual acuity. Results: Our data show that high myopia, the female sex, and no cataract surgery are associated with lower prevalence of DR (OR = 0.21, 0.65, and 0.76, respectively; P < 0.001). We also found that among those with DR, people categorized as payers, retirees, and those living in urban or metropolitan areas have better visual acuity (OR = 0.65, 0.65, 0.83, and 0.73, respectively; P < 0.001). Among those with DR, females, presence of cataracts, and no cataract surgery had lower associations with sight-threatening DR (STDR) (OR = 0.68, 0.37, and 0.76, respectively; P < 0.001). Prevalence of DR decreased in older age groups while controlling for DM duration. Conclusion: It is probable that high myopia, the female sex, and better glycemic control are protective against DR and STDR in our study cohort of adults over 60 years of age. It is possible that occupations involving manual labor, delayed cataract surgery, and living past the age of 70 are also protective against DR.
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Affiliation(s)
- Jacquelyn N Hamati
- Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University; Department of Public Health, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Anthony Vipin Das
- Department of EyeSmart EMR and AEye; Department of Indian Health Outcomes, Public Health and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Gumpili Sai Prashanthi
- Department of EyeSmart EMR and AEye; Department of Indian Health Outcomes, Public Health and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Umesh C Behera
- Department of Vitreoretinal Diseases, L. V. Prasad Eye Institute, Bhubaneshwar, Odisha, India
| | - Raja Narayanan
- Department of EyeSmart EMR and AEye; Department of Indian Health Outcomes, Public Health and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Padmaja K Rani
- Smt. Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India, Indiaz
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12
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van Niel J, Geelhoed-Duijvestijn PHLM, Numans ME, Kharagjitsing AV, Vos RC. Type 2 diabetes in South Asians compared to Europeans: Higher risk and earlier development of major cardiovascular events irrespective of the presence and degree of retinopathy. Results from The HinDu The Hague Diabetes Study. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00242. [PMID: 34277967 PMCID: PMC8279625 DOI: 10.1002/edm2.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/09/2022]
Abstract
Introduction South Asians with diabetes have more severe diabetic retinopathy (DR) and cardiovascular complications than white Caucasians. However, how big this gap is and the relation with the severity of DR has not been studied. Here, we quantify the difference in time from diabetes diagnosis until a first non‐fatal Major Adverse Cardiovascular Event (TUF MACE) in different DR groups in South Asians and Europeans. Methods 3831 adults with type 2 diabetes, 1358 South Asians and 2473 Europeans, treated in our diabetes clinic between 2006 and 2017 were included. Data on risk factors, diabetes duration, age of diagnosis and diabetes complications were collected from the diabetes‐specific database and analysed using descriptive statistics and Cox regression. DR was graded in 3 categories, and non‐fatal MACE was pre‐specified. Results Prevalence of non‐fatal MACE was the same when DR was absent, increased with increasing severity of DR in both ethnic groups, but was more frequent in South Asians with DR (mild: 50 vs. 42% and severe 62 vs. 46%. Classic risk factors only differed in relation to smoking habits, which were significantly lower in South Asians. After correction for classic risk factors and age at diabetes diagnosis TUF MACE was significantly shorter in South Asians, an effect also seen in the no‐DR group (4.1 yrs. HR 1.5, 95% CI 1.3–1.8 and 7.4 yrs. earlier, HR 2.0, 95% CI 1.6–2.6 for no‐DR and severe DR, respectively). Conclusions When adjusted for age at diabetes diagnosis, we show that time until first non‐fatal MACE in South Asians is significantly shorter compared to Europeans and increases from no‐ to severe DR.
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Affiliation(s)
- Judith van Niel
- Department of Internal Medicine Haaglanden Medical Center The Hague The Netherlands.,Department of Public Health and Primary Care Leiden University Medical Center (LUMC Leiden The Netherlands
| | | | - Mattijs E Numans
- Department of Public Health and Primary Care Leiden University Medical Center (LUMC Leiden The Netherlands
| | - Aan V Kharagjitsing
- Department of Public Health and Primary Care Leiden University Medical Center (LUMC Leiden The Netherlands.,Department Diabetology and Endocrinology University Hospital Brussels & Diabetes Research Centre Vrije Universiteit Brussel (VUB Brussel Belgium
| | - Rimke C Vos
- Department of Public Health and Primary Care Leiden University Medical Center (LUMC Leiden The Netherlands
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13
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Banerjee P, Dutta Chowdhury M, Bandyopadhyay S, Chakraborty S. An institution-based cross-sectional study on the prevalence of diabetic retinopathy from Kolkata. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_197_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Rajalakshmi R, Behera UC, Bhattacharjee H, Das T, Gilbert C, Murthy GVS, Pant HB, Shukla R. Spectrum of eye disorders in diabetes (SPEED) in India. Report # 2. Diabetic retinopathy and risk factors for sight threatening diabetic retinopathy in people with type 2 diabetes in India. Indian J Ophthalmol 2020; 68:S21-S26. [PMID: 31937724 PMCID: PMC7001176 DOI: 10.4103/ijo.ijo_21_19] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: To assess the proportion of people with type 2 diabetes mellitus (T2DM) with diabetic retinopathy (DR) and sight-threatening DR (STDR) and associated risk factors in select eye-care facilities across India. Methods: In this observational study, data of people with T2DM presenting for the first time at the retina clinic of eye-care facilities across India was recorded. Data collected in 2016 over 6 months included information on systemic, clinical, and ocular parameters. International Clinical Diabetic Retinopathy (ICDR) classification scale was used to grade DR. STDR was defined as presence of severe nonproliferative (NPDR), proliferative diabetic retinopathy (PDR), and/or diabetic macular edema (DME). Results: The analysis included 11,182 people with T2DM from 14 eye-care facilities (mean age 58.2 ± 10.6 years; mean duration of diabetes 9.1 ± 7.6 years; 59.2% male). The age-standardized proportion of DR was 32.3% (95%Confidence Interval, CI: 31.4-33.2) and STDR was 19.1% (95%CI: 18.4-19.8). DME was diagnosed in 9.1% (95%CI: 8.5-9.6) and 10.7% (95%CI: 10.1-11.3) people had PDR. Statistically significant factors associated with increased risk of DR (by multivariate logistic regression analysis) were: male gender (Odds ratio[OR] 1.57, 95%CI: 1.16-2.15); poor glycemic control–glycated hemoglobin (HbA1c >10%)(OR 2.39, 95% CI: 1.1-5.22); requirement of insulin (OR 2.55, 95%CI: 1.8-3.6);history of hypertension (OR 1.42, 95%CI: 1.06-1.88) and duration of diabetes >15 years (OR 5.25, 95%CI: 3.01-9.15). Conclusion: Diabetic retinopathy was prevalent in 1/3rd and sight-threatening DR in 1/5th of people with T2DM presenting at eye-care facilities in this pan-India facility-based study. The duration of diabetes was the strongest predictor for retinopathy.
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Affiliation(s)
- Ramachandran Rajalakshmi
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Umesh C Behera
- Department of Vitreo-Retina, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Taraprasad Das
- Department of Vitreo-Retina, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Clare Gilbert
- London School of Hygiene and Tropical Medicine, London, UK
| | - G V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Hira B Pant
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Rajan Shukla
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
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15
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Shiferaw WS, Akalu TY, Desta M, Kassie AM, Petrucka PM, Assefa HK, Aynalem YA. Glycated hemoglobin A1C level and the risk of diabetic retinopathy in Africa: A systematic review and meta-analysis. Diabetes Metab Syndr 2020; 14:1941-1949. [PMID: 33039936 DOI: 10.1016/j.dsx.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Diabetic retinopathy is a frequent cause of acquired blindness worldwide. Various studies have reported the effects of glycemic control on the risk of diabetic retinopathy, but the results remain inconclusive. Therefore, this meta-analysis was performed to determine the association between glycated hemoglobin A1C levels and diabetic retinopathy in Africa. METHODS A systematic search was performed using the PubMed, African Journals Online, Google Scholar, Scopus, and Wiley Online Library from inception to June 11, 2020, for observational studies addressing the association of hemoglobin A1c levels with diabetic retinopathy. The I2 statistic was used to check heterogeneity across the included studies. A random-effects model was applied to estimate the pooled effect size (OR) and respective 95% confidence interval across studies. A funnel plot and Egger's regression test were used to determine the presence of publication bias. Sensitivity analysis was used to determine the effect of a single study on the overall estimation. All statistical analyses were performed using STATA™ Version 14 software. RESULT A total of 23 articles with 18,099 study participants were included in this meta-analysis. In the present review, when HbA1c was analyzed as a categorical variable, poor glycemic control (HbA1c >7%) was associated with an increased risk of diabetic retinopathy when compared with good glycemic control (OR = 1.25; 95% CI; 1.14, 1.38). Similarly, when HbA1c was analyzed as a continuous variable, a higher HbA1c was associated with an increased risk of diabetic retinopathy (MD: 0.42, 95% CI; 0.11, 0.98). CONCLUSION Our meta-analysis indicated evidence for poor glycemic control as an independent risk factor for the development of diabetic retinopathy in patients with diabetes mellitus. Therefore, the authors suggest that clinicians should advise their patients with diabetes to maintain their HbA1c levels within the normal range.
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Affiliation(s)
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Science, Debre Markos University, Ethiopia
| | - Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, Ethiopia
| | | | | | - Hilina Ketema Assefa
- Department of Nursing, College of Health Science, Debre Berhan University, Ethiopia
| | - Yared Asmare Aynalem
- Department of Nursing, College of Health Science, Debre Berhan University, Ethiopia
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16
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management
of Type 2 Diabetes Mellitus 2020. Int J Diabetes Dev Ctries 2020. [PMCID: PMC7371966 DOI: 10.1007/s13410-020-00819-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology & Metabolism, UCMS-GTB Hospital, Delhi, India
| | - B. M. Makkar
- Dr Makkar’s Diabetes & Obesity Centre Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana India
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Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Autoimmune Thyroid Disease is Associated with a Lower Prevalence of Diabetic Retinopathy in Patients with Type 1 Diabetic Mellitus. Medicina (B Aires) 2020; 56:medicina56060255. [PMID: 32466561 PMCID: PMC7353863 DOI: 10.3390/medicina56060255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 12/30/2022] Open
Abstract
Background and objectives: The aim of the study was to assess the correlation of autoimmune thyroid diseases (AITD) in patients with diabetes mellitus type 1 (DM1) with the occurrence of diabetic retinopathy (DR). Materials and Methods: The inclusion criteria for the study were: type 1 diabetes diagnosed on the basis of WHO criteria lasting at least a year, presence of AITD for at least a year, and age over 18 years. The control group consisted of patients without diagnosed AITD (DM1noAITD), selected according to age, BMI and DM1 duration. Anthropometric parameters, metabolic risk factors such as glycated hemoglobin (HbA1c), lipids and blood pressure, thyroid status and the presence of DR were assessed. Results: The study involved 200 patients with type 1 diabetes aged 36 ± 12 years, 70 men and 130 women. Patients from the study group (DM1AITD) had significantly lower creatinine concentration, significantly lower systolic blood pressure (SBP), glycated hemoglobin (HbA1c) percentage and triglyceride (TG) concentration, and higher high-density lipoprotein (HDL-cholesterol) concentration than the control group (DM1noAITD). There was a significantly lower chance of non-proliferative diabetic retinopathy (NPDR) among DM1AITD than in the control group. Conclusions: Patients with DM1 and AITD were metabolically better balanced, as evidenced by a significantly lower SBP, percentage of HbA1c and TG, as well as significantly higher HDL-cholesterol in this group. Patients with DM1 and AITD were significantly less likely to have NPDR than the control group.
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Rajalakshmi R, Shanthi Rani CS, Venkatesan U, Unnikrishnan R, Anjana RM, Jeba Rani S, UmaSankari G, Sivaprasad S, Raman R, Mohan V. Correlation between markers of renal function and sight-threatening diabetic retinopathy in type 2 diabetes: a longitudinal study in an Indian clinic population. BMJ Open Diabetes Res Care 2020; 8:8/1/e001325. [PMID: 32475840 PMCID: PMC7265015 DOI: 10.1136/bmjdrc-2020-001325] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/11/2020] [Accepted: 04/28/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Previous epidemiological studies have reported on the prevalence of diabetic kidney disease (DKD) and diabetic retinopathy (DR) from India. The aim of this study is to evaluate the effect of DKD on the development of new-onset DR and sight-threatening diabetic retinopathy (STDR) in Asian Indians with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS The study was done on anonymized electronic medical record data of people with T2D who had undergone screening for DR and renal work-up as part of routine follow-up at a tertiary care diabetes center in Chennai, South India. The baseline data retrieved included clinical and biochemical parameters including renal profiles (serum creatinine, estimated glomerular filtration rate (eGFR) and albuminuria). Grading of DR was performed using the modified Early Treatment Diabetic Retinopathy Study grading system. STDR was defined as the presence of proliferative diabetic retinopathy (PDR) and/or diabetic macular edema. DKD was defined by the presence of albuminuria (≥30 µg/mg) and/or reduction in eGFR (<60 mL/min/1.73 m2). Cox regression analysis was used to evaluate the hazard ratio (HR) for DR and STDR. RESULTS Data of 19 909 individuals with T2D (mean age 59.6±10.2 years, mean duration of diabetes 11.1±12.1 years, 66.1% male) were analyzed. At baseline, DR was present in 7818 individuals (39.3%), of whom 2249 (11.3%) had STDR. During the mean follow-up period of 3.9±1.9 years, 2140 (17.7%) developed new-onset DR and 980 individuals with non-proliferative DR (NPDR) at baseline progressed to STDR. Higher serum creatinine (HR 1.5, 95% CI 1.3 to 1.7; p<0.0001), eGFR <30 mL/min/1.73 m2 (HR 4.9, 95% CI 2.9 to 8.2; p<0.0001) and presence of macroalbuminuria >300 µg/mg (HR 3.0, 95% CI 2.4 to 3.8; p<0.0001) at baseline were associated with increased risk of progression to STDR. CONCLUSIONS DKD at baseline is a risk factor for progression to STDR. Physicians should promptly refer their patients with DKD to ophthalmologists for timely detection and management of STDR.
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Affiliation(s)
- Ramachandran Rajalakshmi
- Ophthalmology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | | | | | - Ranjit Unnikrishnan
- Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Saravanan Jeba Rani
- Data Management, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ganesan UmaSankari
- Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Sobha Sivaprasad
- University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Rajiv Raman
- Vitreo-Retina Services, Vision Research Foundation, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
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Abstract
Diabetic retinopathy (DR) is one of the main causes of visual loss in individuals aged 20–64 years old. The aim of this study was to investigate, in a multicenter retrospective cross-sectional study, sex-gender difference in DR in a large sample of type 2 diabetic patients (T2DM). 20,611 T2DM regularly attending the units for the last three years were classified as having: (a) No DR (NDR), (b) nonproliferative DR (NPDR), or (c) preproliferative/proliferative DR (PPDR). DR of all grades was present in 4294 T2DM (20.8%), with a significant higher prevalence in men as compared to women (22.0% vs. 19.3% p < 0.0001). Among DR patients, both NPDR and PPDR were significantly more prevalent in men vs. women (p = 0.001 and p = 0.0016, respectively). Women had similar age and BMI, but longer diabetes duration, worse glycemic metabolic control, and more prevalence of hypertension and chronic renal failure (CRF) of any grade vs. men. No significant differences between sexes were evident in term of drug therapy for diabetes and associate pathologies. Conclusions: In this large sample of T2DM, men show higher prevalence of DR vs. women, in spite of less represented risk factors, suggesting that male sex per se might be a risk factor for DR development.
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20
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Chawla R, Madhu SV, Makkar BM, Ghosh S, Saboo B, Kalra S. RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020. Indian J Endocrinol Metab 2020; 24:1-122. [PMID: 32699774 PMCID: PMC7328526 DOI: 10.4103/ijem.ijem_225_20] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Rajeev Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - S. V. Madhu
- Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, New Delhi, India
| | - B. M. Makkar
- Dr. Makkar's Diabetes and Obesity Centre, Paschim Vihar, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, Gujarat, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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21
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Ghamdi AHA. Clinical Predictors of Diabetic Retinopathy Progression; A Systematic Review. Curr Diabetes Rev 2020; 16:242-247. [PMID: 30767747 DOI: 10.2174/1573399815666190215120435] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/12/2018] [Accepted: 02/08/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study was conducted to discuss the clinical value of published Diabetic Retinopathy Progression determinants. METHODS The data for systematic review was collected from the published studies through PubMed and Medline. These studies discussed the clinical predictors of Diabetic Retinopathy (DR) progression. The common keywords used were diabetic Retinopathy, diabetes mellitus, systolic blood pressure, hemoglobin, and albuminuria. RESULTS Diabetic Retinopathy is one of the common causes of irreversible visual impairment among adults. Poor glycemic control, systemic hypertension, diabetes duration, dyslipidemia, and microalbuminuria are the major risk factors for the development and progression of diabetic retinopathy. Recently, increased aortic stiffness has been identified as a prognostic marker of diabetic retinopathy and peripheral neuropathy. CONCLUSION Certain groups of diabetic individuals are at higher risk to have progressive diabetic retinopathy and eventually visual impairment. Clinical determinants and predictors are considered as prognostic markers and could help physicians to develop an effective risk-based screening program for this condition.
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Affiliation(s)
- Abdul Hamid Al Ghamdi
- Department of Ophthalmology, Faculty of Medicine, Taif University, Taif, Saudi Arabia
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22
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Li M, Wang Y, Liu Z, Tang X, Mu P, Tan Y, Wang J, Lin B, Deng J, Peng R, Zhang R, He Z, Li D, Zhang Y, Yang C, Li Y, Chen Y, Liu X, Chen Y. Females with Type 2 Diabetes Mellitus Are Prone to Diabetic Retinopathy: A Twelve-Province Cross-Sectional Study in China. J Diabetes Res 2020; 2020:5814296. [PMID: 32377522 PMCID: PMC7191394 DOI: 10.1155/2020/5814296] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS To investigate the distribution of diabetic retinopathy (DR) by sex in patients with type 2 diabetes mellitus (T2DM) in a twelve-province cross-sectional study in China. METHODS Patients with T2DM, whose ages were ≥18 years, were recruited from 76 cities/counties in 12 provinces in mainland China between January 2015 and December 2018. All participants received a standardized interview, eye examinations, and digital fundus photography. The presence and severity of DR were diagnosed and classified by retina specialists according to the DR domestic typing method. RESULTS A total of 12,766 participants (5963 males and 6803 females) were eligible for this study. The total prevalence of DR was 30.1%. Females exhibited a significantly higher prevalence of DR than males (31.1% vs. 29.0%, P = 0.011). A multivariate logistic regression analysis confirmed that female sex was an independent predictor for a higher prevalence of DR after adjusting for age, the duration of diabetes, economic status, and the presence of hypertension (OR: 1.096, 95% CI: 1.013-1.186, P = 0.023). Even after stratification by the diabetic duration, age, and economic status, female sex was still independently associated with the presence of DR in patients whose T2DM history was more than 10 years, whose ages were over 60 years, or who were in a relatively intermediate economic area. CONCLUSION Females had a higher prevalence of DR than males in T2DM patients with a diabetic history of more than 10 years, ages over 60 years, or a relatively intermediate economic status.
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Affiliation(s)
- Mei Li
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- VIP Medical Service Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yina Wang
- VIP Medical Service Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Zifeng Liu
- Clinical Data Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Xixiang Tang
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- VIP Medical Service Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Panwei Mu
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Ying Tan
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Jing Wang
- Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514021, China
| | - Bairun Lin
- Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514021, China
| | - Juan Deng
- Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Ruiping Peng
- Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Rongyu Zhang
- Guangzhou Da'an Clinical Laboratory Center Co. Ltd., Guangzhou 440100, China
| | - Zhihui He
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou 510000, China
| | - Dongling Li
- Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514021, China
| | - Yongjun Zhang
- Department of Endocrinology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai 519100, China
| | - Caixian Yang
- Department of Endocrinology & Metabolism, Qingyuan People's Hospital, Qingyuan 511518, China
| | - Yuan Li
- Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514021, China
| | - Yuming Chen
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xun Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yanming Chen
- Department of Endocrinology & Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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Sadat Mahmoudi Nezhad G, Razeghinejad R, Janghorbani M, Mohamadian A, Hassan Jalalpour M, Bazdar S, Salehi A, Molavi Vardanjani H. Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis. J Ophthalmic Vis Res 2019; 14:321-335. [PMID: 31660112 PMCID: PMC6815336 DOI: 10.18502/jovr.v14i3.4790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/06/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose
To estimate the pooled prevalence and incidence of diabetic retinopathy (DR) in Iran and to investigate their correlations with the Human Development Index (HDI), healthcare access (i.e., density of specialists and sub-specialists), and methodological issues. Methods
Electronic databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and local databases were searched for cohort and cross-sectional studies published prior to January 2018. Prevalence and incidence rates of DR were extracted from January 2000 to December 2017 and random effects models were used to estimate pooled effect sizes. The Joanna Briggs Institute critical appraisal tool was applied for quality assessment of eligible studies. Results A total of 55,445 participants across 33 studies were included. The pooled prevalence (95% CI) of DR in diabetic clinics (22 studies), eye clinics (4 studies), and general population (7 studies) was 31.8% (24.5 to 39.2), 57.8% (50.2 to 65.3), and 29.6% (22.6 to 36.5), respectively. It was 7.4% (3.9 to 10.8) for proliferative DR and 7.1% (4.9 to 9.4) for clinically significant macular edema. The heterogeneity of individual estimates of prevalence was highly significant. HDI (P < 0.001), density of specialists (P = 0.004), subspecialists (P < 0.001), and sampling site (P = 0.041) were associated with heterogeneity after the adjustment for type of DR, duration of diabetes, study year, and proportion of diabetics with controlled HbA1C. Conclusion Human development and healthcare access were correlated with the prevalence of DR. Data were scarce on the prevalence of DR in less developed provinces. Participant recruitment in eye clinics might overestimate the prevalence of DR.
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Affiliation(s)
- Golnoush Sadat Mahmoudi Nezhad
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.,Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Mohsen Janghorbani
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Mohamadian
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Jalalpour
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somaye Bazdar
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Salehi
- MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Thapa R, Twyana SN, Paudyal G, Khanal S, van Nispen R, Tan S, Thapa SS, van Rens G. Prevalence and risk factors of diabetic retinopathy among an elderly population with diabetes in Nepal: the Bhaktapur Retina Study. Clin Ophthalmol 2018; 12:561-568. [PMID: 29615832 PMCID: PMC5870654 DOI: 10.2147/opth.s157560] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Aim Diabetic retinopathy (DR) is an emerging cause of blindness in developing countries. This study aimed to explore the prevalence and risk factors of DR in an elderly population in Nepal. Subjects and methods This is a population-based, cross-sectional study. A total of 1860 subjects at the age 60 years and above participated (response rate 88.6%). A detailed history was obtained, presenting and best-corrected visual acuity were measured, and anterior segment and posterior segment examinations were carried out. Blood pressure and random blood sugar were recorded; body mass index was calculated, and abdominal girth was measured. DR was graded by clinical examination using Early Treatment Diabetic Retinopathy Study criteria. Results Diabetes was found in 168 (9%) subjects (mean age 69.6 years), 31 (18.5%) of whom were newly diagnosed. The prevalence of DR was 23.8% (95% confidence interval [CI]: 17.7%–31%) among the persons with diabetes. The prevalence of DR among newly diagnosed subjects with diabetes was 6.5% (95% CI: 0.8%–21.4%). The prevalence of vision-threatening DR was 9.5% (95% CI: 5.5%–15%) and was higher in males. The prevalence of DR was 83.3% (95% CI: 35.9%–99.6%) among those with diabetes for over 20 years. In multivariable logistic regression analysis, duration of diabetes, hypertension, and alcohol consumption were significantly associated with DR. Conclusion DR is a common problem among the elderly population with diabetes in Nepal. The duration of diabetes, hypertension, and alcohol consumption are the risk factors for the development of DR. Strategies have to be developed for timely diagnosis of diabetes and screening for DR.
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Affiliation(s)
- Raba Thapa
- Vitreo-retina Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Shankha N Twyana
- Department of Eye Bank, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Govinda Paudyal
- Vitreo-retina Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Ruth van Nispen
- Department of Ophthalmology and the Amsterdam Public Health Research Institute, Vrije University Medical Center, Amsterdam, the Netherlands
| | - Stevie Tan
- Department of Ophthalmology and the Amsterdam Public Health Research Institute, Vrije University Medical Center, Amsterdam, the Netherlands
| | - Suman S Thapa
- Glaucoma Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Ghmb van Rens
- Department of Ophthalmology and the Amsterdam Public Health Research Institute, Vrije University Medical Center, Amsterdam, the Netherlands
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25
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Li YY, Yang XF, Gu H, Liu XP, Snellingen T, Liu NP. The Beijing Desheng Diabetic Eye Study: rationale, design, methodology and baseline data. Int J Ophthalmol 2018; 11:108-116. [PMID: 29376000 DOI: 10.18240/ijo.2018.01.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/26/2017] [Indexed: 01/08/2023] Open
Abstract
AIM To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study (BDDES), and to determine the prevalence of diabetic retinopathy (DR) and possible risk factors in patients with type 2 diabetes mellitus (T2DM) in an urban community of Beijing, China. METHODS Community-based prospective cohort study of persons diagnosed with T2DM aged 30y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic dispositions. RESULTS A total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male (P=0.031), lower income level (P=0.011), lower education background (P=0.022), longer duration of diabetes (P=0.001), younger age at diabetic onset (P=0.001), higher systolic blood pressure (P=0.007), higher glycosylated hemoglobin A1c levels (P=0.001), high albuminuria (P=0.03), and use of insulin (P<0.001). For vision-threatening DR, four factors were significant: younger age at diabetic onset (P<0.001), higher systolic blood pressure (P=0.042), high albuminuria (P<0.001), and use of insulin (P<0.001). CONCLUSION The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.
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Affiliation(s)
- Yun-Yun Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Xiu-Fen Yang
- Department of Ophthalmology, Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hong Gu
- Department of Ophthalmology, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo 315040, Zhejiang Province, China
| | - Xi-Pu Liu
- Sekwa Institute of Medicine, Beijing 100035, China
| | | | - Ning-Pu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
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26
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Chua J, Lim CXY, Wong TY, Sabanayagam C. Diabetic Retinopathy in the Asia-Pacific. Asia Pac J Ophthalmol (Phila) 2018; 7:3-16. [PMID: 29376231 DOI: 10.22608/apo.2017511] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Diabetic retinopathy (DR), the most common complication of diabetes mellitus, is the leading cause of new cases of blindness in middle-aged and elderly in the Asia-Pacific. It has been estimated that 51% of all those with blindness due to DR globally (n = 424,400) and 56% of those with visual impairment due to DR (2.1 million) come from the Asia-Pacific. Prevalence of DR among those with diabetes ranged from 10% in India to 43% in Indonesia within the Asia-Pacific. Awareness of DR among persons with diabetes ranged from 28% to 84%. Most common modifiable risk factors for DR in the Asia-Pacific were hyperglycemia, blood pressure, dyslipidemia, and obesity. Implementation of systematic screening programs for DR and advancement in telemedicine screening methods have increased patient coverage and cost-effectiveness, though there are still numerous factors impeding screening uptake in the low-middle income regions of the Asia-Pacific. Management and treatment of DR in the Asia-Pacific is mainly limited to traditional laser retinopexy, but it is suboptimal despite new clinical approaches such as use of intravitreal anti.vascular endothelial growth factor and steroids due to limited resources. Further research and data are required to structure a more cost-effective public healthcare program and more awareness-building initiatives to increase the effectiveness of DR screening programs.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Claire Xin Ying Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- University College Dublin, Dublin, Ireland
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Centre for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore
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Shah K, Gandhi A, Natarajan S. Diabetic Retinopathy Awareness and Associations with Multiple Comorbidities: Insights from DIAMOND Study. Indian J Endocrinol Metab 2018; 22:30-35. [PMID: 29535933 PMCID: PMC5838906 DOI: 10.4103/ijem.ijem_240_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is leading cause of visual impairment in working-age adults. Macular edema can occur with or without other signs of retinopathy. METHODS This was a single-center, retrospective study conducted over 2 years in patients (>40 years of age) having type 2 diabetes mellitus (T2DM). Outcome measures were to analyze awareness and prevalence of DR and association of DR with identified risk factors. RESULTS Overall 6000 T2DM patients over 2 years were retrospectively evaluated. Almost 63% (n = 3780) of patients were unaware that diabetes affects the retina. Almost 65% (n = 3894) of patients were reported to have DR. Total 78.98% of males, and 69.50% of females had DR. There was a significant increase in the incidence of DR with age (P < 0.00001). Almost 60.80% (n = 3653) of patients having DR were from working age group (40-70 years). Evidently, 42% (n = 2520) of patients having DR had HbA1c > 9% (P < 0.00001). Overall 52.02% (n = 1820) of smokers were reported of DR (P < 0.00001). With the increase in total cholesterol and triglycerides, there was a significant increase in DR incidence (P < 0.00001). A strong association was observed between hypertension and DR, with 42.6% (n = 2556) of patients having coexistence of hypertension and DR (P < 0.00001). Patients having diabetic kidney disease (DKD) also reported DR. A high proportion of patients (49.11%, n = 2947) had co-existence of cardiac morbidity and DR. Almost 47% (n = 2845) of patients having DR were also reported anemia. Totally 43.85% (n = 2631) of patients with microalbuminuria had two times more risk of developing proliferative DR (P < 0.00001). The statistical significance for the association of DR with risk factors, calculated by Pearson Chi-Square method of analysis was found statistically significant (P < 0.00001). CONCLUSION The study reported the high prevalence and significantly high unawareness for DR in T2DM patients. All the risk factors are independently and significantly associated with DR (P < 0.00001).
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Affiliation(s)
- Kiran Shah
- Director, Diabetes and Thyroid Care Center, Borivali West, Mumbai, India
| | - Alka Gandhi
- Director, Aayushi Diabetes Center, Mumbai, India
| | - Sundaram Natarajan
- Chairman and Medical Director, Aditya Jyot Eye Hospital Pvt. Ltd., Mumbai, Maharashtra, India
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28
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Nadarajan B, Saya GK, Krishna RB, Lakshminarayanan S. Prevalence of Diabetic Retinopathy and its Associated Factors in a Rural Area of Villupuram District of Tamil Nadu, India. J Clin Diagn Res 2017; 11:LC23-LC26. [PMID: 28892938 PMCID: PMC5583923 DOI: 10.7860/jcdr/2017/20946.10294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 12/20/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION There is limited information on prevalence of Diabetic Retinopathy (DR) among diabetic subjects and its associated factors in a rural setting in developing countries including India. The information will be useful for initiating early screening strategies for this group in the community. AIM To assess the prevalence and certain associated factors of DR among diabetic subjects in a rural area of Tamil Nadu, India. MATERIALS AND METHODS This cross-sectional study was conducted among 105 Type 2 diabetic subjects in Pakkam and Mandagapattu sub-center area of Kondur Primary Health Center in Villupuram district of Tamil Nadu, India. Data on associated factors which include sociodemographic factors, duration of disease, family history, and frequency of blood test, treatment regularity, hypertension, visual acuity and cataract were collected. Detailed eye examination including visual acuity, direct ophthalmoscope and Non Mydriatic Fundus Camera was done. Data was analysed by univariate analysis and described in proportion or percentages. RESULTS The mean age of the study population was 56.69 years. About 47 (44.8%) of the subjects were more than 60 years of age followed by 44 subjects (41.9%) in age group 45-59 years. Fundus examination in at least one eye was seen in 83 people (79.0%). Prevalence of DR in any eye and both the eye was 32.53% (27/83) and 31.58% (24/76) respectively. Severity of DR was moderate (51.9%) followed by mild (44.4%) and severe (3.7%). DR prevalence was more among >60 years age group (p=0.032) and lesser education level (p=0.057). There was no association of DR with duration of disease, family history of diabetes, treatment regularity, presence of hypertension, visual acuity and cataract (p>0.05). CONCLUSION The prevalence of DR was inferred to be high and further larger follow up studies will explore the role of associated factors and its quantification in the causation of DR.
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Affiliation(s)
- Balasubramanian Nadarajan
- Epidemiologist, Office of Deputy Director of Health Services, Villupuram District, Tamil Nadu, India
| | - Ganesh Kumar Saya
- Additional Professor, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ramesh Babu Krishna
- Additional Professor and Head, Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Subitha Lakshminarayanan
- Assistant Professor, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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29
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Sabanayagam C, Yip W, Gupta P, Mohd Abdul RBB, Lamoureux E, Kumari N, Cheung GCM, Cheung CY, Wang JJ, Cheng CY, Wong TY. Singapore Indian Eye Study-2: methodology and impact of migration on systemic and eye outcomes. Clin Exp Ophthalmol 2017; 45:779-789. [DOI: 10.1111/ceo.12974] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Charumathi Sabanayagam
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
- Centre for Quantitative Medicine; Duke-NUS Medical School; Singapore
| | - Wanfen Yip
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
| | | | - Ecosse Lamoureux
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program; Duke-NUS Medical School; Singapore
| | - Neelam Kumari
- Department of Ophthalmology and Visual Sciences; Khoo Teck Puat Hospital; Hong Kong
| | - Gemmy CM Cheung
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program; Duke-NUS Medical School; Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences; Chinese University of Hong Kong Eye Centre; Hong Kong
| | - Jie Jin Wang
- Centre for Vision Research; University of Sydney; New South Wales Australia
| | - Ching-Yu Cheng
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program; Duke-NUS Medical School; Singapore
| | - Tien Yin 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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30
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Vinuthinee-Naidu MN, Zunaina E, Azreen-Redzal A, Nyi-Nyi N. Correlation of retinal nerve fibre layer and macular thickness with serum uric acid among type 2 diabetes mellitus. BMC Ophthalmol 2017; 17:91. [PMID: 28615022 PMCID: PMC5471720 DOI: 10.1186/s12886-017-0486-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 06/08/2017] [Indexed: 12/17/2022] Open
Abstract
Background Uric acid is a final breakdown product of purine catabolism in humans. It’s a potent antioxidant and can also act as a pro-oxidant that induces oxidative stress on the vascular endothelial cells, thus mediating progression of diabetic related diseases. Various epidemiological and experimental evidence suggest that uric acid has a role in the etiology of type 2 diabetes mellitus. We conducted a cross-sectional study to evaluate the correlation of retinal nerve fibre layer (RNFL) and macular thickness with serum uric acid in type 2 diabetic patients. Methods A cross-sectional study was conducted in the Eye Clinic, Hospital Universiti Sains Malaysia, Kelantan between the period of August 2013 till July 2015 involving type 2 diabetes mellitus patients with no diabetic retinopathy and with non-proliferative diabetic retinopathy (NPDR). An evaluation for RNFL and macular thickness was measured using Spectralis Heidelberg optical coherence tomography. Six ml of venous blood was taken for the measurement of serum uric acid and glycosylated haemoglobin (HbA1C). Results A total of 180 diabetic patients were recruited (90 patients with no diabetic retinopathy and 90 patients with NPDR) into the study. The mean level of serum uric acid for both the groups was within normal range and there was no significance difference between the two groups. Based on gender, both male and female gender showed significantly higher level of mean serum uric acid in no diabetic retinopathy group (p = 0.004 respectively). The mean serum uric acid was significantly higher in patient with HbA1C < 6.5% (p < 0.031). Patients with NPDR have thicker RNFL and macular thickness compared to patients with no diabetic retinopathy. However, only the RNFL thickness of the temporal quadrant and the macular thickness of the superior outer, inferior outer and temporal outer subfields were statistically significant (p = 0.038, p = 0.004, 0.033 and <0.001 respectively). There was poor correlation between RNFL and macular thickness with serum uric acid in both the groups. Conclusion Serum uric acid showed a poor correlation with RNFL and macular thickness among type 2 diabetic patients.
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Affiliation(s)
- Munisamy-Naidu Vinuthinee-Naidu
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150, Kubang Kerian, Kelantan, Malaysia.,Department of Ophthalmology, Hospital Sultanah Bahiyah, 05460, Alor Setar, Kedah, Malaysia
| | - Embong Zunaina
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia. .,Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Anuar Azreen-Redzal
- Department of Ophthalmology, Hospital Sultanah Bahiyah, 05460, Alor Setar, Kedah, Malaysia
| | - Naing Nyi-Nyi
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, 16150, Kubang Kerian, Kelantan, Malaysia.,Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
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31
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Sunita M, Singh AK, Rogye A, Sonawane M, Gaonkar R, Srinivasan R, Natarajan S, Stevens FCJ, Scherpbier AJJA, Kumaramanickavel G, McCarty C. Prevalence of Diabetic Retinopathy in Urban Slums: The Aditya Jyot Diabetic Retinopathy in Urban Mumbai Slums Study—Report 2. Ophthalmic Epidemiol 2017; 24:303-310. [DOI: 10.1080/09286586.2017.1290258] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mohan Sunita
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Arvind Kumar Singh
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Ashwini Rogye
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Manish Sonawane
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Ravina Gaonkar
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Radhika Srinivasan
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | | | - Fred C. J. Stevens
- Department of Educational Development & Research, Maastricht University, Maastricht, the Netherlands
| | - A. J. J. A. Scherpbier
- Department of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Wang D, Shen B, Wu C, Xue Y, Liu Y. The Relationship between Cardiovascular Autonomic Dysfunction and Ocular Abnormality in Chinese T2DM. J Diabetes Res 2017; 2017:7125760. [PMID: 28656153 PMCID: PMC5471552 DOI: 10.1155/2017/7125760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/14/2017] [Accepted: 03/26/2017] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE This study aims to explore the relationship between autonomic nerve dysfunction-assessed by cardiovascular autonomic neuropathy risk score (CAN-RS)-and ocular abnormality in Chinese type 2 diabetes mellitus (T2DM). METHOD This is a cross-sectional study. A total of 335 subjects with T2DM were enrolled. The state of visual acuity, the lens, the vitreous, and the fundus were tested by professional ophthalmic instruments. The electrochemical skin conductance (ESC) of the hands and feet was measured by SUDOSCAN, from which a cardiovascular autonomic neuropathy risk score (CAN-RS) was calculated. Receiver operating characteristic (ROC) curves were drawn to evaluate the feasibility and accuracy of CAN-RS in diabetic oculopathy screening. RESULTS Abnormalities of the lens, vitreous, and fundus accounted for 7.8%, 5.1%, and 9.9%, respectively, in this study. The means of hands and feet ESC were higher than 60 μS, and CAN-RS was 33.1 ± 14.8%. In logistic regression analysis, CAN-RS was positively associated with lens (OR = 1.055, P < 0.001) and vitreous (OR = 1.044, P < 0.01) abnormality. The area under ROC to detect lens and vitreous abnormality was 0.713 and 0.725, respectively. CONCLUSION CAN-RS, a cardiac autonomic nerve dysfunction index calculated by SUDOSCAN, may be a promising index for lens and vitreous abnormality screening in T2DM patients. Further studies are needed to confirm the conclusion.
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Affiliation(s)
- Dandan Wang
- Department of Endocrinology, The 306th Teaching Hospital of People's Liberation Army, Peking University, Beijing, China
| | - Baiyu Shen
- Department of Endocrinology, The 306th Teaching Hospital of People's Liberation Army, Peking University, Beijing, China
| | - Chunrong Wu
- Department of Endocrinology, The 306th Hospital of People's Liberation Army, Beijing, China
| | - Yanyan Xue
- Department of Endocrinology, The 306th Hospital of People's Liberation Army, Beijing, China
| | - Yanjun Liu
- Department of Endocrinology, The 306th Teaching Hospital of People's Liberation Army, Peking University, Beijing, China
- Department of Endocrinology, The 306th Hospital of People's Liberation Army, Beijing, China
- *Yanjun Liu:
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33
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Gadkari SS, Maskati QB, Nayak BK. Prevalence of diabetic retinopathy in India: The All India Ophthalmological Society Diabetic Retinopathy Eye Screening Study 2014. Indian J Ophthalmol 2016; 64:38-44. [PMID: 26953022 PMCID: PMC4821119 DOI: 10.4103/0301-4738.178144] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim: The aim of this study is to ascertain the prevalence of diabetic retinopathy (DR) in diabetic patients across the nation and attempt to establish history-based risk factors. Materials and Methods: A cross-sectional study of diabetic patients was conducted as an initiative of the All India Ophthalmological Society from 14th November to 21st November 2014. Known diabetics were evaluated voluntarily by members of the society at 194 centers using a structured protocol provided by the society for examination. The results were evaluated to ascertain the prevalence of DR in the population studied and to establish relation with gender, age, and history-based risk factors such as duration of diabetes, insulin use, and other end-organ disease using the Chi-square test. Results: A total of 6218 known diabetics were screened. Totally, 5130 data entry forms were considered suitable for further evaluation. About 61.2% were males, 88.6% were between 40 and 80 years of age, almost two-thirds of the patients were from the west and south zones, and over half had diabetes more than 5 years. The data set was predominantly urban 84.7% and 46.1% had no family history. DR prevalence in the entire data set was 21.7%. Prevalence was more in males (P = 0.007), diabetics more than 5 years (P = 0.001), those above 40 years (P = 0.01), insulin users (P = 0.001), and history of vascular accidents (P = 0.0014). Significantly 22.18% of patients detected with DR had a vision of 6/18 or better in the worse eye. Conclusion: The study reiterated the findings of earlier regional studies on a pan Indian scale and put data in perspective.
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Affiliation(s)
- Salil S Gadkari
- Head Office, All Ophthalmological Society, Near Deepak Memorial Hospital, Karkardooma, New Delhi, India
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Rajalakshmi R, Prathiba V, Mohan V. Does tight control of systemic factors help in the management of diabetic retinopathy? Indian J Ophthalmol 2016; 64:62-8. [PMID: 26953026 PMCID: PMC4821124 DOI: 10.4103/0301-4738.178146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diabetic retinopathy (DR), one of the leading causes of preventable blindness, is associated with many systemic factors that contribute to the development and progression of this microvascular complication of diabetes. While the duration of diabetes is the major risk factor for the development of DR, the main modifiable systemic risk factors for development and progression of DR are hyperglycemia, hypertension, and dyslipidemia. This review article looks at the evidence that control of these systemic factors has significant benefits in delaying the onset and progression of DR.
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Affiliation(s)
| | | | - Viswanathan Mohan
- Department of Diabetology, Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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Rajalakshmi R, Prathiba V, Mohan V. Author's reply. Indian J Ophthalmol 2016; 64:477-8. [PMID: 27488167 PMCID: PMC4991191 DOI: 10.4103/0301-4738.187694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ramachandran Rajalakshmi
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Vijayaraghavan Prathiba
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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Yang XF, Deng Y, Gu H, Lim A, Snellingen T, Liu XP, Wang NL, Domalpally A, Danis R, Liu NP. C-reactive protein and diabetic retinopathy in Chinese patients with type 2 diabetes mellitus. Int J Ophthalmol 2016; 9:111-8. [PMID: 26949620 DOI: 10.18240/ijo.2016.01.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/27/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the relationship between C-reactive protein (CRP) and diabetic retinopathy (DR) in a cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS Community-based observational cohort study. There were 1131 participants recruited from November 2009 to September 2011 in Desheng community in urban Beijing. Patients diagnosed T2DM were recruited and underwent a standardized evaluation consisting of a questionnaire, ocular and anthropometric examinations and laboratory investigation. The presence and severity of DR were assessed by seven fields 30° color fundus photographs. Subjects were then classified into groups with no DR, any DR, or vision-threatening DR. CRP was analyzed from serum of study subjects. RESULTS A total of 1007 patients with T2DM were included for analysis, including 408 (40.5%) men and 599 (59.5%) women. The median CRP level was 1.5 mg/L for women and 1.1 mg/L for men (P=0.004, OR 0.37, 95% CI 0.18-0.74). After adjusting for possible covariates, higher levels of CRP were associated with lower prevalence of any DR (P=0.02, OR 0.55, 95% CI 0.35-0.89), but not associated with vision-threatening DR (P=0.62, OR 0.78, 95% CI 0.28-2.14). After stratification by sex, the inverse association between CRP and DR was found to be statistically significant in men (P=0.006, OR 0.35, 95% CI 0.16-0.73), but not in women (P=0.58, OR 0.88, 95% CI 0.29-1.16). CONCLUSION The data drawn from a Chinese population with T2DM suggest that increasing CRP levels may be inversely associated with development of DR.
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Affiliation(s)
- Xiu-Fen Yang
- Department of Ophthalmology, the Friendship Hospital, Capital Medical University, Beijing 100050, China; Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yu Deng
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hong Gu
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Apiradee Lim
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani Campus, Muang Pattani 9400, Thailand
| | | | - Xi-Pu Liu
- Sekwa Research Institute, Beijing 100088, China
| | - Ning-Li Wang
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Amitha Domalpally
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison 53705, Wisconsin, USA
| | - Ronald Danis
- Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison 53705, Wisconsin, USA
| | - Ning-Pu Liu
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Prabhu M, Kakhandaki A, Chandra KRP, Dinesh MB. A Hospital Based Study Regarding Awareness of Association Between Glycosylated Haemoglobin and Severity of Diabetic Retinopathy in Type 2 Diabetic Individuals. J Clin Diagn Res 2016; 10:NC01-4. [PMID: 26894100 DOI: 10.7860/jcdr/2016/15834.7014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 11/02/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Diabetic retinopathy is one of the most common microvascular complications seen in diabetic patients after a long term of uncontrolled glycaemic status as assessed by glycosylated Haemoglobin A (HbA1c). Hence awareness of glycaemic control is necessary to prevent vision threatening complications. AIM To assess the awareness regarding association between glycosylated Haemoglobin (HbA1c) and diabetic retinopathy among diabetic patients and to assess the impact of lack of this knowledge on the severity of diabetic retinopathy (DR). MATERIALS AND METHODS This hospital based cross-sectional study was conducted in the ophthalmology OPD on 200 adult diabetic patients, between November 2012 and January 2013, who were assessed for their knowledge regarding association between HbA1c and its impact on the progress of DR. The study was done with the help of a semi structured questionnaire which included demographic details, literacy levels, diabetic status and awareness of HbA1c. STATISTICS USED Cochran Armitage test for trend, Fisher Exact test, chi-square for trend and Student's t test. RESULTS Among the 200 diabetic individuals attending our OPD, 180 (90%) were aware of the importance of blood sugar levels and its fluctuation in type 2 diabetes. Only 23 (11.5%) were aware of HbA1c whereas 10 (5%) misinterpreted it as levels of haemoglobin, 3 (1.5%) did not completely comprehend. About 164 (82%) patients were not aware of the significance or the terminology of HbA1c. Out of the 200 patients, 58 patients showed presence of some grade of DR. Amongst these 58 patients, 7(12.1%) were aware of HbA1c and all the11 patients with clinically significant macular oedema (CSME) were aware of the risk factors of elevated blood sugar levels but ignorant of HbA1c. Among the remaining 142 individuals who showed no signs of DR, 16 (27.5%) were aware of and comprehended the role of HbA1c. CONCLUSION Our study highlights the gross ignorance of role of HbA1c in the progress of DR among diabetic individuals. It is a known fact that the risk of DR reduces by 35% for every 1% reduction in HbA1c. Hence a strict control of blood sugar level with regular monitoring of HbA1c can help diabetic individuals in prevention of progress of DR, thus preventing severe vision loss.
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Affiliation(s)
- Mridula Prabhu
- Associate Professor, Department of Ophthalmology, S D M College of Medical Sciences and Hospital , Sattur, Dharwad, India
| | - Anupama Kakhandaki
- Professor, Department of Ophthalmology, S D M College of Medical Sciences and Hospital , Sattur, Dharwad, India
| | - K R Pravin Chandra
- Associate Professor, Department of Community Medicine, S D M College of Medical Sciences and Hospital , Sattur, Dharwad, India
| | - M B Dinesh
- Postgraduate, Department of Ophthalmology, S D M College of Medical Sciences and Hospital , Sattur, Dharwad, India
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Kengne AP, Gouking P, Wawo E, Koki G, Balti E, Hakapoka H, Dehayem MY, Sobngwi E, Mbanya JC. Cardiovascular risk profile, diabetes specific factors, and prevalent microvascular eye complications in sub-Saharan Africans with type 2 diabetes. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-014-0283-y] [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: 10/24/2022] Open
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Tanuja A, Guruprasad BS, Prashanth K, Prasad I. Prevalence and risk factors of diabetic retinopathy in a rural population of South India. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-014-0276-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Incidence Density and Risk Factors of Diabetic Retinopathy Within Type 2 Diabetes: A Five-Year Cohort Study in China (Report 1). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:7899-909. [PMID: 26184262 PMCID: PMC4515698 DOI: 10.3390/ijerph120707899] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/29/2015] [Accepted: 07/07/2015] [Indexed: 11/17/2022]
Abstract
A prospective study was carried out from August 2010 to August 2014 in the community of Fengyutan (China). Six hundred and twenty two T2D subjects were collected. The incidence density of diabetic retinopathy (DR) was 1.81% person-year (95% confidence interval, CI: 1.21–2.43% person-year). After a Cox regression model analysis and adjusted confounding factors, independent predictors related to the incidence of DR including male gender (adjusted hazard ratios, aHR: 1.47, 95% CI: 1.21–1.62), with hypertension (aHR: 1.49, 95%: 1.12–1.73), duration of diabetes > 10 years (aHR: 2.28, 95%: 2.05–2.42), uncontrolled diabetes (aHR: 1.76, 95%: 1.41–2.01), total cholesterol ≥ 200 mg/dL (aHR: 1.54, 95%: 1.34–1.72) and HbA1c ≥ 7% (mmol/mol) (aHR: 2.12, 95%: 1.87–2.32). Duration of T2D revealed the significantly dose-response relationship to the onset of DR. The incidence density of DR in the Chinese community was relatively low in comparison with other studies. More attention should be paid to the T2D patients, especially of male gender, with hypertension, longer duration of diabetes, uncontrolled diabetes, total cholesterol ≥ 200mg/dL and HbA1c ≥ 7% (mmol/mol).
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Abougalambou SSI, Abougalambou AS. Risk factors associated with diabetic retinopathy among type 2 diabetes patients at teaching hospital in Malaysia. Diabetes Metab Syndr 2015; 9:98-103. [PMID: 25470640 DOI: 10.1016/j.dsx.2014.04.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Diabetic retinopathy (DR) is the leading cause of blindness in the United States and it is the leading cause of new cases of blindness in adults aged 20-74. It is estimated that about 20% of patients with type 2 DM have evidence of diabetic retinopathy at diagnosis with diabetes. OBJECTIVE To evaluate the prevalence of DR and to determine risk factors related to diabetic retinopathy among type 2 diabetes patients attending endocrinology clinics at Hospital Universiti Sains Malaysia (HUSM). SUBJECTS AND METHODS The study design was observational prospective longitudinal follow-up study, the study was conducted with sample of 1077 type 2 diabetes mellitus outpatient recruited via attended the diabetes clinics at HUSM. Diagnosis of retinopathy is based on finding the diagnostic signs of retinopathy on eye exams by fundoscopy. Logistic regression analysis was used to assess the independent variables that affect the development of retinopathy. RESULTS The prevalence of retinopathy was 39.3%. It has been noticed from this study findings, that the progression of retinopathy is been influenced by five independent risk factors such as duration of diabetes, presence neuropathy, total cholesterol at second and third visit and createnine clearance. CONCLUSION DR is highly prevalent among type 2 DM. The progression of retinopathy is been influenced by five independent risk factors such as duration of diabetes, presence neuropathy, total cholesterol at second and third visit and createnine clearance. DR is a serious diabetic complication and public health strategies are required in order to reduce its risk factors and decrease its prevalence.
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Abstract
The rising prevalence of diabetes in South Asians has significant health and economic implications. South Asians are predisposed to the development of diabetes due to biologic causes which are exacerbated by lifestyle and environmental factors. Furthermore, they experience significant morbidity and mortality from complications of diabetes, most notably coronary artery disease, cerebrovascular disease, and chronic kidney disease. Therefore, understanding the pathophysiology and genetics of diabetes risk factors and its associated complications in South Asians is paramount to curbing the diabetes epidemic. With this understanding, the appropriate screening, preventative and therapeutic strategies can be implemented and further developed. In this review, we discuss in detail the biologic and lifestyle factors that predispose South Asians to diabetes and review the epidemiology and pathophysiology of microvascular and macrovascular complications of diabetes in South Asians. We also review the ongoing and completed diabetes prevention and management studies in South Asians.
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Abstract
The purpose of this paper is to review male-female differences in the incidence and prevalence of diabetes and diabetic retinopathy. These differences will be established primarily through results from our present research and a review of related literature. Previously, we have demonstrated that neuroretinal dysfunction can be used to predict the location of future retinopathy up to three years before it is manifest. Our current research suggests that, for type 2 diabetes, the normal differences in neuroretinal function between nondiabetic males and females under 50 years of age are altered in patients with type 2 diabetes. Furthermore, local neuroretinal function in type 2 diabetes is more abnormal in adult males compared with adult females. The literature also suggests that there are male-female differences in the occurrence of diabetes. In adolescence, the incidence of type 1 diabetes is greater in males, whereas in type 2 diabetes, the incidence is greater in females. This excess of females in type 2 diabetes shifts to a more equal incidence between the two sexes in adults. In addition, advanced retinopathy in type 1 diabetes appears to be more common in males, and the presence and severity of diabetic retinopathy at the time of diagnosis in type 2 diabetes appears to be more associated with male sex. Although the reasons for male-female differences identified in this review are unknown, sex appears to be a significant factor in certain aspects of diabetes incidence and diabetic retinopathy.
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Affiliation(s)
- Glen Y Ozawa
- Berkeley School of Optometry, University of California , Berkeley, CA , USA
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Katulanda P, Ranasinghe P, Jayawardena R. Prevalence of retinopathy among adults with self-reported diabetes mellitus: the Sri Lanka diabetes and Cardiovascular Study. BMC Ophthalmol 2014; 14:100. [PMID: 25142615 PMCID: PMC4141126 DOI: 10.1186/1471-2415-14-100] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/18/2014] [Indexed: 12/12/2022] Open
Abstract
Background At present there are no large scale nationally-representative studies from Sri Lanka on the prevalence and associations of Diabetic Retinopathy (DR). The present study aims to evaluate the prevalence and risk factors for DR in a community-based nationally-representative sample of adults with self-reported diabetes mellitus from Sri Lanka. Methods A cross-sectional community-based national study among 5,000 adults (≥18 years) was conducted in Sri Lanka, using a multi-stage stratified cluster sampling technique. An interviewer-administered questionnaire was used to collect data. Ophthalmological evaluation of patients with ‘known’ diabetes (previously diagnosed at a government hospital or by a registered medical practitioner) was done using indirect ophthalmoscopy. A binary-logistic regression analysis was performed with ‘presence of DR’ as the dichotomous dependent variable and other independent covariates. Results Crude prevalence of diabetes was 12.0% (n = 536), of which 344 were patients with ‘known’ diabetes. Mean age was 56.4 ± 10.9 years and 37.3% were males. Prevalence of any degree of DR was 27.4% (Males-30.5%, Females-25.6%; p = 0.41). In patients with DR, majority had NPDR (93.4%), while 5.3% had maculopathy. Patients with DR had a significantly longer duration of diabetes than those without. In the binary-logistic regression analysis in all adults duration of diabetes (OR:1.07), current smoking (OR:1.67) and peripheral neuropathy (OR:1.72) all were significantly associated with DR. Conclusions Nearly 1/3rd of Sri Lankan adults with self-reported diabetes are having retinopathy. DR was associated with diabetes duration, cigarette smoking and peripheral neuropathy. However, further prospective follow up studies are required to establish causality for identified risk factors.
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Affiliation(s)
- Prasad Katulanda
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, Sri Lanka.
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Tang L, Ye H, Hong Q, Wang L, Wang Q, Wang H, Xu L, Bu S, Zhang L, Cheng J, Liu P, Le Y, Ye M, Mai Y, Duan S. Elevated CpG island methylation of GCK gene predicts the risk of type 2 diabetes in Chinese males. Gene 2014; 547:329-33. [PMID: 24992032 DOI: 10.1016/j.gene.2014.06.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 06/06/2014] [Accepted: 06/27/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND The GCK gene encodes hexokinase 4, which catalyzes the first step in most glucose metabolism pathways. The purpose of our study is to assess the contribution of GCK methylation to type 2 diabetes (T2D). METHODS AND RESULTS GCK methylation was evaluated in 48 T2D cases and 48 age- and gender-matched controls using the bisulphite pyrosequencing technology. Among the four CpG sites in the methylation assay, CpG4 and the other three CpGs (CpG1-3) were not in high correlation (r<0.5). Significantly elevated methylation levels of GCK CpG4 methylation were observed in T2D patients than in the healthy controls (P=0.004). A breakdown analysis by gender indicated that the association between CpG4 methylation and T2D was specific to males (P=0.002). It is intriguing that another significant male-specific association was also found between GCK CpG4 methylation and total cholesterol (TC) concentration (r=0.304, P=0.036). CONCLUSION Our results showed that elevated GCK CpG4 methylation might suggest a risk of T2D in Chinese males. Gender disparity in GCK CpG4 methylation might provide a clue to elaborate the pathogenesis of T2D.
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Affiliation(s)
- Linlin Tang
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China; The Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, China; Diabetes Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Huadan Ye
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Qingxiao Hong
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Lingyan Wang
- Bank of Blood Products, Ningbo No.2 Hospital, Ningbo, Zhejiang 315010, China
| | - Qinwen Wang
- The Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, China; Diabetes Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Hongwei Wang
- Section of Endocrinology, Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Leiting Xu
- The Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, China; Diabetes Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Shizhong Bu
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China; Diabetes Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Lina Zhang
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China; Diabetes Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Jia Cheng
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China; Diabetes Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Panpan Liu
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China; Diabetes Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Yanping Le
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China; Diabetes Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Meng Ye
- The Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, China.
| | - Yifeng Mai
- The Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, China.
| | - Shiwei Duan
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China; The Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, China; Diabetes Center, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China.
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Kajiwara A, Miyagawa H, Saruwatari J, Kita A, Sakata M, Kawata Y, Oniki K, Yoshida A, Jinnouchi H, Nakagawa K. Gender differences in the incidence and progression of diabetic retinopathy among Japanese patients with type 2 diabetes mellitus: a clinic-based retrospective longitudinal study. Diabetes Res Clin Pract 2014; 103:e7-10. [PMID: 24503044 DOI: 10.1016/j.diabres.2013.12.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 12/28/2013] [Indexed: 12/21/2022]
Abstract
A clinic-based retrospective longitudinal study conducted for 5.8 ± 2.5 years, including 383 (M/F 245/138) Japanese patients with type 2 diabetes mellitus showed that females exhibit a significantly higher prevalence of proliferative diabetic retinopathy (DR) at baseline and that female gender is an independent risk factor for the development of DR.
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Affiliation(s)
- A Kajiwara
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - H Miyagawa
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - J Saruwatari
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - A Kita
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - M Sakata
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Y Kawata
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - K Oniki
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - A Yoshida
- Jinnouchi Clinic, Diabetes Care Center, Kumamoto, Japan
| | - H Jinnouchi
- Jinnouchi Clinic, Diabetes Care Center, Kumamoto, Japan
| | - K Nakagawa
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan; Center for Clinical Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan.
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Karoli R, Fatima J, Shukla V, Garg P, Ali A. Predictors of diabetic retinopathy in patients with type 2 diabetes who have normoalbuminuria. Ann Med Health Sci Res 2013; 3:536-40. [PMID: 24380004 PMCID: PMC3868119 DOI: 10.4103/2141-9248.122087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Microalbuminuria is an independent predictor of retinopathy, so absence of microalbuminuria may tend clinician not to screen for diabetic retinopathy (DR). Aim: The aim of our study was to estimate prevalence of DR in patients with type 2 diabetes who have normoalbuminuria, and to study predictors for DR, which can identify these high-risk individuals. Subjects and Methods: In a prospective cross-sectional study that included patients with type 2 DM and normoalbuminuria. Diagnosis of DR was made by a trained ophthalmologist based on the presence of clinical features in the fundus of both eyes following the International Clinical DR guidelines. The statistical analyses were performed using Statistical Package for the Social Sciences 15.0 version software (Chicago, IL, USA). The continuous variables expressed as means (SD and Student's t-test or Mann–Whitney test were used, as appropriate, to determine differences in them. Categorical variables were presented as percentage. The Pearson's Chi-square test or Fisher's exact test, as appropriate, was used to determine the differences in them. Results: A total of 226 patients with type 2 DM and normoalbuminuria were enrolled in the study that included 110 males (48.6%), and 116 females (51.4%) Mean (SD) duration of diabetes was 8.2 (5.6) years. DR of any grade was present in 49/226 (22%) patients. Of the patients with DR of any grade, 31/49 (63%) had mild non-proliferative diabetic retinopathy (NPDR) 10/49 (22%) had moderate to severe NPDR and 8/49 (15%) had PDR. Duration of diabetes (OR 1.01, 95% CI, 0.86-2.2, P = 0.04), higher systolic blood pressure (OR 2.2, 95% CI, 1.6-4.5, P = 0.01), low hemoglobin (OR 1.4, 95% CI, 0.45-2.9, P = 0.01), and a higher tertile of urinary albumin excretion rate (OR 4.12, 95% CI, 1.92-7.57, P = 0.001) had independently significant association with DR. Conclusion: The risk of DR exists in patients with type 2 diabetes even in normoalbuminuric individuals. Close monitoring is particularly needed if patients have longer duration of diabetes, hypertension, anemia, or high normal albuminuria.
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Affiliation(s)
- R Karoli
- Department of Medicine, Era's Lucknow Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India
| | - J Fatima
- Department of Medicine, Era's Lucknow Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India
| | - V Shukla
- Department of Medicine, Era's Lucknow Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India
| | - P Garg
- Department of Ophthalmology, Era's Lucknow Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India
| | - A Ali
- Department of Medicine, Era's Lucknow Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India
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Hughes AD, Bathula R, Park C, Tillin T, Wit N, McG Thom S, Chaturvedi N. Microcirculatory rarefaction in South Asians - a potential mechanism for increased cardiovascular risk and diabetes. PLoS One 2013; 8:e76680. [PMID: 24116136 PMCID: PMC3792020 DOI: 10.1371/journal.pone.0076680] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/30/2013] [Indexed: 12/15/2022] Open
Abstract
People of South Asian descent have an increased risk of cardiovascular disease (CVD) and diabetes, but little is known about the microcirculation in South Asian people despite evidence that this plays an important role in the aetiology of CVD. We compared the retinal microcirculation in a population-based sample of 287 middle-aged adults (144 European 143 South Asian) matched for age and sex. Retinal photographs were taken and analysed using a validated semi-automated program and microvascular measures were compared. Blood pressure, anthropometry and fasting bloods were also measured. South Asians had significantly fewer arteriolar and venular vessels and bifurcations. Arterioles and venules were longer and venules were also more tortuous in South Asians. These differences were not explained by adjustment for traditional risk factors including blood pressure, body mass index, diabetes or measures of insulin resistance. People of South Asian descent have rarefaction of the retinal microcirculation compared to age-sex matched individuals of European descent. Reduced microvascular density could contribute to the elevated risk of CVD and impaired glucose tolerance in South Asian people.
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Affiliation(s)
- Alun D. Hughes
- International Centre for Circulatory Health, NHLI Division, Faculty of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
- * E-mail:
| | - Raj Bathula
- International Centre for Circulatory Health, NHLI Division, Faculty of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Chloe Park
- International Centre for Circulatory Health, NHLI Division, Faculty of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Therese Tillin
- International Centre for Circulatory Health, NHLI Division, Faculty of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas Wit
- International Centre for Circulatory Health, NHLI Division, Faculty of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Simon McG Thom
- International Centre for Circulatory Health, NHLI Division, Faculty of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nish Chaturvedi
- International Centre for Circulatory Health, NHLI Division, Faculty of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
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Raman R, Gupta A, Kulothungan V, Sharma T. Prevalence and risk factors of diabetic retinopathy in subjects with suboptimal glycemic, blood pressure and lipid control. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, Report 33). Curr Eye Res 2012; 37:513-23. [PMID: 22577770 DOI: 10.3109/02713683.2012.669005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the rate of achieving optimal metabolic control among subjects with type 2 diabetes, to elucidate the influence of suboptimal control on diabetic retinopathy (DR) and to analyze the risk factors associated with DR in the subjects with suboptimal control. MATERIAL AND METHODS A population-based, cross-sectional study was conducted in south India. The study population consisted of 1414 subjects with type 2 diabetes. Optimal control of glycosylated hemoglobin (HbA1c), blood pressure (BP) and lipids was defined as: optimal HbA1c <7%, suboptimal HbA1c ≥ 7%; optimal BP ≤ 130/80 mm Hg, suboptimal BP >130/80 mm Hg; optimal low-density lipoprotein (LDL-C) <100 mg/dl, suboptimal LDL ≥ 100 mg/dl. RESULTS Of the subjects, 13.6% achieved combined optimal target levels for all metabolic parameters. When compared to subjects with optimal control, those with suboptimal control of HbA1c (trend P < 0.0001) and systolic blood pressure (SBP, trend P = 0.007) were more likely to have DR. Subjects having a combination of suboptimal glycemic and BP control (P < 0.0001 for SBP, P = 0.004 for diastolic blood pressure (DBP)), and suboptimal glycemic, BP and LDL control (P < 0.0001 for SBP, P = 0.017 for DBP), were more likely to have DR when compared to the subjects having optimal control of respective combinations. The factors associated with DR in the subjects with suboptimal control were younger age (P = 0.014 for BP, P = 0.016 for HbA1c), male gender (P = 0.035 for BP, P = 0.027 for HbA1c, P = 0.043 for LDL), presence of anemia (P = 0.021 for BP, P = 0.036 for HbA1c) and microalbuminuria (P < 0.0001 for both BP and HbA1c). CONCLUSIONS We found high prevalence of suboptimal metabolic control among subjects with type 2 diabetes. Suboptimal glycemic and SBP control, and their combination was the most detrimental for the development of DR.
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Affiliation(s)
- Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Ozawa GY, Bearse MA, Bronson-Castain KW, Harrison WW, Schneck ME, Barez S, Adams AJ. Neurodegenerative differences in the retinas of male and female patients with type 2 diabetes. Invest Ophthalmol Vis Sci 2012; 53:3040-6. [PMID: 22491405 DOI: 10.1167/iovs.11-8226] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of our study is to determine whether neuroretinal function, measured by the multifocal electroretinogram, differs between males and females with type 2 diabetes and no retinopathy. METHODS This study included 70 eyes from 70 adult subjects (14 control males, 22 control females, 16 males with type 2 diabetes, and 18 females with type 2 diabetes). A template-scaling technique was used to obtain first-order P1 implicit times and N1-P1 amplitudes from photopic multifocal electroretinograms within the central 45 degrees. RESULTS The males with type 2 diabetes were significantly more abnormal than their female counterparts in two separate analyses of local neuroretinal function. First, the total number of retinal locations with an abnormally delayed implicit time (z score ≥ 2) was higher (P < 0.001) in the diabetic males (482 locations = 29.2%) compared to the diabetic females (298 locations = 16.1%). Second, in the response topographies that consisted of 103 means of local implicit times for each group, the diabetic males were significantly delayed (P < 0.025) at 23 corresponding positions (22.3%) compared to the diabetic females. At the same time, no corresponding stimulus locations were significantly delayed in the diabetic females compared to the diabetic males. CONCLUSIONS Neuroretinal function is more abnormal in males than in females for adults with type 2 diabetes and no retinopathy. These results suggest that, relative to males, females may have some protection from, or resistance to, neurodegenerative changes that precede the development of background retinopathy in type 2 diabetes.
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Affiliation(s)
- Glen Y Ozawa
- Berkeley School of Optometry, University of California, Berkeley, California 94720, USA.
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