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Sebastian-Valles F, Martínez-Alfonso J, Arranz Martin JA, Jiménez-Díaz J, Hernando Alday I, Navas-Moreno V, Armenta-Joya T, Fandiño García MDM, Román Gómez GL, Garai Hierro J, Lobariñas LEL, González-Ávila C, Martinez de Icaya P, Martínez-Vizcaíno V, Marazuela M, Sampedro-Nuñez MA. Time above range and no coefficient of variation is associated with diabetic retinopathy in individuals with type 1 diabetes and glycated hemoglobin within target. Acta Diabetol 2024:10.1007/s00592-024-02347-5. [PMID: 39105807 DOI: 10.1007/s00592-024-02347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
AIMS This study aimed to investigate the association between glucose metrics and diabetic retinopathy in type 1 diabetes (T1D) patients using flash continuous glucose monitoring (FGM) systems, including those maintaining glycated hemoglobin (HbA1c) within the target range. METHODS We conducted a cross-sectional study involving 1070 T1D patients utilizing FGM systems. Data on clinical, anthropometric, and socioeconomic characteristics were collected and retinopathy was classified based on international standards. RESULTS Patients' mean age was 47.6 ± 15.0 years, with 49.4% of them being females. Within the cohort, 24.8% of patients presented some form of retinopathy. In the analysis involving the entire sample of subjects, male gender (OR = 1.51, p = 0.027), Time Above Range (TAR) > 250 mg/dL (OR = 1.07, p = 0.025), duration of diabetes (OR = 1.09, p < 0.001), smoking (OR = 2.30, p < 0.001), and history of ischemic stroke (OR = 5.59, p = 0.025) were associated with diabetic retinopathy. No association was observed between the coefficient of variation and diabetic retinopathy (p = 0.934). In patients with HbA1c < 7%, the highest quartile of TAR > 250 was independently linked to diabetic retinopathy (OR = 8.32, p = 0.040), in addition to smoking (OR = 2.90, p = 0.031), duration of diabetes (OR = 1.09, p < 0.001), and hypertension (OR = 2.35, p = 0.040). CONCLUSION TAR > 250 mg/dL significantly emerges as a modifiable factor associated with diabetic retinopathy, even among those patients maintaining recommended HbA1c levels. Understanding glucose metrics is crucial for tailoring treatment strategies for T1D patients.
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Affiliation(s)
- Fernando Sebastian-Valles
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, 28006, Spain.
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Hospital Universitario de La Princesa, Talca, Chile.
- Hospital Universitario de La Princesa, Diego de León 62, Madrid, 28005, Spain.
| | - Julia Martínez-Alfonso
- Department of Family and Community Medicine, Hospital La Princesa/Centro de Salud Daroca, Madrid, 28006, Spain
| | - Jose Alfonso Arranz Martin
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, 28006, Spain
| | - Jessica Jiménez-Díaz
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, Leganés, Madrid, 28194, Spain
| | - Iñigo Hernando Alday
- Department of Endocrinology and Nutrition, Hospital Universitario Basurto, Bilbao, 48013, Spain
| | - Victor Navas-Moreno
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, 28006, Spain
| | - Teresa Armenta-Joya
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, 28006, Spain
| | | | - Gisela Liz Román Gómez
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, Leganés, Madrid, 28194, Spain
| | - Jon Garai Hierro
- Department of Endocrinology and Nutrition, Hospital Universitario Basurto, Bilbao, 48013, Spain
| | | | - Carmen González-Ávila
- Department of Neurology, Hospital Universitario Infanta Elena, Valdemoro, 28342, Spain
| | | | - Vicente Martínez-Vizcaíno
- Department of Neurology, Hospital Universitario Infanta Elena, Valdemoro, 28342, Spain
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, Cuenca, 16071, Spain
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, 28006, Spain
| | - Miguel Antonio Sampedro-Nuñez
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, 28006, Spain
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Özata Gündoğdu K, Doğan E, Çelik E, Alagöz G. Retinal nerve fiber layer and ganglion cell complex thickness in diabetic smokers without diabetic retinopathy. Cutan Ocul Toxicol 2024; 43:22-26. [PMID: 37874321 DOI: 10.1080/15569527.2023.2268162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE To compare the thickness of the retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC-IPL) in smoker and nonsmoker diabetics without diabetic retinopathy. MATERIALS AND METHODS Patients with diabetes were divided into two groups according to their smoking status: Group 1 consisted of 38 smoker diabetics who had chronically smoked more than 20 cigarettes per day for more than five years; Group 2 consisted of 38 nonsmoker diabetics. After a detailed ophthalmologic examination, the mean and regional (superior, supratemporal, inferior, inferotemporal, temporal, nasal, superonasal, and inferonasal) RNFL and GC-IPL thicknesses were measured with spectral-domain optic coherence tomography (SD-OCT) and compared between groups. RESULTS The mean age was 54.7 ± 10.5 and 51.2 ± 9.7 years in the smoker and nonsmoker groups, respectively (p = 0.14). Gender, duration of diabetes, and the mean axial length were similar between groups (p:0.43, p:0.54, p: 0.52, respectively). Mean RNFL thickness was 89.1 ± 8.0 µm in the smoker group and 93.4 ± 7.0 µm in the nonsmoker group, and it was significantly thinner in the smoker group (p = 0.01). The temporal RNFL thickness in the smoker group was thinner than in the nonsmoker group (p = 0.02). There was no difference in superior, inferior, and nasal RNFL thicknesses between the groups (p = 0.31, p = 0.12, p = 0.39, respectively). The mean macular GC-IPL thickness of the smoker and nonsmoker groups was 78.53 ± 15.74 µm and 83.08 ± 5.85 µm, respectively (p = 0.09). Superior, superonasal, inferonasal, inferior, inferotemporal, and superotemporal quadrant GC-IPL thicknesses were similar between the groups (p = 0.07, p = 0.60, p = 0.55, p = 0.77, p = 0.71, p = 0.08, respectively). The groups showed no difference in minimum GC-IPL thickness (p = 0.43). There was a significant negative correlation between smoking exposure and mean, inferior quadrant RNFL thicknesses in the smoker group (p = 0.04, r= -0.32, and p = 0.01, r= -0.39, respectively). CONCLUSION Mean RNFL thickness was significantly thinner in smoker diabetics. Although not statistically significant, especially mean, superior, and superotemporal GC-IPL was thinner in smoker diabetics. The results suggest a potential association between the coexistence of diabetes and smoking with alterations in RNFL and GC-IPL thickness.
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Affiliation(s)
- Kübra Özata Gündoğdu
- Department of Ophthalmology, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Emine Doğan
- Department of Ophthalmology, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Erkan Çelik
- Department of Ophthalmology, Sakarya University Education and Research Hospital, Sakarya, Turkey
| | - Gürsoy Alagöz
- Department of Ophthalmology, Sakarya University Education and Research Hospital, Sakarya, Turkey
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Simó R, Hernández C. What else can we do to prevent diabetic retinopathy? Diabetologia 2023; 66:1614-1621. [PMID: 37277664 PMCID: PMC10390367 DOI: 10.1007/s00125-023-05940-5] [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: 01/04/2023] [Accepted: 03/31/2023] [Indexed: 06/07/2023]
Abstract
The classical modifiable factors associated with the onset and progression of diabetic retinopathy are the suboptimal control of blood glucose levels and hypertension, as well as dyslipidaemia. However, there are other less recognised modifiable factors that can play a relevant role, such as the presence of obesity or the abnormal distribution of adipose tissue, and others related to lifestyle such as the type of diet, vitamin intake, exercise, smoking and sunlight exposure. In this article we revisit the prevention of diabetic retinopathy based on modulating the modifiable risk factors, as well as commenting on the potential impact of glucose-lowering drugs on the condition. The emerging concept that neurodegeneration is an early event in the development of diabetic retinopathy points to neuroprotection as a potential therapeutic strategy to prevent the advanced stages of the disease. In this regard, the better phenotyping of very early stages of diabetic retinopathy and the opportunity of arresting its progression using treatments targeting the neurovascular unit (NVU) are discussed.
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Affiliation(s)
- Rafael Simó
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain.
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM, ID CB15/00071), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Cristina Hernández
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM, ID CB15/00071), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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El-Tawab SS, Ibrahim IK, Megallaa MH, Mgeed RMA, Elemary WS. Neutrophil–lymphocyte ratio as a reliable marker to predict pre-clinical retinopathy among type 2 diabetic patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023. [DOI: 10.1186/s43166-023-00177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Abstract
Background
Diabetic retinopathy is now recognized as a neurovascular in lieu of a microvascular complication. Visual evoked potentials (VEPs) are greatly valuable in detecting early diabetic retinal functional changes before the occurrence of structural damage. Low-grade inflammation plays a fundamental part in the development and progression of retinopathy in diabetics. Detecting diabetic patients with early retinopathy before the occurrence of clinical symptoms provides a window of opportunity to ensure the best prognosis for these eyes. Neutrophil–lymphocyte ratio (NLR) has recently been introduced as a novel marker of inflammation in various diseases. Indeed, the presence of a cheap, available, and reliable marker of inflammation that is capable to detect pre-clinical diabetic retinopathy (P-DR) is crucial for early intervention to retard the progression of ocular damage. As far as we know no previous studies investigated the role of NLR in the detection of P-DR. The aim of this study was to investigate the quality of prediction of NLR in detecting pre-clinical retinopathy in type 2 diabetic patients.
Results
In this case–control study, VEPs results showed a significant delay in P100 latencies of the patients’ group compared to the control group. According to the VEPs results, the patient group was further subdivided into two: diabetic with VEPs changes (a group with P-DR) and diabetic without VEPs changes. NLR was significantly elevated in patients with P-DR (p < 0.001). NLR cut-off point ≥ 1.97 is able to predict P-DR with 89.29% sensitivity and 84.37% specificity. Linear regression model revealed that NLR is the only independent factor that predicts P-DR. (odds ratio 3.312; 95% confidence interval 1.262–8.696, p = 0.015*.
Conclusions
Visual evoked potentials have an important role to evaluate the visual pathway in diabetics and to diagnose pre-clinical diabetic retinopathy before the occurrence of structural damage. Neutrophil–lymphocyte ratio is a reliable marker for the detection of pre-clinical diabetic retinopathy with good sensitivity (89.29%) and specificity (84.37%). Finding a reliable available laboratory test to predict P-DR could be of help to save diabetic patients from serious ocular complications.
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Moir J, Rodriguez SH, Chun LY, Massamba N, Skondra D. Racial differences in quantitative optical coherence tomography angiography findings between older non-diabetics with co-morbidities. PLoS One 2023; 18:e0285360. [PMID: 37146056 PMCID: PMC10162566 DOI: 10.1371/journal.pone.0285360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/22/2023] [Indexed: 05/07/2023] Open
Abstract
This cross-sectional study compared optical coherence tomography angiography (OCTA) parameters between older Black and White adults with systemic comorbidities in an effort to further understand racial differences in the retinal microvasculature. We analyzed vessel density at the superficial (SCP), intermediate (ICP), and deep capillary plexuses (DCP), foveal avascular zone (FAZ) parameters, and blood flow area (BFA) at the choriocapillaris. We used a mixed-effects linear regression model, controlling for hypertension and two eyes from the same subject, to compare OCTA parameters. Black subjects had lower foveal vessel density at the SCP and ICP, while no differences were observed at the parafovea or 3x3 mm macular area of any capillary layer. Black subjects had greater FAZ area, perimeter, and FD-300, a measurement of vessel density in a 300 μm wide ring around the FAZ. Black subjects also had lower BFA at the choriocapillaris. Within a cohort of subjects without hypertension, these differences remained statistically significant, with the exception of foveal vessel density at the SCP and foveal BFA of the choriocapillaris. These findings suggest that normative databases of OCTA parameters must strive to be diverse in nature to adequately capture differences across patient populations. Further study is required to understand if baseline differences in OCTA parameters contribute to epidemiological disparities in ocular diseases.
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Affiliation(s)
- John Moir
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Sarah H Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, United States of America
| | - Lindsay Y Chun
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, United States of America
| | - Nathalie Massamba
- Department of Ophthalmology, Handicap, and Vision, Pitie Salpetriere Hospital, Sorbonne University, Paris, France
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, United States of America
- J. Terry Ernest Ocular Imaging Center, University of Chicago, Chicago, Illinois, United States of America
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Kellner U, Kellner S, Weinitz S, Farmand G. [Exogenously induced retinopathies]. Klin Monbl Augenheilkd 2022; 239:1493-1511. [PMID: 36395811 DOI: 10.1055/a-1961-8166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Exogenously induced retinopathies can be caused by consumation of stimulating substances, systemic or ocular medications, vaccinations, light or irradiation. Some of the effects are transient, whereas other effects induce irreversible toxic reactions. Retinal damage may develop either acutely with obvious relation to the damaging cause, but often may take a long duration of repeated use of a substance or medication. External stimulants (e.g. nicotine, alcohol, poppers, methanol) are the most frequent cause of exogenously induced retinal damage. Side effects from systemic drugs (e.g. hydroxychloroquine, ethambutol, MEK-, ERK-, FLT3-, checkpoint inhibitors, didanosin, pentosanpolysulfat sodium) or intravitreally applied drugs (e.g. antibiotics, VEGF-inhibitors) are less frequent. Ocular side effects associated with vaccinations are rare. Ambient light sources induce no damaging effects on the retina. Incorrect use of technical or medical light sources (e.g. laser pointers) without adherence to safety recommendations or unshielded observation of the sun might induce permanent retinal damage. Local or external irradiation might induce retinal vascular damage resulting in radiation retinopathy.
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Kellner U, Kellner S, Weinitz S, Farmand G. Exogen bedingte Retinopathien. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1879-7221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
ZusammenfassungExogen bedingte Retinopathien werden am häufigsten durch externe Stimulanzien, seltener durch unerwünschte Arzneimittelwirkungen systemisch oder intravitreal eingesetzter Medikamente und
noch seltener durch Impfungen oder die Einwirkung von Lichtstrahlung verursacht. Die Kenntnis exogener Ursachen und ihre mögliche Symptomatik ist zur Prophylaxe oder zur Früherkennung
schädigender Wirkungen und zur adäquaten Beratung der Patienten wichtig.
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Reduced Vessel Density in the Mid-Periphery and Peripapillary Area of the Superficial Capillary Plexus in Non-Proliferative Diabetic Retinopathy. J Clin Med 2022; 11:jcm11030532. [PMID: 35159984 PMCID: PMC8836591 DOI: 10.3390/jcm11030532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
Our aim in this study was to assess the vessel density (VD) and vessel skeleton density (VSD) in the nasal area of the superficial capillary plexus (SCP) of diabetic subjects without diabetic retinopathy (DR), or in those with a non-proliferative diabetic retinopathy (NPDR), and to evaluate the relationship between the VD and VSD and the severity of DR. In this prospective study, the VD and VSD in the SCP were measured and analyzed on 6 × 6-mm macular and nasal optical coherence tomography angiography scans. The three concentric circles of the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid were used and divided into zones numbered from 1 to 9 in the macular area and from 1 to 8 in the nasal area. The VD was significantly lower in the nasal peripapillary area (p = 0.0028), and both the VD and VSD were significantly lower in the macular area (p = 0.0131 and p = 0.0132, respectively) in patients with more severe DR. The SD was significantly lower in zones 5 (p = 0.0315) and 6 (p = 0.0324) in the nasal grid in patients with more severe DR. We showed a lower superficial capillary flow in the nasal periphery and peripapillary area in patients with more severe DR.
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Alé-Chilet A, Bernal-Morales C, Barraso M, Hernández T, Oliva C, Vinagre I, Ortega E, Figueras-Roca M, Sala-Puigdollers A, Esquinas C, Gimenez M, Esmatjes E, Adán A, Zarranz-Ventura J. Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus-Report 2: Diabetic Kidney Disease. J Clin Med 2021; 11:197. [PMID: 35011940 PMCID: PMC8745787 DOI: 10.3390/jcm11010197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study is to investigate potential associations between optical coherence tomography angiography (OCTA) parameters and diabetic kidney disease (DKD) categories in type 1 diabetes mellitus (T1DM) patients and controls. A complete ocular and systemic examination, including OCTA imaging tests and bloods, was performed. OCTA parameters included vessel density (VD), perfusion density (PD), foveal avascular zone area (FAZa), perimeter (FAZp) and circularity (FAZc) in the superficial vascular plexus, and DKD categories were defined according to glomerular filtration rate (GFR), albumin-creatinine ratio (ACR) and KDIGO prognosis risk classifications. A total of 425 individuals (1 eye/1 patient) were included. Reduced VD and FAZc were associated with greater categories of GFR (p = 0.002, p = 0.04), ACR (p = 0.003, p = 0.005) and KDIGO risk prognosis classifications (p = 0.002, p = 0.005). FAZc was significantly reduced in greater KDIGO prognosis risk categories (low risk vs. moderate risk, 0.65 ± 0.09 vs. 0.60 ± 0.07, p < 0.05). VD and FAZc presented the best diagnostic performance in ROCs. In conclusion, OCTA parameters, such as VD and FAZc, are able to detect different GFR, ACR, and KDIGO categories in T1DM patients and controls in a non-invasive, objective quantitative way. FAZc is able to discriminate within T1DM patients those with greater DKD categories and greater risk of DKD progression.
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Affiliation(s)
- Aníbal Alé-Chilet
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
| | - Carolina Bernal-Morales
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| | - Marina Barraso
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
| | - Teresa Hernández
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Cristian Oliva
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Irene Vinagre
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Emilio Ortega
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08036 Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Cristina Esquinas
- Respiratory Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Marga Gimenez
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Enric Esmatjes
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Alfredo Adán
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Javier Zarranz-Ventura
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
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Maeda-Gutiérrez V, Galván-Tejada CE, Cruz M, Galván-Tejada JI, Gamboa-Rosales H, García-Hernández A, Luna-García H, Gonzalez-Curiel I, Martínez-Acuña M. Risk-Profile and Feature Selection Comparison in Diabetic Retinopathy. J Pers Med 2021; 11:1327. [PMID: 34945799 PMCID: PMC8705564 DOI: 10.3390/jpm11121327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
One of the main microvascular complications presented in the Mexican population is diabetic retinopathy which affects 27.50% of individuals with type 2 diabetes. Therefore, the purpose of this study is to construct a predictive model to find out the risk factors of this complication. The dataset contained a total of 298 subjects, including clinical and paraclinical features. An analysis was constructed using machine learning techniques including Boruta as a feature selection method, and random forest as classification algorithm. The model was evaluated through a statistical test based on sensitivity, specificity, area under the curve (AUC), and receiving operating characteristic (ROC) curve. The results present significant values obtained by the model obtaining 69% of AUC. Moreover, a risk evaluation was incorporated to evaluate the impact of the predictors. The proposed method identifies creatinine, lipid treatment, glomerular filtration rate, waist hip ratio, total cholesterol, and high density lipoprotein as risk factors in Mexican subjects. The odds ratio increases by 3.5916 times for control patients which have high levels of cholesterol. It is possible to conclude that this proposed methodology is a preliminary computer-aided diagnosis tool for clinical decision-helping to identify the diagnosis of DR.
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Affiliation(s)
- Valeria Maeda-Gutiérrez
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro 98000, Mexico; (V.M.-G.); (J.I.G.-T.); (H.G.-R.); (A.G.-H.); (H.L.-G.)
| | - Carlos E. Galván-Tejada
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro 98000, Mexico; (V.M.-G.); (J.I.G.-T.); (H.G.-R.); (A.G.-H.); (H.L.-G.)
| | - Miguel Cruz
- Unidad de Investigación Médica en Bioquímica, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Instituto Mexicano del Seguro Social, Mexico City, Av. Cuauhtémoc 330, Col. Doctores, Del. Cuauhtémoc, Ciudad de Mexico 06720, Mexico;
| | - Jorge I. Galván-Tejada
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro 98000, Mexico; (V.M.-G.); (J.I.G.-T.); (H.G.-R.); (A.G.-H.); (H.L.-G.)
| | - Hamurabi Gamboa-Rosales
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro 98000, Mexico; (V.M.-G.); (J.I.G.-T.); (H.G.-R.); (A.G.-H.); (H.L.-G.)
| | - Alejandra García-Hernández
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro 98000, Mexico; (V.M.-G.); (J.I.G.-T.); (H.G.-R.); (A.G.-H.); (H.L.-G.)
| | - Huizilopoztli Luna-García
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro 98000, Mexico; (V.M.-G.); (J.I.G.-T.); (H.G.-R.); (A.G.-H.); (H.L.-G.)
| | - Irma Gonzalez-Curiel
- Unidad Académica de Ciencias Químicas, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro 98000, Mexico; (I.G.-C.); (M.M.-A.)
| | - Mónica Martínez-Acuña
- Unidad Académica de Ciencias Químicas, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro 98000, Mexico; (I.G.-C.); (M.M.-A.)
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