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Mellor J, Jeyam A, Beulens JW, Bhandari S, Broadhead G, Chew E, Fickweiler W, van der Heijden A, Gordin D, Simó R, Snell-Bergeon J, Tynjälä A, Colhoun H. Role of Systemic Factors in Improving the Prognosis of Diabetic Retinal Disease and Predicting Response to Diabetic Retinopathy Treatment. OPHTHALMOLOGY SCIENCE 2024; 4:100494. [PMID: 38694495 PMCID: PMC11061755 DOI: 10.1016/j.xops.2024.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 05/04/2024]
Abstract
Topic To review clinical evidence on systemic factors that might be relevant to update diabetic retinal disease (DRD) staging systems, including prediction of DRD onset, progression, and response to treatment. Clinical relevance Systemic factors may improve new staging systems for DRD to better assess risk of disease worsening and predict response to therapy. Methods The Systemic Health Working Group of the Mary Tyler Moore Vision Initiative reviewed systemic factors individually and in multivariate models for prediction of DRD onset or progression (i.e., prognosis) or response to treatments (prediction). Results There was consistent evidence for associations of longer diabetes duration, higher glycosylated hemoglobin (HbA1c), and male sex with DRD onset and progression. There is strong trial evidence for the effect of reducing HbA1c and reducing DRD progression. There is strong evidence that higher blood pressure (BP) is a risk factor for DRD incidence and for progression. Pregnancy has been consistently reported to be associated with worsening of DRD but recent studies reflecting modern care standards are lacking. In studies examining multivariate prognostic models of DRD onset, HbA1c and diabetes duration were consistently retained as significant predictors of DRD onset. There was evidence of associations of BP and sex with DRD onset. In multivariate prognostic models examining DRD progression, retinal measures were consistently found to be a significant predictor of DRD with little evidence of any useful marginal increment in prognostic information with the inclusion of systemic risk factor data apart from retinal image data in multivariate models. For predicting the impact of treatment, although there are small studies that quantify prognostic information based on imaging data alone or systemic factors alone, there are currently no large studies that quantify marginal prognostic information within a multivariate model, including both imaging and systemic factors. Conclusion With standard imaging techniques and ways of processing images rapidly evolving, an international network of centers is needed to routinely capture systemic health factors simultaneously to retinal images so that gains in prediction increment may be precisely quantified to determine the usefulness of various health factors in the prognosis of DRD and prediction of response to treatment. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Joe Mellor
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Anita Jeyam
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Crewe Road, Edinburgh, Scotland
| | - Joline W.J. Beulens
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Sanjeeb Bhandari
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Geoffrey Broadhead
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Ward Fickweiler
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Amber van der Heijden
- Department of General Practice, Amsterdam Public Health Institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Department of Nephrology, Helsinki University Hospital, University of Helsinki, Finland
| | - Rafael Simó
- Endocrinology & Nutrition, Institut de Recerca Hospital Universitari Vall d’Hebron (VHIR), Barcelona, Spain
| | - Janet Snell-Bergeon
- Clinical Epidemiology Division, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Colorado
| | - Anniina Tynjälä
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Department of Nephrology, Helsinki University Hospital, University of Helsinki, Finland
| | - Helen Colhoun
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Crewe Road, Edinburgh, Scotland
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Wang Q, Cheng H, Jiang S, Zhang L, Liu X, Chen P, Liu J, Li Y, Liu X, Wang L, Li Z, Cai G, Chen X, Dong Z. The relationship between diabetic retinopathy and diabetic nephropathy in type 2 diabetes. Front Endocrinol (Lausanne) 2024; 15:1292412. [PMID: 38344659 PMCID: PMC10853456 DOI: 10.3389/fendo.2024.1292412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
Context Diabetic retinopathy (DR) and diabetic nephropathy (DN), are major microvascular complications of diabetes. DR is an important predictor of DN, but the relationship between the severity of DR and the pathological severity of diabetic glomerulopathy remains unclear. Objective To investigate the relationship between severity of diabetic retinopathy (DR) and histological changes and clinical indicators of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). Methods Patients with T2DM (n=272) who underwent a renal biopsy were eligible. Severity of DR was classified as non-diabetic retinopathy, non-proliferative retinopathy, and proliferative retinopathy (PDR). Relationship between DN and DR and the diagnostic efficacy of DR for DN were explored. Results DN had a higher prevalence of DR (86.4%) and DR was more severe. The sensitivity and specificity of DR in DN were 86.4% and 78.8%, while PDR was 26.4% and 98.5%, respectively. In DN patients, the severity of glomerular lesions (p=0.001) and prevalence of KW nodules (p<0.001) significantly increased with increasing severity of DR. The presence of KW nodules, lower hemoglobin levels, and younger age were independent risk factors associated with more severe DR in patients with DN. Conclusion DR was a good predictor of DN. In DN patients, the severity of DR was associated with glomerular injury, and presence of KW nodules, lower hemoglobin levels and younger age were independent risk factors associated with more severe DR. Trial registration ClinicalTrails.gov, NCT03865914.
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Affiliation(s)
- Qian Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Haimei Cheng
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Shuangshuang Jiang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Li Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiaomin Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Pu Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Jiaona Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Ying Li
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Xiaocui Liu
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Liqiang Wang
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Zhaohui Li
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Zheyi Dong
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
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Li X, Chen M. Correlation of hemoglobin levels with diabetic retinopathy in US adults aged ≥40 years: the NHANES 2005-2008. Front Endocrinol (Lausanne) 2023; 14:1195647. [PMID: 37600684 PMCID: PMC10433903 DOI: 10.3389/fendo.2023.1195647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose The aim of this study was to explore the connection between hemoglobin levels and diabetic retinopathy (DR). Methods Cross-sectional research used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2008. A multiple logistic regression analysis was performed to investigate the association between DR and hemoglobin levels. Additionally, generalized additivity models and smoothed curve fitting were carried out. Results After adjusting for several covariates, there was a negative association between hemoglobin levels and DR in the study, which included 837 participants. The negative association between hemoglobin levels and DR was present in men and women, the obese (BMI > 30), and 60- to 69-year-olds in subgroup analyses stratified by sex, BMI, and age. The association between hemoglobin levels and DR in the normal weight group (BMI < 25) displayed an inverted U-shaped curve with an inflection point of 13.7 (g/dL). Conclusion In conclusion, our research reveals that high hemoglobin levels are related to a decreased risk of DR. Ascertaining the hemoglobin levels ought to be regarded as an integral facet of the monitoring regimen for patients with diabetic complications and that the risk of DR is reduced through the detection and management of hemoglobin levels.
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Affiliation(s)
- Xiao Li
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Meirong Chen
- Ophthalmology Department, Shandong Hospital of Traditional Chinese Medicine, Jinan, China
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Pan T, Gao J, Cai X, Zhang H, Lu J, Lei T. The average 30-minute post-prandial C-peptide predicted diabetic retinopathy progress: a retro-prospective study. BMC Endocr Disord 2023; 23:63. [PMID: 36922809 PMCID: PMC10018901 DOI: 10.1186/s12902-023-01300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The conclusion between Connecting peptide (C-peptide) and diabetic chronic complication was controversial. The purpose of this study is to explore the possible association between average C-peptide with diabetic retinopathy (DR) progression in Chinese patients with type 2 diabetes. METHODS This is a retro-prospective study. 622 patients with type 2 diabetes were included. DR was evaluated using non-mydriatic fundus photography and DR progression was defined as any deterioration of either eye. Fasting and postprandial c-peptide levels were assayed at baseline and follow-up period. Differences between continuous variables were compared using the Mann-Whitney U test; and categorical variables were analyzed by the chi-square test. Correlation between parameters and 30-minute postprandial C-peptide were determined by Spearman correlation test. The relationship between C-peptide and DR progression was evaluated by multivariable binary logistic regression. Two-tailed P-values < 0.05 were regarded as statistically significant. RESULTS DR was present in 162 (26.0%) patients at baseline, and 26.4% of patients were found progression of DR at follow-up. Patients with progression of DR had lower average levels of 30-minute postprandial C-peptide (2.01 ng/ml vs. 2.6 ng/ml, p = 0.015) and 120-minute postprandial C-peptide (3.17 ng/ml vs. 3.92 ng/ml, p < 0.029), as well as average increment of 30-minute (0.41 ng/ml vs. 0.64 ng/ml, p = 0.015) and 120-minute postprandial C-peptide (1.48 ng/ml vs. 1.93 ng/ml, p < 0.017), than those without DR aggravation. Multivariate logistic regression analysis determined that 30-minute postprandial C-peptide and its increment were related to reduced odds ratios for DR progression (odds ratios [OR] = 0.83 and 0.74, respectively). CONCLUSION Our results suggest that the Average 30-minute post-prandial C-peptide and increment were negatively correlated with DR progression, which further demonstrates the importance to preserve β-cell residual function in the prevention for DR progression. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ting Pan
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 LanXi Road, 200062, Shanghai, China
| | - Jie Gao
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 LanXi Road, 200062, Shanghai, China
| | - Xinghua Cai
- Shanghai Putuo Central School of Clinical Medicine, Anhui Medical University, Anhui, China
| | - Huihui Zhang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 LanXi Road, 200062, Shanghai, China
| | - Jun Lu
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 LanXi Road, 200062, Shanghai, China.
| | - Tao Lei
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 LanXi Road, 200062, Shanghai, China.
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Indumathi A, Senthilkumar GP, Jayashree K, Ramesh Babu K. Assessment of circulating fibrotic proteins (periostin and tenascin -C) In Type 2 diabetes mellitus patients with and without retinopathy. Endocrine 2022; 76:570-577. [PMID: 35274283 DOI: 10.1007/s12020-022-03027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Diabetic retinopathy is a leading cause of vision impairment. Surging diabetic population and poor visual care raises the need for better diagnostic tools. Hence, it is worthwhile to look for biomarkers associated with the disease pathogenesis. Periostin and tenascin-C are matricellular proteins mediating fibrillogenesis in retinopathy. Their serum levels and association with the presence and severity of retinopathy in diabetics is of importance to be explored. METHODS The study involved two groups of type 2 diabetes patients, 38 controls without retinopathy and 38 cases with retinopathy. We obtained serum sample and performed biochemical autoanalysis for routine parameters. Special parameters periostin, tenascin-C, and C-peptide were estimated by ELISA. RESULTS Periostin and tenascin-C were significantly elevated in the retinopathy group. Periostin progressively increased among subgroups. C-peptide decreased significantly in retinopathy group and had a negative correlation with duration of DM, duration of retinopathy, HbA1c and tenascin-C. We observed a positive correlation for periostin and tenascin-C with duration of diabetes. The AUC for C-peptide was the highest (0.750) amongst our parameters. HOMA 2 (%B) index was significantly lower in retinopathy group. CONCLUSIONS Serum Levels of PO and TnC increased in retinopathy. As the disease advances, periostin level increases, indicating continuing fibrosis and fibrovascular membrane formation. Periostin and tenascin-C increase with duration of retinopathy whereas levels of C-peptide decrease. C-peptide has a better differentiating potential for DR from DM. Reduced insulin production as indicated by declined HOMA 2-%BETA in retinopathy favors hyperglycemia and chronic inflammatory state for the disease progression.
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Affiliation(s)
- A Indumathi
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Kuppuswamy Jayashree
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - K Ramesh Babu
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Ling M, Zhou J, Pang XQ, Liang J, Qin YF, Huang S, Liang GY, Li YF, Zeng ZS. White Matter Microstructural Abnormalities of the Visual Pathway in Type 2 Diabetes Mellitus: A Generalized Q-sampling Imaging Study. Acad Radiol 2022; 29 Suppl 3:S166-S174. [PMID: 34930656 DOI: 10.1016/j.acra.2021.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/16/2021] [Accepted: 10/21/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Neurodegeneration is an early event in the pathogenesis of diabetic retinopathy (DR). We assessed the white matter microstructural integrity of the visual pathway in diabetes patients vs. healthy subjects, and investigated the advantages of generalized Q-sampling imaging (GQI) in the assessment of the visual pathway. MATERIALS AND METHODS T1-weighted, T2-weighted fluid-attenuated inversion recovery, and simultaneous multislice- diffusion sequences were acquired from 21 DR patients, 29 diabetes patients without DR (NDR group), and 28 age- and gender-matched healthy controls. Diffusion source images were reconstructed to GQI. Region of interest (ROI)-based analysis was utilized to evaluate microstructural alterations in the visual pathway. Multivariate linear regression analysis (forward stepwise method) was performed to investigate associations between clinical data and mean GQI parameters. RESULTS ROI-based analyses indicated that the GQI parameters generalized fractional anisotropy, quantitative anisotropy (QA), and normalized QA (NQA) were significantly lower in the NDR group than in the healthy controls, and even lower in the DR group than in the NDR group. Disease duration was significantly and negatively correlated with mean generalized fractional anisotropy and mean NQA. CONCLUSION GQI could sensitively and non-invasively evaluate the visual pathway in diabetes patients. The nerve fibers of the visual pathway were damaged before the onset of retinopathy, and this damage was aggravated after retinopathy onset, as a consequence of long exposure to hyperglycemia.
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Sardarinia M, Asgari S, Hizomi Arani R, Eskandari F, Azizi F, Khalili D, Hadaegh F. Incidence and risk factors of severe non-proliferative/proliferative diabetic retinopathy: More than a decade follow up in the Tehran Lipids and Glucose Study. J Diabetes Investig 2022; 13:317-327. [PMID: 34403198 PMCID: PMC8847124 DOI: 10.1111/jdi.13647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS/INTRODUCTION To examine the incidence rate of severe non-proliferative and proliferative diabetic retinopathy (severe-NPDR/PDR) and determine its potential risk factors. MATERIALS AND METHODS The study consisted of 1,169 participants (675 women) with type 2 diabetes mellitus, aged ≥20 years. A trained interviewer collected information about the history of pan-retinal photocoagulation as a result of diabetic retinopathy. Multivariable Cox proportional hazards regression models were applied. RESULTS We found 187 cases (126 women) of severe-NPDR/PDR during a median follow-up period of 12.7 years; the corresponding incidence rate was 13.6 per 1,000 person-years. Being overweight (hazard ratio [HR], 95% confidence interval [CI] 0.60, 0.39-0.92) and obese (HR 0.48, 95% CI 0.27-0.83) were associated with lower risk, whereas being smoker (HR 1.75, 95% CI 1.12-2.74), having fasting plasma glucose levels 7.22-10.0 mmol/L (HR 2.81, 95% CI 1.70-4.62), fasting plasma glucose ≥10 mmol/L (HR 5.87, 95% CI 3.67-9.41), taking glucose-lowering medications (HR 2.58, 95% CI 1.87-3.56), prehypertension status (HR 1.65, 95% CI 1.05-2.58) and newly diagnosed hypertension (HR 1.96, 95% CI 1.06-3.65) increased the risk of severe-NPDR/PDR. Among newly diagnosed diabetes patients, being male was associated with a 59% lower risk of severe-NPDR/PDR (HR 0.41, 95% CI 0.21-0.79). Furthermore, patients who had an intermediate level of education (6-12 years) had a higher risk of developing PDR (HR 1.86, 95% CI 1.05-3.30) compared with those who had <6 years of education. CONCLUSIONS Among Iranians with type 2 diabetes mellitus, 1.36% developed severe-NPDR/PDR annually. Normal bodyweight, being a smoker, out of target fasting plasma glucose level, prehypertension and newly diagnosed hypertension status were independent risk factors of severe-NPDR/PDR. Regarding the sight-threatening entity of advanced diabetic retinopathy, the multicomponent strategy to control diabetes, abstinence of smoking and tight control of blood pressure should be considered.
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Affiliation(s)
- Mahsa Sardarinia
- Eye Research CenterRasool‐e‐Akram HospitalIran University of Medical SciencesTehranIran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Reyhane Hizomi Arani
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Fatemeh Eskandari
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Fereidoun Azizi
- Endocrine Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
- Department of Biostatistics and EpidemiologyResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research CenterResearch Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
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Nanayakkara N, Curtis AJ, Heritier S, Gadowski AM, Pavkov ME, Kenealy T, Owens DR, Thomas RL, Song S, Wong J, Chan JCN, Luk AOY, Penno G, Ji L, Mohan V, Amutha A, Romero-Aroca P, Gasevic D, Magliano DJ, Teede HJ, Chalmers J, Zoungas S. Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia 2021; 64:275-287. [PMID: 33313987 PMCID: PMC7801294 DOI: 10.1007/s00125-020-05319-w] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/02/2020] [Indexed: 01/13/2023]
Abstract
AIMS/HYPOTHESIS Few studies examine the association between age at diagnosis and subsequent complications from type 2 diabetes. This paper aims to summarise the risk of mortality, macrovascular complications and microvascular complications associated with age at diagnosis of type 2 diabetes. METHODS Data were sourced from MEDLINE and All EBM (Evidence Based Medicine) databases from inception to July 2018. Observational studies, investigating the effect of age at diabetes diagnosis on macrovascular and microvascular diabetes complications in adults with type 2 diabetes were selected according to pre-specified criteria. Two investigators independently extracted data and evaluated all studies. If data were not reported in a comparable format, data were obtained from authors, presented as minimally adjusted ORs (and 95% CIs) per 1 year increase in age at diabetes diagnosis, adjusted for current age for each outcome of interest. The study protocol was recorded with PROSPERO International Prospective Register of Systematic Reviews (CRD42016043593). RESULTS Data from 26 observational studies comprising 1,325,493 individuals from 30 countries were included. Random-effects meta-analyses with inverse variance weighting were used to obtain the pooled ORs. Age at diabetes diagnosis was inversely associated with risk of all-cause mortality and macrovascular and microvascular disease (all p < 0.001). Each 1 year increase in age at diabetes diagnosis was associated with a 4%, 3% and 5% decreased risk of all-cause mortality, macrovascular disease and microvascular disease, respectively, adjusted for current age. The effects were consistent for the individual components of the composite outcomes (all p < 0.001). CONCLUSIONS/INTERPRETATION Younger, rather than older, age at diabetes diagnosis was associated with higher risk of mortality and vascular disease. Early and sustained interventions to delay type 2 diabetes onset and improve blood glucose levels and cardiovascular risk profiles of those already diagnosed are essential to reduce morbidity and mortality. Graphical abstract.
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Affiliation(s)
- Natalie Nanayakkara
- School Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Andrea J Curtis
- School Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stephane Heritier
- School Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Adelle M Gadowski
- School Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Meda E Pavkov
- Centers for Disease Control and Prevention, Division for Diabetes Translation, Atlanta, GA, USA
| | - Timothy Kenealy
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - David R Owens
- Diabetes Research Group, Swansea University Medical School, Swansea, Wales, UK
| | - Rebecca L Thomas
- Diabetes Research Group, Swansea University Medical School, Swansea, Wales, UK
| | - Soon Song
- Department of Diabetes, Northern General Hospital, Sheffield, UK
| | - Jencia Wong
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Juliana C-N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Shenzhen, People's Republic of China
| | - Andrea O-Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Shenzhen, People's Republic of China
| | - Giuseppe Penno
- Diabetes and Metabolic Disease Section, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana University of Pisa, Pisa, Italy
| | - Linong Ji
- Department of Endocrinology, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Anandakumar Amutha
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Danijela Gasevic
- School Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, UK.
| | - Dianna J Magliano
- School Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - John Chalmers
- The George Institute for Global Health, Camperdown, NSW, Australia
| | - Sophia Zoungas
- School Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- The George Institute for Global Health, Camperdown, NSW, Australia.
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Ren Z, Yang Z, Lu Y, Zhang R, Yang H. Anti‑glycolipid disorder effect of epigallocatechin‑3‑gallate on high‑fat diet and STZ‑induced T2DM in mice. Mol Med Rep 2020; 21:2475-2483. [PMID: 32236613 PMCID: PMC7185284 DOI: 10.3892/mmr.2020.11041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 02/06/2020] [Indexed: 02/07/2023] Open
Abstract
Epigallocatechin-3-gallate (EGCG) is beneficial for inhibiting dyslipidemia and reducing hyperlipidemic risk. The purpose of the present study was to investigate the glycolipid regulatory effects and potential mechanisms of EGCG in a high-fat diet and streptozotocin-induced type 2 diabetes mellitus (T2DM) mouse model. The results demonstrated that EGCG can decrease blood glucose levels and increase insulin resistance in T2DM mice. In addition, EGCG can regulate serum lipid levels, including those of total cholesterol, triglyceride and low-density lipoprotein receptor (LDL-r), and reduce lipid deposition in vascular endothelial cells in a dose-dependent manner. In addition, the gene and protein expression of related scavenger receptors, including cluster of differentiation 36, sterol regulatory element binding protein 2 (SREBP), SREBP cleavage-activating protein and LDL-r, were downregulated in a dose-dependent manner. The present study noted that EGCG possesses potential as a natural product for preventing and treating metabolic hyperlipidemia syndrome, probably by reducing the blood lipid levels, alleviating vascular endothelial cell damage, maintaining normal lipid metabolism in blood vessels and ameliorating glycolipid disorders.
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Affiliation(s)
- Zhongkun Ren
- Department of Medical Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Zhiyong Yang
- Department of Medical Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Yi Lu
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Rongping Zhang
- School of Pharmaceutical Sciences and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Hui Yang
- Biomedical Engineering Center, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
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Ding Y, Ge Q, Qu H, Feng Z, Long J, Wei Q, Zhou Q, Wu R, Yao L, Deng H. Increased serum periostin concentrations are associated with the presence of diabetic retinopathy in patients with type 2 diabetes mellitus. J Endocrinol Invest 2018; 41:937-945. [PMID: 29349642 DOI: 10.1007/s40618-017-0820-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/27/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the association between serum periostin and the presence of diabetic retinopathy (DR). METHODS Serum periostin was detected in 114 healthy subjects, 122 patients with type 2 diabetes mellitus (T2DM) and 159 patients with DR and compared among groups. Clinical data and other laboratory measurements such as glycated hemoglobin (HbA1c), lipid profiles, serum creatinine (Cr) and high-sensitivity CRP (hsCRP) were also collected and compared among groups. For subgroup analysis, patients with DR were divided into a non-proliferated diabetic retinopathy (NPDR) group and a proliferated diabetic retinopathy (PDR) group. Multivariate analysis was performed using logistic regression models. RESULTS The serum periostin level was significantly higher in patients with diabetic retinopathy compared with healthy subjects and patients with T2DM (both P < 0.001, respectively). Also, the periostin level was significantly higher in the PDR group compared to the NPDR group (P = 0.044). Multivariate logistic regression revealed that serum periostin was independently associated with the presence of DR in patients with T2DM (P < 0.001). The receiver operating characteristic (ROC) curves for DR development using serum periostin showed that the area under the receiver operating characteristic curves (AUC) was 0.838 (P < 0.001). CONCLUSIONS The current study demonstrated that serum periostin is significantly associated with the presence of DR in patients with T2DM and is an independent risk factor of DR.
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Affiliation(s)
- Y Ding
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Q Ge
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - H Qu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Z Feng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - J Long
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Q Wei
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Q Zhou
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - R Wu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - L Yao
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - H Deng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Andrade RLM, Callo G, Horta BL. Peptídeo C e mortalidade cardiovascular: revisão sistemática e metanálise. Rev Panam Salud Publica 2018; 43:e23. [PMID: 31093247 PMCID: PMC6459372 DOI: 10.26633/rpsp.2019.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/25/2018] [Indexed: 11/24/2022] Open
Abstract
Objetivo Analisar as evidências de associação entre peptídeo C e mortalidade cardiovascular e geral disponíveis na literatura. Métodos Foi realizada uma revisão sistemática das bases de dados MEDLINE e EMBASE. Foram incluídos artigos publicados em inglês, português ou espanhol relatando estudos observacionais que investigaram a associação entre o peptídeo C e a mortalidade cardiovascular e geral. Buscou-se ainda avaliar a associação entre peptídeo C e fatores de risco cardiometabólicos, fatores hemodinâmicos e medidas antropométricas. A qualidade metodológica dos estudos foi avaliada de acordo com os critérios da escala Newcastle-Ottawa. Resultados Foram identificados 107 estudos relacionados ao tema. Ao final do processo de triagem, foram incluídos 18 artigos que apresentavam dados sobre a associação entre peptídeo C e risco cardiovascular. Cinco estudos forneceram dados sobre a relação entre peptídeo C e mortalidade cardiovascular e geral. O peptídeo C esteve associado positivamente ao IMC em chineses, e inversamente ao HDL colesterol em amostras populacionais na Ásia, Oriente Médio e Estados Unidos. Todavia, não foi possível realizar metanálise para os componentes de risco cardiovascular. Por outro lado, o peptídeo C esteve associado com a mortalidade cardiovascular (RR = 1,62; IC95%: 0,99 a 2,66) e geral (RR = 1,39; IC95%: 1,04 a 1,84). Conclusão Na revisão sistemática e metanálise realizadas, os níveis séricos de peptídeo C estiveram associados positivamente com a mortalidade geral em todos os indivíduos e com a mortalidade cardiovascular em pessoas sem comorbidades. Com base nesses resultados, é possível recomendar o emprego do peptídeo C na prática clínica como proxy da condição de resistência à insulina associada a mortalidade cardiovascular.
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Affiliation(s)
| | - Gabriela Callo
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Epidemiologia, Pelotas (RS), Brasil
| | - Bernardo Lessa Horta
- Universidade Federal de Pelotas (UFPel), Programa de Pós-Graduação em Epidemiologia, Pelotas (RS), Brasil
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Nanayakkara N, Ranasinha S, Gadowski A, Heritier S, Flack JR, Wischer N, Wong J, Zoungas S. Age, age at diagnosis and diabetes duration are all associated with vascular complications in type 2 diabetes. J Diabetes Complications 2018; 32:279-290. [PMID: 29352694 DOI: 10.1016/j.jdiacomp.2017.11.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Type 2 diabetes (T2DM) is increasingly diagnosed in younger patients. The trajectory of complications in patients diagnosed at a younger or older age is not well understood. We examine the associations between age, age at diagnosis and diabetes duration and vascular complications in patients with T2DM. METHODS A cross-sectional study of pre-specified demographic and clinical data, from 3419 adults with T2DM participating in the Australian National Diabetes Audit (2015). Factors associated with diabetes complications were analysed using logistic regression. RESULTS Mean (±SD) current age was 62.9±12.5years, age at diagnosis was 49.4±12.3years and mean diabetes duration was 13.5±9.4years. Macrovascular complications were more prevalent in patients who were older at diabetes diagnosis whereas microvascular complications were more prevalent in patients who were younger at diabetes diagnosis. Age, age at diagnosis and diabetes duration were all independently associated with increased risk of macrovascular complications after adjustment for sex, smoking, BMI and microvascular complications (all p<0.001). In contrast, only diabetes duration was independently associated with microvascular complications after adjustment for sex, smoking, BMI and macrovascular complications (p<0.001). CONCLUSIONS Age, age at diagnosis, and diabetes duration were all independently associated with macrovascular complications whereas only diabetes duration was independently associated with microvascular complications.
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Affiliation(s)
- Natalie Nanayakkara
- School Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, Australia
| | - Sanjeeva Ranasinha
- School Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - Adelle Gadowski
- School Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - Stephane Heritier
- School Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - Jeff R Flack
- Diabetes Centre, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia; Faculty of Medicine, University of NSW, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Natalie Wischer
- National Association Diabetes Centres, Sydney, NSW, Australia
| | - Jencia Wong
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Discipline of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Sophia Zoungas
- School Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, Australia; The George Institute for Global Health, Camperdown, NSW, Australia.
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Song SJ, Han K, Choi KS, Ko SH, Rhee EJ, Park CY, Park JY, Lee KU, Ko KS. Trends in diabetic retinopathy and related medical practices among type 2 diabetes patients: Results from the National Insurance Service Survey 2006-2013. J Diabetes Investig 2017; 9:173-178. [PMID: 28294558 PMCID: PMC5754522 DOI: 10.1111/jdi.12655] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 02/06/2017] [Accepted: 02/26/2017] [Indexed: 11/25/2022] Open
Abstract
Aims/Introduction The present study aimed to analyze the temporal changes in the prevalence, screening rate, visual impairments and treatment patterns of diabetic retinopathy in the Korean population over 8 years. Materials and Methods This was a retrospective population‐based study of Korean national health insurance beneficiaries aged 30 years or older with type 2 diabetes, obtained from the Korean National Health Insurance Claims database from 2006 to 2013 (n = 1,655,495 in 2006 and 2,720,777 in 2013). The annual prevalence rates of diabetes, diabetic retinopathy, dilated fundus examinations, visual impairment, laser treatment and vitrectomy, as determined based on diagnostic and treatment codes, were analyzed. Results There was a steady increase in the prevalence of diabetic retinopathy, from 14.3% in 2006 to 15.9% in 2013. However, the incidence of new diabetic retinopathy cases decreased from 6.7/100 person‐years in 2006 to 5.6 in 2013. Approximately 98% of patients underwent at least one dilated fundus examination during the follow‐up period. The prevalence of diabetic retinopathy peaked in the 60–69 years age group. The prevalence of diabetic retinopathy was higher in female than in male diabetes patients. The proportion of patients who underwent an annual dilated fundus examination improved from 24.3% in 2006 to 30.0% in 2013. Among patients with diabetic retinopathy, constant decreases in the proportions of those who received laser treatment (11.4% in 2006 to 6.9% in 2013) and who underwent vitrectomy (2.4% in 2006 to 1.7% in 2013) were noted. Additionally, a decreasing trend in the prevalence of visual impairment was noted among the patients with diabetic retinopathy, from 2% (4,820/237,267) in 2006 to 0.08% (3,572/431,964) in 2013. Conclusions Although there was a rapid increase in the prevalence of diabetes in the Korean population in the past decade, the prevalence of diabetic retinopathy remained stable during the study period. However, just three out of 10 patients with diabetes underwent regular annual dilated fundus examinations. Thus, an improvement in the continuity of diabetic retinopathy screening among patients with diabetes is necessary to reduce the risk of visual impairment as a result of diabetic retinopathy.
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Affiliation(s)
- Su Jeong Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistics, Catholic University College of Medicine, Seoul, Korea
| | - Kyung Seek Choi
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong-Yeol Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Up Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Soo Ko
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Abstract
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.
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Lu J, Hou X, Zhang L, Jiang F, Hu C, Bao Y, Jia W. Association between body mass index and diabetic retinopathy in Chinese patients with type 2 diabetes. Acta Diabetol 2015; 52:701-8. [PMID: 25604042 DOI: 10.1007/s00592-014-0711-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/30/2014] [Indexed: 12/19/2022]
Abstract
AIMS To explore the factors mediating the relationship between body mass index (BMI) and diabetic retinopathy (DR) in Chinese type 2 diabetes patients. METHODS This is a cross-sectional study. Data of 2,533 patients with type 2 diabetes were studied from the Shanghai Diabetes Registry Database. DR was assessed using non-mydriatic fundus photography and graded as non-DR, mild-moderate (DR I-II), and sight-threatening (DR III-IV). BMI (kg/m(2)) was classified as normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). β cell function was evaluated by fasting C-peptide (FCP). RESULTS DR was present in 701 (27.7 %) patients. Patients with DR had lower BMI (24.3 vs. 24.9 kg/m(2), P = 0.001) and fasting C-peptide (1.46 vs. 1.86 ng/ml, P < 0.001) than those without DR. The association between BMI (2 kg/m(2) interval) and DR was U-shaped; patients with BMI 28-29.9 kg/m(2) had the lowest DR rate. Compared with normal weight, overweight was associated with reduced risk of any DR [odds ratio (OR) 0.73], DR I-II (OR 0.76), and DR III-IV (OR 0.64) after adjustment for sex, age at diabetes diagnosis, and duration of diabetes. This negative association attenuated after adjustment for other confounders and became nonsignificant after further adjustment for FCP. Patients with different BMI categories had similar DR risk when stratified by FCP tertiles. CONCLUSION Overweight patients have lower DR prevalence than normal weight individuals, which may be attributable to better β cell function in overweight patients.
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Affiliation(s)
- Jun Lu
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
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Hu Y, Teng W, Liu L, Chen K, Liu L, Hua R, Chen J, Zhou Y, Chen L. Prevalence and risk factors of diabetes and diabetic retinopathy in Liaoning province, China: a population-based cross-sectional study. PLoS One 2015; 10:e0121477. [PMID: 25785633 PMCID: PMC4364908 DOI: 10.1371/journal.pone.0121477] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 02/11/2015] [Indexed: 11/25/2022] Open
Abstract
Aim To evaluate the prevalence and risk factors of diabetes and diabetic retinopathy (DR) in northeast area of China with a population-based study. Methods A population of 3173 (aged from 20 to 80 years old) was stratified by geographical location and age in Liaoning province, China. Prediabetes and diabetes were diagnosed according to the guideline of American Diabetes Association. Retinal photographs were obtained by using digital non-mydriatic camera for the presence and grading of DR according to the modified ETDRS Airlie house classification. Blood samples and comprehensive questionnaires were obtained for evaluation of laboratory results and risk factors. Results The prevalence of prediabetes and diabetes was 20.7% and 10.4%, respectively. Among diabetes patients, DR prevalence was 11.9%. Age, obesity, total cholesterol, triglycerides, hypertension, living in rural areas and diabetes family history are all risk factors for prediabetes and diabetes. Waist-to-hip circumference rate served as a better obesity index to estimate diabetes risk compared with body mass index and waist circumference. Among all risk factors that we investigated, only the length of diabetes history was associated with the incidence of DR. However, DR prevalence in the newly discovered patients in rural areas was significantly higher than that in urban areas. Conclusion According to this study, 1 in 10 people has diabetes, 2 in 10 people have prediabetes, and 1 in 10 diabetics has DR in Liaoning province. In rural areas, diabetes was poorly recognized with limited medical resources, which probably resulted in more diabetes patient at a high risk of DR.
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Affiliation(s)
- Yuedong Hu
- Department of Ophthalmology, the First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, the People’s Republic of China
- Diabetic Eye Center of Liaoning province, Shenyang City, Liaoning Province, the People’s Republic of China
| | - Weiping Teng
- Department of Endocrinology, the First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, the People’s Republic of China
- The key Laboratory of Endocrine diseases of Liaoning Province, Shenyang City, Liaoning Province, the People’s Republic of China
| | - Limin Liu
- Department of Ophthalmology, the First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, the People’s Republic of China
- Diabetic Eye Center of Liaoning province, Shenyang City, Liaoning Province, the People’s Republic of China
| | - Kang Chen
- Department of Ophthalmology, the First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, the People’s Republic of China
| | - Lei Liu
- Department of Ophthalmology, the First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, the People’s Republic of China
- Diabetic Eye Center of Liaoning province, Shenyang City, Liaoning Province, the People’s Republic of China
| | - Rui Hua
- Department of Ophthalmology, the First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, the People’s Republic of China
| | - Jun Chen
- Department of Ophthalmology, the First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, the People’s Republic of China
| | - Yun Zhou
- Department of Ophthalmology, the First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, the People’s Republic of China
| | - Lei Chen
- Department of Ophthalmology, the First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, the People’s Republic of China
- Diabetic Eye Center of Liaoning province, Shenyang City, Liaoning Province, the People’s Republic of China
- The key Laboratory of Endocrine diseases of Liaoning Province, Shenyang City, Liaoning Province, the People’s Republic of China
- * E-mail:
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C-peptide ameliorates renal injury in type 2 diabetic rats through protein kinase A-mediated inhibition of fibronectin synthesis. Biochem Biophys Res Commun 2015; 458:674-680. [DOI: 10.1016/j.bbrc.2015.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/04/2015] [Indexed: 12/16/2022]
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Wu J, Li X, Tao Y, Wang Y, Peng Y. Free Triiodothyronine Levels Are Associated with Diabetic Nephropathy in Euthyroid Patients with Type 2 Diabetes. Int J Endocrinol 2015; 2015:204893. [PMID: 26697065 PMCID: PMC4677198 DOI: 10.1155/2015/204893] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/05/2015] [Accepted: 11/12/2015] [Indexed: 12/20/2022] Open
Abstract
Objective. To investigate the association of thyroid function and diabetic nephropathy (DN) in euthyroid patients with type 2 diabetes. Methods. A total of 421 patients were included in this cross-sectional study. The following parameters were assessed: anthropometric measurements, fast plasma glucose, serum creatinine, lipid profile, HbA1c, free triiodothyronine (FT3), free thyroxine, thyroid-stimulating hormone levels, and urinary albumin-to-creatinine ratio (UACR). Patients with UACR of ≥30 mg/g were defined as those suffering from DN. Results. Of the 421 patients, 203 (48.2%) suffered from DN, and no difference was found between males and females. The patients with DN yielded significantly lower FT3 levels than those without DN (P < 0.01). The prevalence of DN showed a significantly decreasing trend across the three tertiles based on FT3 levels (59.6%, 46.4%, and 38.6%, P < 0.01). After adjustment for gender and age, FT3 levels were found to correlate positively with estimated glomerular filtration rate (P = 0.03) and negatively with UACR (P < 0.01). Multiple linear regression analysis showed that FT3 level was independently associated with UACR (β = -0.18, t = -3.70, and P < 0.01). Conclusion. Serum FT3 levels are inversely associated with DN in euthyroid patients with type 2 diabetes, independent of traditional risk factors.
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Affiliation(s)
- Jingcheng Wu
- Department of Endocrinology and Metabolism, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Xiaohua Li
- Department of Endocrinology and Metabolism, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Yang Tao
- Department of Clinical Laboratory, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu 212002, China
| | - Yufei Wang
- Department of Endocrinology and Metabolism, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Yongde Peng
- Department of Endocrinology and Metabolism, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China
- *Yongde Peng:
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