Risk factors for diabetic retinopathy: a case-control study

Association between Glucose-lowering Treatments and Risk of Diabetic Retinopathy in People with Type 2 Diabetes: A Nationwide Cohort Study

INTRODUCTION

Glycaemic variability is possibly linked to the development of diabetic retinopathy, and newer second-line glucose-lowering treatments in type 2 diabetes might reduce glycaemic variability.

AIM

This study aimed to investigate whether newer second-line glucose-lowering treatments are associated with an alternative risk of developing diabetic retinopathy in people with type 2 diabetes.

METHODS

A nationwide cohort of people with type 2 diabetes on second-line glucose-lowering treatment regimens in 2008-2018 was extracted from the Danish National Patient Registry. Adjusted time to diabetic retinopathy was estimated with a Cox Proportional Hazards model. The model was adjusted for age, sex, diabetes duration, alcohol abuse, treatment start year, education, income, history of late-diabetic complications, history of non-fatal major adverse cardiovascular events, history of chronic kidney disease, and history of hypoglycaemic episodes.

RESULTS

Treatment regimens of metformin + basal insulin (HR: 3.15, 95% CI: 2.42-4.10) and metformin + glucagon-like peptide-1 receptor agonist (GLP-1-RA, HR: 1.46, 95% CI: 1.09-1.96) were associated with an increased risk of diabetic retinopathy compared with metformin + dipeptidyl peptidase-4 inhibitors (DPP-4i). Treatment with metformin + sodium-glucose cotransporter-2 inhibitor (SGLT2i, HR: 0.77, 95% CI: 0.28-2.11) was associated with the numerically lowest risk of diabetic retinopathy compared with all regimens investigated.

CONCLUSION

Findings from this study indicate that basal insulin and GLP-1-RA are suboptimal second- line choices for people with type 2 diabetes at risk of developing diabetic retinopathy. However, many other considerations concerning the choice of second-line glucose-lowering treatment for type 2 diabetes patients should be taken into account.

Association between the triglyceride glucose index and diabetic retinopathy in type 2 diabetes: a meta-analysis

The triglyceride-glucose (TyG) index is an accessible and reliable surrogate indicator of insulin resistance and is strongly associated with diabetes. However, its relationship with diabetic retinopathy (DR) remains controversial. This meta-analysis aimed to assess the relationship between the TyG index and the prevalence of DR. Initial studies were searched from PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI) electronic databases. The retrieval time range was from the establishment of the database to June 2023. Pooled estimates were derived using a random-effects model and reported as odds ratio (OR) with 95% confidence intervals (CIs). Two researchers independently assessed the methodological quality of the included studies. The Newcastle-Ottawa Quality Scale (NOS) was utilized to assess cohort studies or case-control studies. The Agency for Healthcare Research and Quality (AHRQ) methodology checklist was applied to assess cross-sectional studies. Ten observational studies encompassing 13716 patients with type 2 diabetes were included in the meta-analysis. The results showed that a higher TyG index increased the risk of DR compared with a low TyG index (OR: 2.34, 95% CI: 1.31-4.19, P < 0.05). When the index was analyzed as a continuous variable, consistent results were observed (OR: 1.48, 95% CI: 1.12-1.97, P < 0.005). There was no significant effect on the results of the sensitivity analyses excluding one study at a time (P all < 0.05). A higher TyG index may be associated with an increased prevalence of DR in patients with type 2 diabetes. However, high-quality cohort or case-control studies are needed to further substantiate this evidence.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023432747.

Individual and Systems-Based Risk Factors for Diabetic Vitrectomy in an Urban Safety-Net Hospital

OBJECTIVE

To identify individual and systems-focused risk factors for pars plana vitrectomy among patients with proliferative diabetic retinopathy (PDR) in a diverse, urban, safety-net hospital setting.

DESIGN

Single-center, retrospective, observational, case-control study at Zuckerberg San Francisco General Hospital and Trauma Center between 2017 and 2022.

SUBJECTS

Two hundred twenty-two patients with PDR over a 5-year span (2017-2022), consisting of 111 cases who underwent vitrectomy for vision-threatening complications (tractional retinal detachment, nonclearing vitreous hemorrhage, and neovascular glaucoma) and 111 controls with PDR with no history of vitrectomy or vision-threatening complications. Controls were matched 1:1 through incidence density sampling.

METHODS

Medical records were reviewed from time of entry into hospital system to vitrectomy date (or date-matched clinic visit for controls). Individual-focused exposures included age, gender, ethnicity, language, homelessness, incarceration, smoking status, area deprivation index, insurance status, baseline retinopathy stage, baseline visual acuity, baseline hemoglobin A1c, panretinal photocoagulation status, and cumulative anti-VEGF treatments. System-focused exposures included external department involvement, referral route, time within hospital and ophthalmology systems, interval between screening and ophthalmology appointment, interval between conversion to proliferative disease and panretinal photocoagulation or first treatment, and loss-to-follow-up in intervals of active proliferative disease.

MAIN OUTCOME MEASURES

Odds ratios (ORs) for each exposure on vision-threatening diabetic complications requiring vitrectomy.

RESULTS

The absence of panretinal photocoagulation was the primary significant individual-focused risk factor for vitrectomy in the multivariable analysis (OR, 4.78; P = 0.011). Systems-focused risk factors included longer interval between PDR diagnosis and initial treatment (weeks; OR, 1.06; P = 0.024) and greater cumulative duration of loss-to-follow-up during intervals of active PDR (months; OR, 1.10; P = 0.002). Greater duration in the ophthalmology system was the primary systems-focused protective factor against vitrectomy (years; OR, 0.75; P = 0.035).

CONCLUSIONS

Largely modifiable variables modulate risk of complications requiring diabetic vitrectomy. Each additional month of loss-to-follow-up for patients with active proliferative disease increased odds of vitrectomy by 10%. Optimizing modifiable factors to promote earlier treatment and maintain critical follow-up in proliferative disease may reduce vision-threatening complications requiring vitrectomy in a safety-net hospital setting.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Prevalence and Determinants of Diabetic Retinopathy Among Type 2 Diabetic Patients in Saudi Arabia: A Systematic Review

Diabetic retinopathy (DR) is a preventable complication of diabetes; however, it is a serious one if not early recognized and properly managed as it can lead to visual impairment. This review aimed to summarize the prevalence and determinants of DR among type 2 diabetic patients in Saudi Arabia. Eligible articles for this systematic review were quantitative observational studies that were English-published between 2015 and 2021, peer-reviewed, and conducted on patients with type 2 diabetes mellitus (DM). The studies were obtained by searching PubMed/Medline, ScienceDirect, Cochrane Library Database, and Google Scholar. The risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Out of 16 preliminary studies, 12 were eligible for inclusion in this systematic review. One study was a chart review, one was a prospective study, and the remaining were cross-sectional studies. Regarding the study tool, retinopathy was diagnosed by an ophthalmologist using fundus photography and/or slit-lamp examination in most of the studies (n=7). However, some studies reported obtaining data from patient interviews and medical files (n=4). Concerning the outcome, an overall high prevalence of DR (ranging between 6.25% and 88.1%) and some significant associated risk factors were determined, including longer duration of diabetes, older age, poor blood pressure control, poor glycemic control, and physical inactivity. Most studies showed moderate overall quality. In conclusion, DR is a common complication of type 2 diabetes in Saudi Arabia. Some avoidable risk factors are identified, through which the doctors can identify patients at high risk of DR through early screening and can, thus, initiate prompt treatment to reduce the risk of vision deterioration.

Seeing Red: Associations between Historical Redlining and Present-Day Visual Impairment and Blindness

PURPOSE

Redlining was a discriminatory housing policy in the United States that began in 1933 and denoted neighborhoods with high proportions of Black individuals as "undesirable" and a high risk for lending, which therefore excluded people from obtaining traditional insured mortgages to purchase a home. Simultaneously, realtors discouraged Black individuals from purchasing homes in predominantly non-Black neighborhoods. This resulted in decreased home ownership and wealth accumulation among Black individuals and neighborhoods with high proportions of Black individuals. This study investigated rates of visual impairment and blindness (VIB) in neighborhoods that at one time were graded for redlining.

DESIGN

Secondary data analysis of American Community Survey data and historical grades for redlining.

PARTICIPANTS

United States census tracts (CTs) from 2010 with historical grades for redlining.

METHODS

One-way analysis of variance, Kruskal-Wallis test, chi-square test, and logistic regression modeling.

MAIN OUTCOME MEASURES

The main outcome was CT percentage of residents reporting VIB and the association with historical grades for redlining. Grades were converted to numeric values (1 to 4, with higher values indicating worse grade) and aggregated over a CT based on the distribution of grades within to obtain a redlining score. Logistic regression was used to model the effect of redlining on the probability of having VIB.

RESULTS

Eleven thousand six hundred sixty-eight CTs were analyzed. Logistic regression found that a 1-unit increase in average redlining score was associated with a 13.4% increased odds of VIB after controlling for CT measures of age, sex, people of color (any non-White race), state, and population size (odds ratio [OR], 1.134; 95% confidence interval [CI], 1.131-1.138; P < 0.001). Similar results were observed for an additional model that adjusted for the estimated percentage of Black residents within a CT (OR, 1.180; 95% CI, 1.177-1.183; P < 0.001).

CONCLUSIONS

Historical government-sanctioned residential segregation through redlining was found to be associated with higher proportions of people living with VIB in these neighborhoods today. Understanding how neighborhood segregation impacts eye health is important for planning improved mechanisms of eye care delivery to mitigate health disparities.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Prognostic factors for the development and progression of proliferative diabetic retinopathy in people with diabetic retinopathy

BACKGROUND

Diabetic retinopathy (DR) is characterised by neurovascular degeneration as a result of chronic hyperglycaemia. Proliferative diabetic retinopathy (PDR) is the most serious complication of DR and can lead to total (central and peripheral) visual loss. PDR is characterised by the presence of abnormal new blood vessels, so-called "new vessels," at the optic disc (NVD) or elsewhere in the retina (NVE). PDR can progress to high-risk characteristics (HRC) PDR (HRC-PDR), which is defined by the presence of NVD more than one-fourth to one-third disc area in size plus vitreous haemorrhage or pre-retinal haemorrhage, or vitreous haemorrhage or pre-retinal haemorrhage obscuring more than one disc area. In severe cases, fibrovascular membranes grow over the retinal surface and tractional retinal detachment with sight loss can occur, despite treatment. Although most, if not all, individuals with diabetes will develop DR if they live long enough, only some progress to the sight-threatening PDR stage.  OBJECTIVES: To determine risk factors for the development of PDR and HRC-PDR in people with diabetes and DR.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 5), Ovid MEDLINE, and Ovid Embase. The date of the search was 27 May 2022. Additionally, the search was supplemented by screening reference lists of eligible articles. There were no restrictions to language or year of publication.  SELECTION CRITERIA: We included prospective or retrospective cohort studies and case-control longitudinal studies evaluating prognostic factors for the development and progression of PDR, in people who have not had previous treatment for DR. The target population consisted of adults (≥18 years of age) of any gender, sexual orientation, ethnicity, socioeconomic status, and geographical location, with non-proliferative diabetic retinopathy (NPDR) or PDR with less than HRC-PDR, diagnosed as per standard clinical practice. Two review authors independently screened titles and abstracts, and full-text articles, to determine eligibility; discrepancies were resolved through discussion. We considered prognostic factors measured at baseline and any other time points during the study and in any clinical setting. Outcomes were evaluated at three and eight years (± two years) or lifelong.  DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from included studies using a data extraction form that we developed and piloted prior to the data collection stage. We resolved any discrepancies through discussion. We used the Quality in Prognosis Studies (QUIPS) tool to assess risk of bias. We conducted meta-analyses in clinically relevant groups using a random-effects approach. We reported hazard ratios (HR), odds ratios (OR), and risk ratios (RR) separately for each available prognostic factor and outcome, stratified by different time points. Where possible, we meta-analysed adjusted prognostic factors. We evaluated the certainty of the evidence with an adapted version of the GRADE framework.   MAIN RESULTS: We screened 6391 records. From these, we identified 59 studies (87 articles) as eligible for inclusion. Thirty-five were prospective cohort studies, 22 were retrospective studies, 18 of which were cohort and six were based on data from electronic registers, and two were retrospective case-control studies. Twenty-three studies evaluated participants with type 1 diabetes (T1D), 19 with type 2 diabetes (T2D), and 17 included mixed populations (T1D and T2D). Studies on T1D included between 39 and 3250 participants at baseline, followed up for one to 45 years. Studies on T2D included between 100 and 71,817 participants at baseline, followed up for one to 20 years. The studies on mixed populations of T1D and T2D ranged from 76 to 32,553 participants at baseline, followed up for four to 25 years.  We found evidence indicating that higher glycated haemoglobin (haemoglobin A1c (HbA1c)) levels (adjusted OR ranged from 1.11 (95% confidence interval (CI) 0.93 to 1.32) to 2.10 (95% CI 1.64 to 2.69) and more advanced stages of retinopathy (adjusted OR ranged from 1.38 (95% CI 1.29 to 1.48) to 12.40 (95% CI 5.31 to 28.98) are independent risk factors for the development of PDR in people with T1D and T2D. We rated the evidence for these factors as of moderate certainty because of moderate to high risk of bias in the studies.  There was also some evidence suggesting several markers for renal disease (for example, nephropathy (adjusted OR ranged from 1.58 (95% CI not reported) to 2.68 (2.09 to 3.42), and creatinine (adjusted meta-analysis HR 1.61 (95% CI 0.77 to 3.36)), and, in people with T1D, age at diagnosis of diabetes (< 12 years of age) (standardised regression estimate 1.62, 95% CI 1.06 to 2.48), increased triglyceride levels (adjusted RR 1.55, 95% CI 1.06 to 1.95), and larger retinal venular diameters (RR 4.28, 95% CI 1.50 to 12.19) may increase the risk of progression to PDR. The certainty of evidence for these factors, however, was low to very low, due to risk of bias in the included studies, inconsistency (lack of studies preventing the grading of consistency or variable outcomes), and imprecision (wide CIs). There was no substantial and consistent evidence to support duration of diabetes, systolic or diastolic blood pressure, total cholesterol, low- (LDL) and high- (HDL) density lipoproteins, gender, ethnicity, body mass index (BMI), socioeconomic status, or tobacco and alcohol consumption as being associated with incidence of PDR. There was insufficient evidence to evaluate prognostic factors associated with progression of PDR to HRC-PDR.  AUTHORS' CONCLUSIONS: Increased HbA1c is likely to be associated with progression to PDR; therefore, maintaining adequate glucose control throughout life, irrespective of stage of DR severity, may help to prevent progression to PDR and risk of its sight-threatening complications. Renal impairment in people with T1D or T2D, as well as younger age at diagnosis of diabetes mellitus (DM), increased triglyceride levels, and increased retinal venular diameters in people with T1D may also be associated with increased risk of progression to PDR. Given that more advanced DR severity is associated with higher risk of progression to PDR, the earlier the disease is identified, and the above systemic risk factors are controlled, the greater the chance of reducing the risk of PDR and saving sight.

Sex-Related Effects of Gut Microbiota in Metabolic Syndrome-Related Diabetic Retinopathy

The metabolic syndrome (MetS) is a complex disease of metabolic abnormalities, including obesity, insulin resistance, hypertension and dyslipidaemia, and it is associated with an increased risk of cardiovascular disease (CVD). Diabetic retinopathy (DR) is the leading cause of vision loss among working-aged adults around the world and is the most frequent complication in type 2 diabetic (T2D) patients. The gut microbiota are a complex ecosystem made up of more than 100 trillion of microbial cells and their composition and diversity have been identified as potential risk factors for the development of several metabolic disorders, including MetS, T2D, DR and CVD. Biomarkers are used to monitor or analyse biological processes, therapeutic responses, as well as for the early detection of pathogenic disorders. Here, we discuss molecular mechanisms underlying MetS, the effects of biological sex in MetS-related DR and gut microbiota, as well as the latest advances in biomarker research in the field. We conclude that sex may play an important role in gut microbiota influencing MetS-related DR.

The Correlation between Waist Circumference and the Pro-Inflammatory Adipokines in Diabetic Retinopathy of Type 2 Diabetes Patients

Central obesity is one of the major risk factors for type 2 diabetes mellitus (DM), and the most common complication of DM is diabetic retinopathy. However, the exact relationship between obesity and DR remains unknown. In this study, we evaluate the effect of obesity on DR by comparing the aqueous humor-derived adipokines. For the analysis, 37 DR patients and 29 non-DR-patients participated. To evaluate the obesity of the patients, body mass index (BMI) and waist circumference (WC) were used. By comparing the concentrations of adipokines obtained from the aqueous humor of the two groups, the relationship between DR and adipokines was analyzed. In addition, by analyzing the correlation between obesity and adipokines in patients, the relationship between central obesity and DR was finally confirmed. The WC was significantly higher in patients than in the non-patient group. The concentrations of all adipokines compared in this study were significantly higher in the DR group than in the non-DM group (p < 0.05). Among them, adiponectin, leptin, TNF-α, Factor D (adipsin), lipocalin-2 (NGAL), Serpin E1 (PAI-1), and CXCL8 (IL-8) were confirmed to have a positive correlation with central obesity (defined as WC). These findings suggest that central obesity is strongly associated with the risk of DR.

Risk of diabetic retinopathy and retinal neurodegeneration in individuals with type 2 diabetes: Beichen Eye Study

Objective

Our aim was to evaluate associations of different risk factors with odds of diabetic retinopathy (DR) diagnosis and retinal neurodegeneration represented by macular ganglion cell-inner plexiform layer (mGCIPL).

Methods

This cross-sectional study analyzed data from individuals aged over 50 years examined between June 2020 and February 2022 in the community-based Beichen Eye Study on ocular diseases. Baseline characteristics included demographic data, cardiometabolic risk factors, laboratory findings, and medications at enrollment. Retinal thickness in both eyes of all participants was measured automatically via optical coherence tomography. Risk factors associated with DR status were investigated using multivariable logistic regression. Multivariable linear regression analysis was performed to explore associations of potential risk factors with mGCIPL thickness.

Results

Among the 5037 included participants with a mean (standard deviation, SD) age of 62.6 (6.7) years (3258 women [64.6%]), 4018 (79.8%) were control individuals, 835 (16.6%) were diabetic individuals with no DR, and 184 (3.7%) were diabetic individuals with DR. The risk factors significantly associated with DR status were family history of diabetes (odds ratio [OR], 4.09 [95% CI, 2.44-6.85]), fasting plasma glucose (OR, 5.88 [95% CI, 4.66-7.43]), and statins (OR, 2.13 [95% CI, 1.03-4.43]) relative to the control individuals. Compared with the no DR, diabetes duration (OR, 1.17 [95% CI, 1.13-1.22]), hypertension (OR, 1.60 [95% CI, 1.26-2.45]), and glycated hemoglobin A1C (HbA1c) (OR, 1.27 [95% CI, 1.00-1.59]) were significantly correlated with DR status. Furthermore, age (adjusted β = -0.19 [95% CI, -0.25 to -0.13] μm; P < 0.001), cardiovascular events (adjusted β = -0.95 [95% CI, -1.78 to -0.12] μm; P = 0.03), and axial length (adjusted β = -0.82 [95% CI, -1.29 to -0.35] μm; P = 0.001) were associated with mGCIPL thinning in diabetic individuals with no DR.

Conclusion

Multiple risk factors were associated with higher odds of DR development and lower mGCIPL thickness in our study. Risk factors affecting DR status varied among the different study populations. Age, cardiovascular events, and axial length were identified as potential risk factors for consideration in relation to retinal neurodegeneration in diabetic patients.

Correlation of C-Peptide With Complications Observed in Children and Adolescents With Type 1 Diabetes in Tanzania: A Cross-Sectional Survey

Type 1 diabetes mellitus (T1DM) complications corelate with C-peptide levels. However, the C-Peptide role has not been explored in resource limited countries. This study explored the relationship between C-peptide and complications. A cross-sectional study involving participants aged 0 to 25 years with T1DM in Dar es salaam Tanzania, between 2021 and 2022 was done. Diabetes nephropathy and retinopathy were assessed. About 281 (92.4%) participants were screened, 144 (51.2%) were females. Mean age was 19 ± 6 years. Majority 175 (62.3%) had poor glycemic control (HbA1c) > 10%, and low C-Peptide level 201 (71.5%). Retinopathy was 11.7% and risk for nephropathy was 41.3%. About 13.4% and 41.8% with low C peptide had Retinopathy and high-risk nephropathy respectively. Age at diagnosis, poor glycemic control, low c peptide and duration of diabetes were associated with complications. Further prospective studies are needed to capture when complications set in, so to have better strategies to prevent complications.

A Guide to Genome-Wide Association Study Design for Diabetic Retinopathy

Diabetic retinopathy (DR) is the most common microvascular complication related to diabetes. There is evidence that genetics play an important role in DR pathogenesis, but the complexity of the disease makes genetic studies a challenge. This chapter is a practical overview of the basic steps for genome-wide association studies with respect to DR and its associated traits. Also described are approaches that can be adopted in future DR studies. This is intended to serve as a guide for beginners and to provide a framework for further in-depth analysis.

Social Determinants of Health and Impact on Screening, Prevalence, and Management of Diabetic Retinopathy in Adults: A Narrative Review

Diabetic retinal disease (DRD) is the leading cause of blindness among working-aged individuals with diabetes. In the United States, underserved and minority populations are disproportionately affected by diabetic retinopathy and other diabetes-related health outcomes. In this narrative review, we describe racial disparities in the prevalence and screening of diabetic retinopathy, as well as the wide-range of disparities associated with social determinants of health (SDOH), which include socioeconomic status, geography, health-care access, and education.

Dietary Intake and Diabetic Retinopathy: A Systematic Review of the Literature

Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus. The evidence connecting dietary intake and DR is emerging, but uncertain. We conducted a systematic review to comprehensively summarize the current understanding of the associations between dietary consumption, DR and diabetic macular edema (DME). We systematically searched PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials between January 1967 to May 2022 for all studies investigating the effect of diet on DR and DME. Of the 4962 articles initially identified, 54 relevant articles were retained. Our review found that higher intakes of fruits, vegetables, dietary fibers, fish, a Mediterranean diet, oleic acid, and tea were found to have a protective effect against DR. Conversely, high intakes of diet soda, caloric intake, rice, and choline were associated with a higher risk of DR. No association was seen between vitamin C, riboflavin, vitamin D, and milk and DR. Only one study in our review assessed dietary intake and DME and found a risk of high sodium intake for DME progression. Therefore, the general recommendation for nutritional counseling to manage diabetes may be beneficial to prevent DR risk, but prospective studies in diverse diabetic populations are needed to confirm our findings and expand clinical guidelines for DR management.

Study on the Development of a Conceptual Framework to Identify the Risk Factors of Diabetic Retinopathy among Diabetic Patients: A Concept Paper

The most common complication of diabetes mellitus (DM) is diabetic retinopathy (DR). The control of DR risk factors is essential for the effective prevention of DR. There is currently a lack of research to guide DR-related research in Malaysia. This concept paper aimed to review published studies and propose a conceptual framework (CF) as a guide for future research to determine the prevalence of DR and its risk factors across DM patients. After a review of prior research, this study has presented a CF that takes into account these four key elements: the patient's sociodemographic characteristics, comorbidities, complications, and diabetes conditions, namely, the length of the disease and glycaemic control. In the suggested CF, ethnicity was highlighted as a crucial risk factor for DR across lower- to middle-income countries (LMIC) and multiracial countries. In order to guide future studies, scientific guidance is essential. The proposed CF would help future research to conduct scientific research related to DR. Also, the proposed CF was tailored to suit research across LMIC and multiracial countries.

Prevalence of Diabetic Retinopathy in Undiagnosed Diabetic Patients: A Nationwide Population-Based Study

BACKGROUND

We investigated the prevalence of diabetic retinopathy (DR) in patients with undiagnosed diabetes through a nationwide survey, compared to those with known diabetes.

METHODS

Among the participants of the Korean National Health and Nutrition Examination Surveys (KNHANES) from 2017 to 2018, individuals aged ≥40 years with diabetes and fundus exam results were enrolled. Sampling weights were applied to represent the entire Korean population. Newly detected diabetes patients through KNHANES were classified under "undiagnosed diabetes."

RESULTS

Among a total of 9,108 participants aged ≥40 years, 951 were selected for analysis. Of them, 31.3% (standard error, ±2.0%) were classified under "undiagnosed diabetes." The prevalence of DR in patients with known and undiagnosed diabetes was 24.5%±2.0% and 10.7%±2.2%, respectively (P<0.001). The DR prevalence increased with rising glycosylated hemoglobin (HbA1c) levels in patients with known and undiagnosed diabetes (P for trend=0.001 in both). Among those with undiagnosed diabetes, the prevalence of DR was 6.9%±2.1%, 8.0%±3.4%, 5.6%±5.7%, 16.7%±9.4%, and 42.6%±14.8% for HbA1c levels of <7.0%, 7.0%-7.9%, 8.0%-8.9%, 9.0%-9.9%, and ≥10.0% respectively. There was no difference in the prevalence of hypertension, dyslipidemia, hypertriglyceridemia, or obesity according to the presence or absence of DR.

CONCLUSION

About one-third of patients with diabetes were unaware of their diabetes, and 10% of them have already developed DR. Considering increasing the prevalence of DR according to HbA1c level was found in patients with undiagnosed diabetes like those with known diabetes, screening and early detection of diabetes and DR are important.

Using Patient Health Profile Evaluation for Predicting the Likelihood of Retinopathy in Patients with Type 2 Diabetes: A Cross-Sectional Study Using Latent Profile Analysis

Background: To determine whether long-term self-management among patients with type 2 diabetes mellitus has the risk of developing complications. Methods: We conducted a survey of self-management behavior using diabetes self-management scales (DMSES-C and TSRQ-d) from November 2019 to May 2020 linked with biomarkers (glucose, lipid profile, blood pressure, and kidney function), and the varying measure values were transformed into normal rate proportions. We performed latent profile analysis (LPA) to categorize the patient into different patient health profiles using five classes (C1-C5), and we predicted the risk of retinopathy after adjusting for covariates. Results: The patients in C1, C2, and C4 had a higher likelihood of retinopathy events than those in C5, with odds ratios (ORs) of 1.655, 2.168, and 1.788, respectively (p = 0.032). In addition, a longer duration of diabetes was correlated with an increased risk of retinopathy events as well as being elderly. Conclusions: Optimal biomarker health profiles and patients with strong motivation pertaining to their T2DM care yielded better outcomes. Health profiles portraying patient control of diabetes over the long term can categorize patients with T2DM into different behavior groups. Customizing diabetes care information into different health profiles raises awareness of control strategies for caregivers and patients.

Risk Factors Associated With Diabetic Retinopathy: A Cross-Sectional Study Within Palestinian Patients in Northern West Bank

Risk factors associated with diabetes mellitus (DM) have been widely researched worldwide, but the determinants of these factors among diabetic retinopathy (DR) in Palestine are currently unclear. We aimed to assess the prevalence of DR among DM in Northern West Bank and identify factors associated with DR natural history. Patients with Type 2 diabetes (T2D) (n = 300, age &gt; 18 years) from a main diabetic center covering all northern provinces of Palestine were enrolled to this cross-sectional research. Demographic information including age, sex, and duration of T2D was obtained. Moreover, HbA1C, BMI, hypertension (HTN), controlled T2D, current smoking, and total cholesterol level were assessed. Potential correlations between these factors and DR diagnosed by ophthalmologist were evaluated using different tests on SPSS version 22. Prevalence of DR among our population was 30%; 47.8% of these patients showed mild non-proliferative DR (NPDR), 23.3% moderate NPDR, 16.7% severe NPDR, and 12.2% proliferative DR (PDR). Univariate logistic regression analysis showed age (p = 0.007), HTN (p = 0.022), uncontrolled T2D (p = 0.025), and duration of T2D (&lt;0.001) were mostly associated with DR while multivariate logistic regression showed duration of T2D as the major and solely risk factor for prevalence of DR (p &lt; 0.0001) and were positively correlated with severities of NPDR and being a strong predictor in the PDR (p = 0.001). We identified several important risk factors that affect DR, which could assist to develop effective strategies for metabolic disease prevention among populations in Palestine. Furthermore, our data suggest a necessity to control sugar serum levels and HTN.

Determinants of diabetic retinopathy in Tikur Anbessa Hospital, Ethiopia: a case-control study

Background

Diabetic retinopathy is the most frequent complication of Diabetes Mellitus and remains the leading cause of preventable blindness. However, there are limited studies on the determinants of diabetic retinopathy in the study area as well in Ethiopia. Hence, this study aimed to assess the determinants of diabetic retinopathy among diabetic patients at Tikur Anbessa Hospital.

Methods

An institution-based unmatched case–control study design was conducted at Tikur Anbessa Hospital from May 11 to June 26, 2020. Diabetic patients who developed retinopathy within 2 years were cases in the study. Patients who were free of retinopathy were controls in this study. Data were collected using a pretested interviewer-administered questionnaire, Topcon retinal examination, and a record review. The collected data were entered into Epi Data version 3.1 software, and analyzed using SPSS version 25. Binary logistic regression analysis was used to assess the determinants of diabetic retinopathy.

Results

A total of 282 patients (142 cases and 140 controls) were included in the study. The mean age (± Standard deviation) for the cases and the controls were 50.6 (SD: ± 18.7) and 44.9 (SD: ± 17.65) respectively. Patients who had a glucometer at home (AOR = 0.048; 95% CI: 0.005–0.492), exercise adherence (AOR = 0.075; 95% CI: 0.007–0.84), diabetes duration < 5 years (AOR = 0.005; 95% CI: 0.00–0.10) and 5–10 years (AOR = 0.041; 95% CI: 0.003–0.57), health information on diabetic complications (AOR = 0.002; 95% CI: 0.00–0.042) and appointments every month (AOR = 0.004; 95% CI: 0.00–0.073) and every 3 months (AOR = 0.022; 95% CI: 0.002–0.23) were less likely to develop diabetic retinopathy. Participants who had poor glycemic control (AOR = 19.9; 95% CI: 2.34–168.69), systolic hypertension (AOR = 23.4; 95% CI: 2.56–215.36) and nephropathy (AOR = 17.85; 95% CI: 2.01–158.1), had a higher risk of developing diabetic retinopathy.

Conclusions

Patients who had a glucometer at home, exercise adherence, diabetes duration < 10 years, health information on diabetic complications, and frequent follow-up had a preventive role. However, poor glycemic control, systolic hypertension, and nephropathy increase the risk of diabetic retinopathy. A concerted effort should be made to improve the health status of patients with Diabetes Mellitus, with particular emphasis on lifestyle modification practices to prevent diabetic retinopathy.

Reduction of Glut1 in the Neural Retina But Not the RPE Alleviates Polyol Accumulation and Normalizes Early Characteristics of Diabetic Retinopathy

Hyperglycemia is a key determinant for development of diabetic retinopathy (DR). Inadequate glycemic control exacerbates retinopathy, while normalization of glucose levels delays its progression. In hyperglycemia, hexokinase is saturated and excess glucose is metabolized to sorbitol by aldose reductase via the polyol pathway. Therapies to reduce retinal polyol accumulation for the prevention of DR have been elusive because of low sorbitol dehydrogenase levels in the retina and inadequate inhibition of aldose reductase. Using systemic and conditional genetic inactivation, we targeted the primary facilitative glucose transporter in the retina, Glut1, as a preventative therapeutic in diabetic male and female mice. Unlike WT diabetics, diabetic Glut1 ^+/- mice did not display elevated Glut1 levels in the retina. Furthermore, diabetic Glut1 ^+/- mice exhibited ameliorated ERG defects, inflammation, and oxidative stress, which was correlated with a significant reduction in retinal sorbitol accumulation. Retinal pigment epithelium-specific reduction of Glut1 did not prevent an increase in retinal sorbitol content or early hallmarks of DR. However, like diabetic Glut1 ^+/- mice, reduction of Glut1 specifically in the retina mitigated polyol accumulation and diminished retinal dysfunction and the elevation of markers for oxidative stress and inflammation associated with diabetes. These results suggest that modulation of retinal polyol accumulation via Glut1 in photoreceptors can circumvent the difficulties in regulating systemic glucose metabolism and be exploited to prevent DR.SIGNIFICANCE STATEMENT Diabetic retinopathy affects one-third of diabetic patients and is the primary cause of vision loss in adults 20-74 years of age. While anti-VEGF and photocoagulation treatments for the late-stage vision threatening complications can prevent vision loss, a significant proportion of patients do not respond to anti-VEGF therapies, and mechanisms to stop progression of early-stage symptoms remain elusive. Glut1 is the primary facilitative glucose transporter for the retina. We determined that a moderate reduction in Glut1 levels, specifically in the retina, but not the retinal pigment epithelium, was sufficient to prevent retinal polyol accumulation and the earliest functional defects to be identified in the diabetic retina. Our study defines modulation of Glut1 in retinal neurons as a targetable molecule for prevention of diabetic retinopathy.

Diabetic retinopathy in the Eastern Morocco: Different stage frequencies and associated risk factors

Diabetes is a major cause of morbidity and mortality worldwide. It can affect many organs and, over time, leads to serious complications. Diabetic retinopathy (DR), a specific ocular complication of diabetes, remains the leading cause of vision loss and vision impairment in adults. This work is the first in Eastern Morocco aimed at identifying the different stages of DR and to determine their frequencies and associated risk factors. It is a case-control study conducted from December 2018 to July 2019 at the ophthalmology department of Al-Irfane Clinic (Oujda). Data were obtained from a specific questionnaire involving 244 diabetic patients (122 cases with retinopathy vs 122 controls without retinopathy). All results were analyzed by the EPI-Info software. This study shows a predominance of proliferative diabetic retinopathy (PDR) with 57.4% of cases (uncomplicated proliferative diabetic retinopathy (UPDR): 23.8%; complicated proliferative diabetic retinopathy (CPDR): 33.6%). The non-proliferative diabetic retinopathy (NPDR) represents 42.6% (minimal NPDR: 8.2%; moderate NPDR: 26.2%; severe NPDR: 8.2%). The determinants of DR were insulin therapy, high blood pressure, poor glycemic control and duration of diabetes. Regarding the chronological evolution, retinopathy precedes nephropathy. Diabetic nephropathy (DN) was present in 10.6% of cases especially in patients with PDR. In summary, the frequency of PDR was higher than that of NPDR. DR appears before DN with a high frequency of DN in patients with PDR. Good glycemic control and blood pressure control, as well as early diagnosis are the major preventive measures against DR.

Correlates of diabetic retinopathy in type 2 diabetes mellitus patients in Makkah Al-Mukarramah, Saudi Arabia

BACKGROUND:

Diabetic retinopathy (DR) is a serious complication of diabetes that can cause visual impairment. The objective of this study was to estimate the prevalence and identify the determinants of DR in type 2 diabetes mellitus patients attending the diabetic center at Al-Noor Specialist Hospital in Makkah, Saudi Arabia.

MATERIALS AND METHODS:

A cross-sectional study was conducted in a sample of type 2 diabetic patients registered at the diabetic center at Al-Noor Specialist Hospital. Data was collected using a validated self-administered questionnaire. Grading of DR was done by slit-lamp examination and colored fundus photographs. Descriptive analysis included frequency and percentage for categorical variables, and mean, median, standard deviation (SD), and interquartile range, for continuous variables. Chi-square test used to test for association between two categorical variables; Student's t-test or Mann-Whitney U test as appropriate employed to compare continuous variable between two groups. Logistic regression analysis was utilized to identify correlates of DR after controlling for confounders.

RESULTS:

The study comprised 251 type 2 diabetic patients aged between 28 and 80 years, with an arithmetic mean of 56.8 and standard deviation of ±9.9 years. The prevalence of DR was 54.6%; mild nonproliferative (NP) type was present in 52.6% of the patients with DR, whereas severe NP type was present in 15.3% of them; the proliferative type was present in only 4.4% of those with DR. Multivariate logistic regression analysis revealed that patients who had had diabetes for a 11 to 16 years (adjusted odds ratio [AOR] = 3.52, P = 0.035), patients who did not take daily medications on time (AOR = 9.75, P = 0.008), patients who did not go for fundus examination annually (AOR = 3.62, P = 0.011), and patients with uncontrolled diabetes (AOR = 12.18, P < 0.001) were at higher significant risk for DR. Patients not treated with insulin were 70% less likely to develop DR (AOR = 0.30, P = 0.015). An increase of one unit in body mass index was significantly associated with increase in the probability of developing DR by 11% (AOR = 1.11, P = 0.024).

CONCLUSION:

DR is very prevalent in type 2 diabetic patients attending the diabetic center at Al-Noor Specialist Hospital, Makkah Al-Mukarramah; particularly the mild NP type.

Prevalence, Patterns and Predictors of Chronic Complications of Diabetes Mellitus at a Large Referral Hospital in Ethiopia: A Prospective Observational Study

PURPOSE

Diabetes mellitus complications are responsible for increased disability, morbidity, and mortality. This study aimed to assess prevalence, patterns, and predictors of chronic complications of diabetes among people with diabetes.

PATIENTS AND METHODS

The study was conducted using a prospective observational study design which was done on people with diabetes attending the ambulatory clinic of Mettu Karl Referral Hospital. The data were collected using a consecutive type of sampling technique from April 15 to August 9, 2019. The data were entered into Epidata manager version 4.4.2. Logistic regression analysis was done to identify predictors of chronic complications of diabetes.

RESULTS

A total of 330 participants were included in this study. The mean age of participants was 49.9±14.2, and 156 (47.3%) were 41 to 60 years old. About 127 (38.5%) had one or more chronic complications. The predictors of chronic diabetes complications were resident in urban areas [AOR: 1.94; 95% CI: (1.17, 3.20); p = 0.010], duration of diabetes 10 years [AOR: 2.05, 95% CI: (1.21, 3.47); p = 0.007], hypertension [AOR: 4.19; 95% CI: (2.54, 6.91); p < 0.001] and poor glycemic control [AOR: 2.82; 95% CI: (1.53, 5.21); p = 0.001].

CONCLUSION

Almost two-fifth of the study participants had chronic complications of diabetes. Residents in urban areas, longer duration of diabetes, hypertension and poor glycemic control were predictors of chronic diabetes complications. It is important to achieve good glycemic control and manage comorbid diseases like hypertension to minimize the risk of chronic diabetes complications.

Serum Iron and Risk of Diabetic Retinopathy

Background: Diabetic retinopathy (DR) is indicated as a major cause of blindness in the world. Emerging evidence supports the interaction of iron metabolism with diabetes. However, little research is available concerning the relationship between iron metabolism and DR. The intent of this paper is to describe the correlation between serum iron and the occurrence of DR. Methods: A total of 5321 participants who underwent related examinations as part of the National Health and Nutrition Examination Survey (2005–2008) were included. DR was defined by the criteria of the Early Treatment for Diabetic Retinopathy Study based on nonmydriatic fundus photography. The cutoff point of serum iron for DR was explored by the receiver operating characteristics curve. The relationship of serum iron with the occurrence of DR was explored by multivariate logistic regression models. Results: Participants with DR had significantly lower serum iron than the control group. Serum iron was negatively correlated with the occurrence of DR after the adjustment of pertinent variables (an odds ratio (OR) of 0.995 (95% CI: 0.992–0.999)). After dividing serum iron into quartiles, the third quartile was associated with DR with an OR of 0.601 (95% CI: 0.418–0.863). Furthermore, the cutoff point of serum iron had an inverse relationship for the occurrence of DR with an OR of 0.766 (95% CI: 0.597–0.984). Conclusion: Serum iron has an inverse association with the occurrence of DR in diabetic adults. The assessment of serum iron levels might be a part of follow-up visits with diabetic patients.

Acute Complications of Diabetes and its Predictors among Adult Diabetic Patients at Jimma Medical Center, Southwest Ethiopia

BACKGROUND

Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia resulting from impairment in insulin secretion, insulin action, or both. It is responsible for a wide range of acute and chronic complications. In this study, we aimed to assess acute complications of diabetes and its predictors among adult DM patients at Jimma Medical Center (JMC), southwest Ethiopia.

METHODS

A facility-based cross-sectional study involving 348 diabetic patients was conducted from February to May 31, 2019 at JMC. Logistic regression was conducted to identify predictors of acute complications of diabetes. Variables with P≤0.25 on bivariate logistic regression were considered candidates for multivariate regression. ORs and 95% CIs  with P<0.05 were considered statistically significant.

RESULTS

Of the 348 patients, 225 (64.7%) were male, and the mean age of study participants was 46±15.5 years. Most (281, 80.7%) had type 2 DM. More than two-thirds (240, 69%)had diabetes duration of <5 years. During the study period, 92 (26.4%) patients developed acute complications of diabetes. Of these, 68 (73.9%) had diabetic ketoacidosis, 21 (22.8%) a hyperglycemic hyperosmolar state, and three (3.3%) hypoglycemia. Presence of comorbidity (AOR 5.6, 95% CI 2.80-11.19), type 1 DM (AOR 9.3, 95% CI 4.36-19.82), uncontrolled blood glucose (AOR 1.91, 95% CI 1.05-3.45), and lack of access to a health facility within a reasonable distance (AOR 1.96, 95% CI 1.11-3.45) were independent predictors of acute complications of diabetes.

CONCLUSION

The magnitude of acute complications among DM patients at JMC was high. Comorbidity, type 1 DM, uncontrolled blood sugar, and lack of access to a health facility within a reasonable distance were independent predictors of acute complications. Clinicians should follow up this subgroup of DM patients closely.

Assessment of Circulating Biomarkers in Relation to Various Stages of Diabetic Retinopathy in Type 2 Diabetic Patients-A Cross Sectional Study

AIM

The aim of this study is to examine the relationship between inflammatory markers, and diabetic retinopathy in type II diabetic patients.

METHODS

The study was a cross-sectional study included 150 type 2 diabetic patients who were divided into 3 groups. 50 in each group are divided as Diabetic patients without retinopathy (DM, n=50), nonproliferative diabetic retinopathy patients (NPDR, n=50), proliferative diabetic retinopathy patients (PDR, n=50). All the patients were subjected to complete clinical examination and laboratory investigations, such as fasting and postprandial blood glucose, serum creatinine, lipid profile tests, glycosylated haemoglobin (HbA1c), fasting insulin, serum inflammatory markers (TNF-alpha, C-reactive protein) and serum VEGF.

RESULTS

The study revealed from the multivariate analysis that age, duration and WHR (waist-hip ratio) are potent risk factors responsible for the risk of Diabetic retinopathy. Similarly, serum creatinine, CRP, TNF- alpha and VEGF are significantly higher in diabetic patients with retinopathy compared to diabetic patients without retinopathy.

CONCLUSION

The study concluded that inflammation was associated with severe diabetic retinopathy in patients with well-controlled diabetes. A possible relationship was provided between the risk factors and biomarkers which are responsible for Diabetic retinopathy. Hence, modifying the risk factors risk and development of severe diabetic retinopathy can be reduced.

Targeting epigenetic modifications as a potential therapeutic option for diabetic retinopathy

Diabetic retinopathy (DR) is the leading cause of visual impairment in adults of working age (20-65 years) in developed countries. The metabolic memory phenomena (persistent effect of a glycemic insult even after retrieved) associated with it has increased the risk of developing the complication even after the termination of the glycemic insult. Hence, the need for finding early diagnosis and treatment options has been of great concern. Epigenetic modifications which generally occur during the beginning stages of the disease are responsible for the metabolic memory effect. Therefore, the therapy based on the reversal of the associated epigenetic mechanism can bring new insight in the area of early diagnosis and treatment mechanism. This review discusses the diabetic retinopathy, its pathogenesis, current treatment options, need of finding novel treatment options, and different epigenetic alterations associated with DR. However, the main focus is emphasized on various epigenetic modifications particularly DNA methylation which are responsible for the initiation and progression of diabetic retinopathy and the use of different epigenetic inhibitors as a novel therapeutic option for DR.

Identification of population characteristics through implementation of the Comprehensive Diabetic Retinopathy Program

Background

Diabetic retinopathy is the most common cause of blindness in working-age adults. Characteristics of patients with diabetes presenting to a retina subspecialty clinic have not been adequately studied, limiting our ability to risk stratify patients with diabetic retinopathy. Our goal is to describe an innovative program that collects structured, longitudinal data on patients with diabetes in a retina clinic, and identifies population characteristics to define patient risk stratification.

Methods

Demographics, body-mass index, blood pressure, hemoglobin A_1c, smoking history, diabetes type, diabetes duration, kidney disease history, and diagnosis codes were collected on all patients with diabetes at the Kellogg Eye Center retina clinic. A mixed effects negative binomial regression was then performed to assess visit frequency as a function of these variables. Visit frequency was used as a marker for cost of care. A subgroup of patients was surveyed about knowledge of diabetes management goals and barriers to better self-management.

Results

There were 2916 patients in the cohort with 1014 in the subgroup. The cohort was predominantly Caucasian (74.5%), with a mean age of 64 years (range 13–99) and a relatively even distribution of sex (53.2% men). The mean maximum hemoglobin A_1c was 8.0% (range 4.3–15.7%), and 57.1% had a diagnosis of diabetic retinopathy. Patients averaged 3.9 visits (range 1–27) during the 18-month study period. Blood pressure and duration of diabetes were positively associated with visit frequency (p < 0.0001, p < 0.0001, respectively). Of the surveyed patients, 87.6% knew their goal hemoglobin A_1c, while only 45.9% identified the correct blood pressure goal. The most common reported barrier to better self-management was “it’s just not working” (47.1%).

Conclusions

Implementation of this program enables the creation of a longitudinal dataset on patients with diabetes. Resulting data can be used to improve quality of care provided to patients at a retina clinic. The findings suggest considerable healthcare resources are being directed to a small patient population. This enhanced understanding of characteristics of patients with diabetes will improve efforts to preserve vision and utilize health system resources efficiently.

Glycemic control and diabetes complications among diabetes mellitus patients attending at University of Gondar Hospital, Northwest Ethiopia

BACKGROUND

Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia due to either insulin deficiency or resistance or both. Hyperglycemia induces tissue damage through mitochondrial superoxide production, affecting retina, glomerulus, and neurons. It requires continuing medical care and ongoing self-care management to prevent and delay acute and long-term complications. Therefore, our study was designed to assess glycemic control and diabetes complications among diabetes patients attending at University of Gondar Hospital.

MATERIALS AND METHODS

A cross-sectional study was conducted among DM patients attending at University of Gondar Hospital diabetes follow-up clinic during February-March 2017. Five milliliters of blood was collected using aseptic technique. Levels of fasting blood sugar (FBS), triglycerides, and cholesterol were measured using MINDRAY BS-200E machine. FBS ≥152 mg/dL was taken as poor glycemic control. Binary and multivariable logistic regression models were used to evaluate associated risk factors for the outcome variable. A P-value of <0.05 was considered as statistically significant.

RESULT

Three hundred sixty-seven diabetes patients were included in this study. About 222 (60.5%) of them had poor glycemic control (FBS ≥152 mg/dL). The proportion of poor glycemic control was slightly higher among type 1 DM patients (61.4%) than type 2 DM patients (59.8%). Age ≥65 years (adjusted odds ratio [AOR]: 0.070; 95% CI: 0.016-0.308), being divorced (AOR: 0.226; 95% CI: 0.064-0.8000), and increased waist circumference (AOR: 0.361: 95% CI: 0.181-0.720) were factors that significantly reduce poor glycemic control. Diabetes complications were slightly higher in insulin- and tablet-only users, 72.5% and 64.5%, respectively. DM complications were also higher in patients who had poor glycemic control (61/222) and type 2 diabetes (78 [37.3%]).

CONCLUSION

Prevalence of poor glycemic control and DM complications was high, which indicate that appropriate intervention is required to improve glycemic control and prevent or control complications among DM patients.

Severity of diabetic retinopathy at the first ophthalmological examination in the Lebanese population

AIM

To determine the percentage and stage of diabetic retinopathy at the first ophthalmological examination after the patient's diagnosis with type 2 diabetes mellitus.

METHODS

A retrospective descriptive study was conducted at 'Clinique du Levant' hospital between 2006 and 2016. A total of 484 randomly selected patients were included. Data were collected and analyzed for selected variables (sex, age, sources of referral, and duration of diabetes).

RESULTS

In total, 119 (24.6%) patients had diabetic retinopathy. Among them, 43 had proliferative diabetic retinopathy (8.9%). About 16.7% of the included patients had macular edema, which was severe in 6.2%. The average age of patients was 62.1 years with an average of 8.3 years of diabetes. About 55% were men, while 45% were women. The patients with no referral source presented 8.9 years after the onset of diabetes, whereas patients referred by general practitioners and secondary medical professionals presented after 5.8 and 5 years, respectively (p < 0.05), but they represented only 23.2% of diabetics. Women presented earlier than men (7.3 versus 9.1 years; p = 0.012). About 82.6% were symptomatic, 44.1% had a visual impairment on Snellen charts that was severe in 11.2%. Also, 37.8% of the patients had a visually significant cataract. The duration of diabetes was the only dependent variable, p < 0.0001. The average age, sources of referral, and sex were not related to the severity of retinopathy.

CONCLUSION

Diabetics with a more severe diabetic retinopathy are presenting late to the ophthalmology clinics. There is a need to promote outreach programs for people with diabetes for early detection of diabetic retinopathy in Lebanon.

Association of Glycated Haemoglobin and Serum Apolipoproteins with Diabetic Retinopathy: An Indian Overview

INTRODUCTION

India is presently facing an epidemic of diabetes mellitus and the risks of chronic complications from the disease are associated with the duration of the disease as well as the degree of hyperglycaemia. Diabetic retinopathy is a known microvascular complication of diabetes mellitus and is the most common cause of blindness in the western countries.Apolipoproteins are the protein component of lipoproteins. Apart from acting as structural proteins, they also act as cofactors to various enzymes.

AIM

To measure the levels of serum apolipoproteins and glycated haemoglobin in cases of diabetic retinopathy and to assess their association with the stages of diabetic retinopathy.

MATERIAL AND METHODS

The 135 diabetic cases [with (110) and without (125) retinopathy] attending the Ophthalmology OPD of this tertiary care hospital were included in the present study. Following retinoscopy, the patients were classified as Non-Proliferative Diabetic Retinopathy (NPDR) (n=75) and Proliferative Diabetic Retinopathy (PDR) (n=35). The controls (n=100) were age and sex matched patients who did not have diabetes. The cases and controls were assessed for HbA1c, total cholesterol, triglycerides, HDL cholesterol, Apo A-I and Apo B-100.

RESULTS

The HbA1c was found to be higher in diabetics without retinopathy (7.02%) as compared to controls (5.58%) (p<0.05) and the highest value was seen in the mild NPDR group (8.82%). The mean value of Apo A-I was found to be lowest in the diabetics without retinopathy at 88 mg/dl and the highest in severe NPDR at 167 mg/dL. The mean value of Apo B-100 was found to be highest in severe NPDR at 114 mg/dL. The mean value of HDL cholesterol was lowest in moderate NPDR at 36.6 mg/dl. Total cholesterol was highest in severe NPDR at 280.88mg/dl while triglyceride was highest in severe NPDR at 286.4mg/dl.

CONCLUSION

In our study, the level of HbA1c was found to range from 5.58% in non-diabetic to 8.82% in mild NPDR. There was a clear association between Apo B-100 and total cholesterol, triglycerides with the highest value of each parameter seen in the severe NPDR group. There was a discordance noted in the levels of HDL and Apo A-I in various groups. Apo B-100 values may be of value in prognosis of diabetic retinopathy as higher values may result in progression of the disease. Further studies involving Lp(a) and homocysteine may be required in cases of diabetic retinopathy.

Expression of JAZF1, ABCC8, KCNJ11and Notch2 genes and vitamin D receptor polymorphisms in type 2 diabetes, and their association with microvascular complications

BACKGROUND

We studied JAZF1, ABCC8, KCNJ11and Notch2 gene expression and vitamin D receptor (VDR) polymorphisms (Fok1 and Bsm1) in patients with type 2 diabetes mellitus (T2DM) and tried to find out their association with microvascular complications in these patients.

METHODS

The study was conducted on 180 patients (93 complicated and 87 noncomplicated) and 150 healthy subjects. Reverse-transcriptase polymerase chain reaction (RT-PCR) was used to assess gene expression and real-time PCR was used to detect VDR genotypes. Serum vitamin D was assessed using Elisa technique.

RESULTS

After adjustment for age, sex, body mass index and glycated hemoglobin, altered Notch2 gene expression was found between patients and controls and between complicated and noncomplicated cases (p = 0.001 and 0.001, respectively) and ABCC8 gene expression showed significant difference between patients and controls only (p = 0.003), while JAZF1and KCNJ11 expression showed no significant difference between the studied groups (p = 0.3 and 0.4, respectively). Serum vitamin D level was decreased in patients compared with controls (p = 0.001), while no difference was detected between complicated and noncomplicated cases (p = 0.1). Our results revealed no significant difference in VDR Fok1 and Bsm1 genotype distributions (p = 0.7 and 0.1, respectively) and allele frequencies (p = 0.4 and 0.1, respectively) between patients and controls. Patients with complications showed increased frequencies of Fok1GG genotype and G allele, while patients without complications showed increased frequencies of AA, then AG Fok1 genotype and A allele (p = 0.001 and 0.001, respectively). In addition, the frequencies of CC Bsm1 genotype and C allele were significantly higher among patients with complications, while frequencies of TT Bsm1 genotype and T allele were significantly higher among patients without complications (p = 0.02 and 0.003, respectively).

CONCLUSION

Altered expression of Notch2 and ABCC8 genes may play a role in the pathogenesis of T2DM. Altered expression of Notch2 and VDR polymorphisms may play a role in the development of microvascular complications in diabetic patients. These results may assist in early identification and management of diabetic complications.

Body mass index and risk of diabetic retinopathy: A meta-analysis and systematic review

Diabetic retinopathy (DR) is a frequent cause of acquired blindness worldwide. Various studies have reported the effects of body mass index (BMI) on the risk of DR, but the results remain controversial. Therefore, a meta-analysis was performed to evaluate the relationship between BMI and the risk of DR.A systematic search was performed using the Cochrane Library, PubMed, and Embase databases to obtain articles published through December 2016. Articles regarding the association between BMI and the risk of DR were retrieved. The adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were included and then pooled with a random effects model.A total of 27 articles were included in this meta-analysis. When BMI was analyzed as a categorical variable, neither being overweight (OR = 0.89, 95% CI 0.75-1.07; P = .21; I = 65%) nor obesity (OR = 0.97, 95% CI 0.73-1.30; P = .86) were associated with an increased risk of DR when compared with normal weight. When BMI was analyzed as a continuous variable, a higher BMI was not associated with an increased risk of DR (OR = 0.99, 95% CI 0.97-1.01; P = .25; I2 = 79%). The pooled results did not significantly change after the sensitivity analysis.Based on the current publications, neither being overweight nor obesity is associated with an increased risk of DR. Further studies should confirm these findings.

Tsallis entropy and sparse reconstructive dictionary learning for exudate detection in diabetic retinopathy

Computer-assisted automated exudate detection is crucial for large-scale screening of diabetic retinopathy (DR). The motivation of this work is robust and accurate detection of low contrast and isolated hard exudates using fundus imaging. Gabor filtering is first performed to enhance exudate visibility followed by Tsallis entropy thresholding. The obtained candidate exudate pixel map is useful for further removal of falsely detected candidates using sparse-based dictionary learning and classification. Two reconstructive dictionaries are learnt using the intensity, gradient, local energy, and transform domain features extracted from exudate and background patches of the training fundus images. Then, a sparse representation-based classifier separates the true exudate pixels from false positives using least reconstruction error. The proposed method is evaluated on the publicly available e-ophtha EX and standard DR database calibration level 1 (DIARETDB1) databases and high exudate detection performance is achieved. In the e-ophtha EX database, mean sensitivity of 85.80% and positive predictive value of 57.93% are found. For the DIARETDB1 database, an area under the curve of 0.954 is obtained.

Traditional uses of medicinal plants to prevent and treat diabetes; an updated review of ethnobotanical studies in Iran

Background:

Obesity and physical inactivity are currently on the rise due to industrialization of the communities, which has recently led to increased incidence of different diseases such as diabetes. Epidemiological studies and figures have demonstrated the growing incidence of diabetes. Relevantly, the side effects of chemical drugs have led patients to use medicinal plants and traditional approaches despite advances in development of chemical drugs. The aim of this review article is to report the medicinal plants and their traditional uses to prevent and treat diabetes according to the findings of ethnobotanical studies conducted in different regions of Iran.

Evidence Acquisitions:

The search terms including ethnobotany, ethnomedicine, ethnopharmacology, phytopharmacology, phytomedicine, Iran, and traditional medicine in combination with diabetes, blood sugar and hyperglycemic were searched from scientific databases.

Results:

The results of this article can be a comprehensive guideline, based on ethnobotany of different regions of Iran, to prevent and treat diabetes. According to this review article, certain plant species such as Urtica dioica L., popularly called nettle, in eight regions, Teucrium polium L., popularly called poleigamander, in five regions, and Trigonella foenum-graecum L., Citrullus colocynthis (L.), Schrad., and Juglans regia L. in four regions, were reported to be frequently used to prevent and treat diabetes

Conclusions:

The introduced medicinal plants in this review can be investigated in further research and produce new drugs with limited side effects