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Ye Y, Dai L, Gu H, Yang L, Xu Z, Li Z. The causal relationship between immune cells and diabetic retinopathy: a Mendelian randomization study. Front Immunol 2024; 15:1381002. [PMID: 39290701 PMCID: PMC11406504 DOI: 10.3389/fimmu.2024.1381002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/18/2024] [Indexed: 09/19/2024] Open
Abstract
Purpose This article explored the causal relationship between immune cells and diabetic retinopathy (DR) using single nucleotide polymorphisms (SNPs) as an instrumental variable and Mendelian randomization (MR). Methods Statistical data were collected from a publicly available genome-wide association study (GWAS), and SNPs that were significantly associated with immune cells were used as instrumental variables (IVs). Inverse variance weighted (IVW) and MR-Egger regression were used for MR analysis. A sensitivity analysis was used to test the heterogeneity, horizontal pleiotropy, and stability of the results. Results We investigated the causal relationship between 731 immune cells and DR risk. All the GWAS data were obtained from European populations and from men and women. The IVW analysis revealed that HLA DR on CD14+ CD16- monocytes, HLA DR on CD14+ monocytes, HLA DR on CD33-HLA DR+, HLA DR on CD33+ HLA DR+ CD14- on CD33+ HLA DR+ CD14dim, and HLA DR on myeloid dendritic cells may increase the risk of DR (P<0.05). HLA DR to CD14-CD16- cells, the monocytic myeloid-derived suppressor cell absolute count, the SSC-A count of CD4+ T cells, and terminally differentiated CD4+ T cells may be protective factors against DR (P<0.05). The sensitivity analysis indicated no heterogeneity or pleiotropy among the selected SNPs. Furthermore, gene annotation of the SNPs revealed significant associations with 10 genes related to the risk of developing PDR and potential connections with 12 other genes related to PDR. Conclusion Monocytes and T cells may serve as new biomarkers or therapeutic targets, leading to the development of new treatment options for managing DR.
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Affiliation(s)
- Yunyan Ye
- Department of Ophthalmology, Li Huili Hospital Affiliated with Ningbo University, Ningbo, China
| | - Lei Dai
- Department of Hepato-Pancreato-Biliary Surgery, Li Huili Hospital Affiliated with Ningbo University, Ningbo, China
| | - Hong Gu
- Department of Ophthalmology, Li Huili Hospital Affiliated with Ningbo University, Ningbo, China
| | - Lan Yang
- Department of Ophthalmology, Li Huili Hospital Affiliated with Ningbo University, Ningbo, China
| | - Zhangxing Xu
- Department of Ophthalmology, Li Huili Hospital Affiliated with Ningbo University, Ningbo, China
| | - Zhiguo Li
- Department of Ophthalmology, Li Huili Hospital Affiliated with Ningbo University, Ningbo, China
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Pei X, Huang D, Li Z. Genetic insights and emerging therapeutics in diabetic retinopathy: from molecular pathways to personalized medicine. Front Genet 2024; 15:1416924. [PMID: 39246572 PMCID: PMC11378321 DOI: 10.3389/fgene.2024.1416924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 08/12/2024] [Indexed: 09/10/2024] Open
Abstract
Diabetic retinopathy (DR) is a major complication of diabetes worldwide, significantly causing vision loss and blindness in working-age adults, and imposing a substantial socioeconomic burden globally. This review examines the crucial role of genetic factors in the development of DR and highlights the shift toward personalized treatment approaches. Advances in genetic research have identified specific genes and variations involved in angiogenesis, inflammation, and oxidative stress that increase DR susceptibility. Understanding these genetic markers enables early identification of at-risk individuals and the creation of personalized treatment plans. Incorporating these genetic insights, healthcare providers can develop early intervention strategies and tailored treatment plans to improve patient outcomes and minimize side effects. This review emphasizes the transformative potential of integrating genetic information into clinical practice, marking a paradigm shift in DR management and advancing toward a more personalized and effective healthcare model.
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Affiliation(s)
- Xiaoting Pei
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Duliurui Huang
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhijie Li
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, China
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Tan L, Wang J, Han J, Sainsbury C, Denniston AK, Crowe FL, Toulis KA, Karamat MA, Yao M, Nirantharakumar K. Socioeconomic Deprivation and the Risk of Sight-Threatening Diabetic Retinopathy: A Population-Based Cohort Study in the U.K. Diabetes Care 2024; 47:844-848. [PMID: 38387082 DOI: 10.2337/dc23-1626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To evaluate the associations between socioeconomic deprivation and sight-threatening diabetic retinopathy (STDR) in individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Data from 175,628 individuals with diabetes in the Health Improvement Network were used to assess the risk of STDR across Townsend Deprivation Index quantiles using Cox proportional hazard regression. RESULTS Among individuals with T1D, the risk of STDR was three times higher (adjusted hazard ratio [aHR] 2.67, 95% CI 1.05-7.78) in the most deprived quintile compared with the least deprived quintile. In T2D, the most deprived quintile had a 28% higher risk (aHR 1.28; 95% CI 1.15-1.43) than the least deprived quintile. CONCLUSIONS Increasing socioeconomic deprivation is associated with a higher risk of developing STDR in people with diabetes. This underscores persistent health disparities linked to poverty, even within a country offering free universal health care. Further research is needed to address health equity concerns in socioeconomically deprived regions.
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Affiliation(s)
- Luyuan Tan
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Jieun Han
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | | | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, U.K
| | - Francesca L Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | | | - Muhammad Ali Karamat
- Diabetes and Endocrinology Specialist Training Committee, Health Education West Midlands, Birmingham, U.K
| | - Mi Yao
- Department of General Practice, Peking University First Hospital, Beijing, China
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Seshasai S, He F, Lam B, Hamzah H, Cheng CY, Li J, Wong TY, Tan GSW, Sabanayagam C. Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes. Asia Pac J Ophthalmol (Phila) 2024; 13:100070. [PMID: 38777093 DOI: 10.1016/j.apjo.2024.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To evaluate the dynamic transitions in diabetic retinopathy (DR) severity over time and associated risk factors in an Asian population with diabetes. DESIGN Longitudinal cohort study METHODS: We analyzed data from 9481 adults in the Singapore Integrated Diabetic Retinopathy Screening Program (2010-2015) with linkage to death registry. A multistate Markov model adjusted for age, sex, systolic blood pressure (SBP), diabetes duration, HbA1c, and body mass index (BMI) was applied to estimate annual transition probabilities between four DR states (no, mild, moderate, and severe/proliferative) and death, and the mean sojourn time in each state. RESULTS The median assessment interval was 12 months, with most patients having 3 assessments. Annual probabilities for DR progression (no-to-mild, mild-to-moderate and moderate-to-severe/proliferative) were 6.1 %, 7.0 % and 19.3 %, respectively; and for regression (mild-to-no, moderate-to-mild and severe-to-moderate) were 55.4 %, 17.3 % and 4.4 %, respectively. Annual mortality rates from each DR state were 1.2 %, 2.0 %, 18.7 %, and 30.0 %. The sojourn time in each state were 8.2, 0.8, 0.8 and 2.2 years. Higher HbA1c and SBP levels were associated with progression of no-mild and mild-moderate DR, and diabetes duration with no-to-mild and moderate-to-severe/proliferative DR. Lower HbA1c levels were associated with regression from mild-to-no and moderate-to-mild, and higher BMI with mild-to-no DR. CONCLUSIONS Our results suggest a prolonged duration (∼8 years) in developing mild DR, with faster transitions (within a year) from mild or moderate states. Moderate/above DR greatly increases the probability of progression and death as compared to mild DR/below. HbA1c was associated with both progression as well as regression.
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Affiliation(s)
| | - Feng He
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Betty Lam
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Haslina Hamzah
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jialiang Li
- Department of Statistics and Data Science, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Wong TY, Tan TE. The Diabetic Retinopathy "Pandemic" and Evolving Global Strategies: The 2023 Friedenwald Lecture. Invest Ophthalmol Vis Sci 2023; 64:47. [PMID: 38153754 PMCID: PMC10756246 DOI: 10.1167/iovs.64.15.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/30/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Tien Yin Wong
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore
- Duke-National University of Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Tien-En Tan
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore
- Duke-National University of Singapore, Singapore
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Li Z, Yuan Y, Qi Q, Wang Q, Feng L. Relationship between dyslipidemia and diabetic retinopathy in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Syst Rev 2023; 12:148. [PMID: 37620980 PMCID: PMC10463379 DOI: 10.1186/s13643-023-02321-2] [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: 10/07/2022] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) affects more than 80% of patients with diabetes. However, literature on the association between serum lipids and DR in patients with type 2 diabetes mellitus (T2DM) is inconsistent. Hence, in this study, we aimed to investigate the relationship between baseline serum lipids and the incidence of DR in patients with T2DM. METHODS We searched relevant articles in the PubMed, Embase databases, and the Cochrane Library up to February 7, 2022, and reviewed the reference lists of the included articles to identify appropriate cohort studies. The weighted mean difference (WMD) and the corresponding 95% confidence intervals (CIs) were calculated. RESULTS Thirteen cohort studies, including 7459 participants, were included in the present study. Higher levels of total cholesterol (2.94 mg/dL, 95% CI 1.32, 4.56), triglycerides (8.13 mg/dL, 95% CI 5.59, 10.66), and low-density lipoprotein cholesterol (2.53 mg/dL, 95% CI 1.02, 4.04) at baseline were observed in patients with later onset of DR. However, no significant difference in the high-density lipoprotein cholesterol level (0.27 mg/dL, 95% CI - 0.91, 1.45) was observed between patients with DR and without DR. CONCLUSION The present results suggest that baseline triglyceride and cholesterol levels are significantly associated with the occurrence of DR in patients with T2DM. Thus, patients with T2DM may benefit from lowering serum lipids. Future studies exploring the relationship between longitudinal changes in serum lipids and DR occurrence are warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022319978.
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Affiliation(s)
- Zhaoping Li
- Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Yuan Yuan
- Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Qianjin Qi
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Qian Wang
- Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Li Feng
- Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, China.
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Lin Z, Li D, Wen L, Wang Y, Wang FH, Liang YB. ASSOCIATION OF OCULAR PERFUSION PRESSURE AND CEREBROSPINAL FLUID PRESSURE WITH CHANGES IN DIABETIC RETINOPATHY. Retina 2023; 43:1107-1113. [PMID: 36977320 DOI: 10.1097/iae.0000000000003792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE To investigate the association between mean ocular perfusion pressure (MOPP), estimated cerebrospinal fluid pressure (CSFP), and changes in diabetic retinopathy (DR) in a Northeastern Chinese population with Type 2 diabetes. METHODS A total of 1,322 subjects from the Fushun Diabetic Retinopathy Cohort Study were enrolled. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and intraocular pressure (IOP) were recorded. MOPP was calculated by the following formula: MOPP = 2/3 [DBP + 1/3 (SBP - DBP)] - IOP, and CSFP was estimated according to the following formula: CSFP = 0.44 × body mass index + 0.16 × DBP - 0.18 × age - 1.91. New development, progression, and regression of DR were graded based on fundus photographs at baseline and during follow-up examinations with a mean interval of 21.2 months using the modified Early Treatment Diabetic Retinopathy Study criteria. RESULTS Increasing MOPP was associated with the incidence of DR in the multivariate model (per 1-mmHg increase: relative risk, 1.06; 95% confidence interval, 1.02-1.10; P = 0.007) and showed a borderline negative association with DR regression (per 1-mmHg increase: relative risk, 0.98; 95% confidence interval, 0.97-1.00; P = 0.053). However, MOPP was not associated with progression of DR. Cerebrospinal fluid pressure was not associated with new development, progression, or regression of DR. CONCLUSION The MOPP, but not the CSFP, was found to influence the development, but not the progression of DR in this Northeastern Chinese cohort.
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Affiliation(s)
- Zhong Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Dong Li
- Fushun Eye Hospital, Fushun, Liaoning, China; and
| | - Liang Wen
- Fushun Eye Hospital, Fushun, Liaoning, China; and
| | - Yu Wang
- Fushun Eye Hospital, Fushun, Liaoning, China; and
| | - Feng Hua Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Lab, Beijing, China
| | - Yuan Bo Liang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Weir NL, Guan W, Karger AB, Klein BEK, Meuer SM, Cotch MF, Guo X, Li X, Tan J, Genter P, Chen YDI, Rotter JI, Ipp E, Tsai MY. OMEGA-3 FATTY ACIDS ARE ASSOCIATED WITH DECREASED PRESENCE AND SEVERITY OF DIABETIC RETINOPATHY: A Combined Analysis of MESA and GOLDR Cohorts. Retina 2023; 43:984-991. [PMID: 36735419 DOI: 10.1097/iae.0000000000003745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Inflammation is associated with diabetic retinopathy development and progression, and previous studies have demonstrated that omega-3 polyunsaturated fatty acids have anti-inflammatory properties. Therefore, the goal of this study was to determine if omega-3 polyunsaturated fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are associated with decreased risk and severity of retinopathy in individuals with type 2 diabetes. METHODS In a combined population of 1,356 individuals with type 2 diabetes from the Multi-Ethnic Study of Atherosclerosis and Genetics of Latino Diabetic Retinopathy cohorts, odds ratios using logistic regression were determined to assess the association between polyunsaturated fatty acids and retinopathy. RESULTS In 1,356 participants with type 2 diabetes, individuals in the fourth quartile of DHA were 17% less likely to have retinopathy compared with the first quartile ( P = 0.009, CI: 0.72-0.95). Secondary analysis revealed 38% lower severity of retinopathy in individuals in the fourth quartile compared with the first quartile of DHA ( P = 0.006; CI: 0.44-0.87) and EPA + DHA ( P = 0.004; CI: 0.44-0.85). No significant associations were observed between EPA and retinopathy. CONCLUSION DHA is inversely associated with the presence and severity of diabetic retinopathy. Increased intake of dietary sources of DHA may provide some protection against retinopathy in individuals with type 2 diabetes and warrants more research as a preventative option.
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Affiliation(s)
- Natalie L Weir
- Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Weihua Guan
- School of Public Health, University of Minnesota, Minnesota
| | - Amy B Karger
- Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Barbara E K Klein
- Department of Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stacy M Meuer
- Department of Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Mary Frances Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute (NEI), Bethesda, Maryland
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California; and
| | - Xiaohui Li
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California; and
| | - Jingyi Tan
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California; and
| | - Pauline Genter
- Division of Endocrinology and Metabolism, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California; and
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California; and
| | - Eli Ipp
- Division of Endocrinology and Metabolism, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Michael Y Tsai
- Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, Minnesota
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Ke J, Li K, Cao B. A Nomogram for Predicting Vision-Threatening Diabetic Retinopathy Among Mild Diabetic Retinopathy Patients: A Case-Control and Prospective Study of Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:275-283. [PMID: 36760600 PMCID: PMC9888403 DOI: 10.2147/dmso.s394607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
AIM This study aims to develop a nomogram for predicting vision-threatening diabetic retinopathy (VTDR) in type 2 diabetes mellitus (T2DM) with mild non-proliferative diabetic retinopathy (NPDR) patients. MATERIALS AND METHODS In case-control analysis, 440 patients with mild NPDR or VTDR were enrolled to identify predictors and develop a nomogram. In the prospective cohort, 120 T2DM patients with mild NPDR were enrolled for external validation. Sensitivity, specificity, and area under the receiver operating characteristic (AUC) were calculated to evaluate the predictive performance of the nomogram. RESULTS In case-control analysis, 2-h C-peptide (OR = 0.85, 95% CI: 0.75 to 0.95, p = 0.006), sural nerve conduction impaired (SNCI) (mildly: OR = 2.18, 95% CI: 1.10 to 4.33, p = 0.026; moderately/severely: 3.66, 95% CI: 1.74 to 7.70, p < 0.001) and UACR (microalbuminuria: OR = 2.37, 95% CI: 1.25 to 4.48, p = 0.008; macroalbuminuria: 4.02, 95% CI: 1.61 to 10.06, p = 0.003) were identified as independent predictors. The concordance index of the prediction nomogram was 0.76 in the training set. In the test set, sensitivity, specificity, and AUC were 84.8%, 60.6%, and 0.73, respectively. In the prospective cohort, median follow-up period was 42 months, and 15 patients (12.5%) developed VTDR. Sensitivity, specificity, and AUC of prediction were 66.7%, 89.5%, and 0.75, respectively. CONCLUSION Introducing 2-h C-peptide, UACR, and SNCI, the nomogram demonstrated a good discriminatory power for predicting risk of VTDR in mild NPDR individuals.
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Affiliation(s)
- Jing Ke
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| | - Kun Li
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| | - Bin Cao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
- Correspondence: Bin Cao, Tel +86-10-6954-3901, Email
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Lin Z, Wen L, Wang Y, Li D, Zhai G, Moonasar N, Wang F, Liang Y. Incidence, progression and regression of diabetic retinopathy in a northeastern Chinese population. Br J Ophthalmol 2022; 107:bjophthalmol-2022-321384. [PMID: 35864776 DOI: 10.1136/bjo-2022-321384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/27/2022] [Indexed: 11/04/2022]
Abstract
AIM To determine the incidence, progression and regression of diabetic retinopathy (DR), with corresponding risk factors, in a northeastern Chinese population of patients with type 2 diabetes. METHODS Among 2006 patients who completed baseline examinations in 2012-2013 and underwent re-examination after a mean interval of 21.2 months, 1392 patients with gradable fundus photographs for both baseline and follow-up examinations were included. Incidence was defined as new development of any DR among patients without DR at baseline. An increase of ≥2 scales (concatenating Early Treatment Diabetic Retinopathy Study levels of both eyes) in eyes with DR at baseline was defined as progression, while a reduction of ≥2 scales was defined as regression. RESULTS The age- and sex-standardised incidence, progression and regression were 5.8% (95% CI 4.7% to 6.9%), 26.8% (95% CI 24.8% to 28.8%) and 10.0% (95% CI 8.6% to 11.3%), respectively. In addition to poor blood glucose control, wider central retinal venular equivalent was associated with both incidence (relative risk (RR) 2.17, 95% CI 1.09 to 4.32, for ≥250 µm vs <210 µm) and progression (RR 2.00, 95% CI 1.02 to 3.96, for ≥250 µm vs <210 µm). Patients without insulin therapy (RR 0.64, 95% CI 0.43 to 0.97) and patients with wider central retinal arteriolar equivalent (RR 1.14, 95% CI 1.02 to 1.26, per 10 µm increase) were likely to exhibit DR regression. CONCLUSION We determined the incidence, progression and regression of DR among northeastern Chinese patients with type 2 diabetes. Retinal vessel diameters, in addition to blood glucose level, influence the natural evolution of DR.
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Affiliation(s)
- Zhong Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Liang Wen
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
| | - Yu Wang
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
| | - Dong Li
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
| | - Gang Zhai
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, China
| | | | - Fenghua Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuanbo Liang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
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