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Dai G, Yu S, Hu S, Luan X, Yan H, Wang X, Song P, Liu X, He X. A Novel Method for the Measurement of Retinal Arteriolar Bifurcation. Ophthalmol Ther 2024; 13:917-933. [PMID: 38294630 PMCID: PMC10912395 DOI: 10.1007/s40123-023-00881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION The purpose of this research was to develop protocols for evaluating the bifurcation parameters of retinal arteriole and establish a reference range of normal values. METHODS In this retrospective study, we measured a total of 1314 retinal arteriolar bifurcations from 100 fundus photographs. We selected 200 from these bifurcations for testing inter-measurer and inter-method agreement. Additionally, we calculated the normal reference range for retinal arteriolar bifurcation parameters and analyzed the effects of gender, age, and anatomical features on retinal arteriolar bifurcation. RESULTS The measurement method proposed in this study has demonstrated nearly perfect consistency among different measurers, with interclass correlation coefficient (ICC) for all bifurcation parameters of retinal arteriole exceeding 0.95. Among healthy individuals, the retinal arteriolar caliber was narrowest in young adults and increased in children, teenagers, and the elderly; retinal arteriolar caliber was greater in females than in males; and the diameter of the inferior temporal branch exceeded that of the superior temporal branch. The angle between the two branches of retinal arteriolar bifurcation was also greater in females than in males. When using the center of the optic disc as a reference point, the angle between the two branches of the retinal arteriole at the proximal or distal ends increased. In contrast, the estimated optimum theoretical values of retinal arteriolar bifurcation were not affected by these factors. CONCLUSIONS The method for the measurement of retinal arteriolar bifurcation in this study was highly accurate and reproducible. The diameter and branching angle of the retinal arteriolar bifurcation were more susceptible to the influence of gender, age, and anatomical features. In comparison, the estimated optimum theoretical values of retinal arteriolar bifurcation were relatively stable. Video available for this article.
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Affiliation(s)
- Guangzheng Dai
- Dragonfleye Healthcare Technology LLC, Shenyang, China
- He Eye Specialist Hospital, Shenyang, China
| | - Sile Yu
- Department of Public Health, He University, Shenyang, 110034, China
| | - Shenming Hu
- Department of Public Health, He University, Shenyang, 110034, China
| | - Xinze Luan
- Department of Public Health, He University, Shenyang, 110034, China
| | - Hairu Yan
- Dragonfleye Healthcare Technology LLC, Shenyang, China
| | - Xiaoting Wang
- Department of Public Health, He University, Shenyang, 110034, China
| | | | - Xinying Liu
- Dragonfleye Healthcare Technology LLC, Shenyang, China
| | - Xingru He
- Department of Public Health, He University, Shenyang, 110034, China.
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Wong TY, Tan TE. The Diabetic Retinopathy "Pandemic" and Evolving Global Strategies: The 2023 Friedenwald Lecture. Invest Ophthalmol Vis Sci 2023; 64:47. [PMID: 38153754 PMCID: PMC10756246 DOI: 10.1167/iovs.64.15.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/30/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Tien Yin Wong
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore
- Duke-National University of Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Tien-En Tan
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore
- Duke-National University of Singapore, Singapore
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Huang Y, Yuan Y, Seth I, Bulloch G, Cheng W, Chen Y, Shang X, Kiburg K, Zhu Z, Wang W. Optic Nerve Head Capillary Network Quantified by Optical Coherence Tomography Angiography and Decline of Renal Function in Type 2 Diabetes: A Three-Year Prospective Study. Am J Ophthalmol 2023; 253:96-105. [PMID: 37059318 DOI: 10.1016/j.ajo.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE To assess the association of optic capillary perfusion with decline in the estimated glomerular filtration rate (eGFR) and to clarify its added value. DESIGN Prospective, observational cohort study. METHODS Patients with type 2 diabetes mellitus without diabetic retinopathy (non-DR) underwent standardized examinations annually during a 3-year follow-up period. The superficial capillary plexus (SCP), deep capillary plexus (DCP), and radial peripapillary plexus (RPC) of optic nerve head (ONH) were visualized using optical coherence tomography angiography (OCTA), and the perfusion density (PD) and vascular density were quantified for the whole image and circumpapillary regions of the ONH. The lowest tercile of annual eGFR slope was defined as the rapidly progressive group, and the highest tercile was considered the stable group. RESULTS A total of 906 patients were included for 3-mm × 3-mm OCTA analysis. After adjusting for other confounders, each 1% decrease in baseline whole en face PD in SCP and RPC was associated with accelerated rates of decline in eGFR by -0.53 mL/min/1.73/m2 per year (95% confidence interval [CI] -0.17 to -0.90; P = .004) and -0.60 mL/min/1.73/m2 per year (95% CI 0.28-0.91), respectively. Adding both whole-image PD in SCP and whole-image PD in RPC to the conventional model increased the area under the curve from 0.696 (95% CI 0.654-0.737) to 0.725 (95% CI 0.685-0.765; P = .031). Another cohort of 400 eligible patients with 6-mm × 6 mm OCTA imaging validated the significant associations between ONH perfusion and rate of eGFR decline (P < .05). CONCLUSIONS Reduced capillary perfusion of ONH in patients with type 2 diabetes mellitus is associated with a greater eGFR decline, and it has additional predictive value for detecting an early stage and progression.
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Affiliation(s)
- Yining Huang
- From Nanshan School (Y.H.), Guangzhou Medical University, Guangzhou, China
| | - Yixiong Yuan
- State Key Laboratory of Ophthalmology (Y.Y., W.C., W.W.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ishith Seth
- Centre for Eye Research Australia (I.S., G.B., X.S., K.K., Z.Z.), Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Gabriella Bulloch
- Centre for Eye Research Australia (I.S., G.B., X.S., K.K., Z.Z.), Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Weijing Cheng
- State Key Laboratory of Ophthalmology (Y.Y., W.C., W.W.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yifan Chen
- John Radcliffe Hospital (Y.C.), Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Xianwen Shang
- Centre for Eye Research Australia (I.S., G.B., X.S., K.K., Z.Z.), Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Katerina Kiburg
- Centre for Eye Research Australia (I.S., G.B., X.S., K.K., Z.Z.), Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Zhuoting Zhu
- Centre for Eye Research Australia (I.S., G.B., X.S., K.K., Z.Z.), Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | - Wei Wang
- State Key Laboratory of Ophthalmology (Y.Y., W.C., W.W.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
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Brazionis L, Quinn N, Dabbah S, Ryan CD, Møller DM, Richardson H, Keech AC, Januszewski AS, Grauslund J, Rasmussen ML, Peto T, Jenkins AJ. Review and comparison of retinal vessel calibre and geometry software and their application to diabetes, cardiovascular disease, and dementia. Graefes Arch Clin Exp Ophthalmol 2023; 261:2117-2133. [PMID: 36801971 DOI: 10.1007/s00417-023-06002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/06/2023] [Accepted: 02/04/2023] [Indexed: 02/20/2023] Open
Abstract
Developments in retinal imaging technologies have enabled the quantitative evaluation of the retinal vasculature. Changes in retinal calibre and/or geometry have been reported in systemic vascular diseases, including diabetes mellitus (DM), cardiovascular disease (CVD), and more recently in neurodegenerative diseases, such as dementia. Several retinal vessel analysis softwares exist, some being disease-specific, others for a broader context. In the research setting, retinal vasculature analysis using semi-automated software has identified associations between retinal vessel calibre and geometry and the presence of or risk of DM and its chronic complications, and of CVD and dementia, including in the general population. In this article, we review and compare the most widely used semi-automated retinal vessel analysis softwares and their associations with ocular imaging findings in common systemic diseases, including DM and its chronic complications, CVD, and dementia. We also provide original data comparing retinal calibre grading in people with Type 1 DM using two softwares, with good concordance.
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Affiliation(s)
- Laima Brazionis
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicola Quinn
- NHMRC Clinical Trials Centre, The University of Sydney, 92 Parramatta Rd, Camperdown, NSW, 2050, Australia
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Sami Dabbah
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Chris D Ryan
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, 92 Parramatta Rd, Camperdown, NSW, 2050, Australia
| | - Dennis M Møller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hilary Richardson
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, 92 Parramatta Rd, Camperdown, NSW, 2050, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, The University of Sydney, 92 Parramatta Rd, Camperdown, NSW, 2050, Australia
| | - Andrzej S Januszewski
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.
- NHMRC Clinical Trials Centre, The University of Sydney, 92 Parramatta Rd, Camperdown, NSW, 2050, Australia.
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Malin Lundberg Rasmussen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
- Institute of Clinical Science, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
| | - Alicia J Jenkins
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, 92 Parramatta Rd, Camperdown, NSW, 2050, Australia
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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Hangartner K, Bajka A, Wiest MRJ, Sidhu S, Toro MD, Maloca PM, Zweifel SA. Assessment of Retinal Vessel Tortuosity Index in Patients with Fabry Disease Using Optical Coherence Tomography Angiography (OCTA). Diagnostics (Basel) 2023; 13:2496. [PMID: 37568859 PMCID: PMC10417007 DOI: 10.3390/diagnostics13152496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Vessel tortuosity (VT) is a parameter used to assess retinal involvement in patients affected by systemic diseases such as Fabry disease (FD). In this study, we assessed a retinal VT index (VTI) using optical coherence tomography angiography (OCTA) in a group of patients with FD (FD cohort) compared to a healthy control group (HC cohort). This is a single-center, retrospective study analysis of all consecutive patients with genetically tested and confirmed FD who underwent regular ophthalmological visits from December 2017 to January 2020 at the Department of Ophthalmology at the University Hospital of Zurich, Switzerland. VTI was calculated for each OCTA image and the results were compared between FD and HC cohort. A total of 56 participants, 32 (male:female ratio 12:20) in the FD cohort and 24 (male:female ratio 13:11) in the HC cohort. Classic onset was determined in 18 patients. Overall, mean VTI (±SD) was 0.21 (±0.07). Male patients with classic-onset FD had a significantly higher mean VTI (0.33, SD ± 0.35) compared to all other subgroups (p-value < 0.05). Further investigations of retinal VTI in patients with FD could be helpful to use OCTA as a noninvasive screening and follow-up modality to assess disease progression in affected patients.
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Affiliation(s)
- Kevin Hangartner
- Faculty of Human Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Anahita Bajka
- Faculty of Human Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Maximilian R. J. Wiest
- Faculty of Human Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Sophia Sidhu
- Faculty of Medicine, University of California San Diego, 5998 Alcala Park, San Diego, CA 92110, USA
| | - Mario D. Toro
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland
- Eye Clinic, Department of Public Health, University Federico II, 80131 Naples, Italy
| | - Peter M. Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031 Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, 4031 Basel, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| | - Sandrine A. Zweifel
- Faculty of Human Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland
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Liu G, Jiang A, Cao L, Ling S, Wang X, Bu S, Lu F. Optic disc and retinal vascular features in first 6 years of Chinese children. Front Pediatr 2023; 11:1101768. [PMID: 37033190 PMCID: PMC10077150 DOI: 10.3389/fped.2023.1101768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose Retinal microvasculature plays an important role in children's fundus lesions and even in their later life. However, little was known on the features of normal retina in early life. The purpose of this study was to explore the normal retinal features in the first 6 years of life and provide information for future research. Methods Children, aged from birth to 6 years old and diagnosed with various unilateral ocular diseases were included. Venous phase fundus fluorescein angiography images with the optic disc at the center were collected. Based on the ResUNet convolutional neural network, optic disc and retinal vascular features in the posterior retina were computed automatically. Results A total of 146 normal eyes of 146 children were included. Among different age groups, no changes were shown in the optic disc diameter (y = -0.00002x + 1.362, R2 = 0.025, p = 0.058). Retinal vessel density and fractal dimension are linearly and strongly correlated (r = 0.979, p < 0.001). Older children had smaller value of fractal dimension (y = -0.000026x + 1.549, R2 = 0.075, p = 0.001) and narrower vascular caliber if they were less than 3 years old (y = -0.008x + 84.861, R2 = 0.205, p < 0.001). No differences were in the density (y = -0.000007x + 0.134, R2 = 0.023, p = 0.067) and the curvature of retinal vessels (lnC = -0.00001x - 4.657, R2 = 0.001, p = 0.667). Conclusions Age and gender did not impact the optic disc diameter, vessel density, and vessel curvature significantly in this group of children. Trends of decreased vessel caliber in the first 3 years of life and decreased vessel complexity with age were observed. The structural characteristics provide information for future research to better understand the developmental origin of the healthy and diseased retina.
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Affiliation(s)
- Guina Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Anna Jiang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Le Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Saiguang Ling
- EVision Technology (Beijing) Co. LTD, Beijing, China
| | - Xi Wang
- EVision Technology (Beijing) Co. LTD, Beijing, China
| | - Shaochong Bu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
- Correspondence: Shaochong Bu Fang Lu
| | - Fang Lu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Shaochong Bu Fang Lu
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Wu L, Gong X, Wang W, Zhang L, Zhou J, Ming X, Yuan M, Huang W, Wang L. Association of retinal fractal dimension and vessel tortuosity with impaired renal function among healthy Chinese adults. Front Med (Lausanne) 2022; 9:925756. [PMID: 36117976 PMCID: PMC9479094 DOI: 10.3389/fmed.2022.925756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThis study investigated the association of retinal fractal dimension (FD) and blood vessel tortuosity (BVT) with renal function [assessed by estimated glomerular filtrate rate (eGFR)] in healthy Chinese adults using swept-source optical coherence tomographic angiography (SS-OCTA).Materials and methodsThis cross-sectional study was conducted among ocular treatment–naïve healthy participants from Guangzhou, China. FD and BVT in the superficial capillary plexus and deep capillary plexus were measured by SS-OCTA with a 3 × 3 macula model. eGFR was calculated using the Xiangya equation, and impaired renal function (IRF) was defined as eGFR = 90 mL/min/1.73 m2. Linear regression was performed to evaluate the relationships between SS-OCTA metrics and renal function.ResultsA total of 729 participants with a mean age of 57.6 ± 9.1 years were included in the final analysis. Compared to participants with normal renal function, those with IRF had lower FD both in the superficial capillary plexus (1.658 ± 0.029 vs. 1.666 ± 0.024, p = 0.001) and deep capillary plexus (1.741 ± 0.016 vs. 1.746 ± 0.016, p = 0.0003), while the deep BVT was larger in participants with IRF than those with normal renal function (1.007 ± 0.002 vs. 1.006 ± 0.002, p = 0.028). The superficial FD was linearly and positively associated with eGFR after adjusting for confounders (β = 0.2257; 95% CI 0.0829–0.3685; p = 0.002), while BVT was not associated with eGFR (all p ≥ 0.05).ConclusionThe patients with IRF had lower FD and larger BVT than those with normal renal function. The superficial FD decreased linearly with renal function deterioration. Our study suggests that the retinal microvasculature can represent a useful indicator of subclinical renal microvascular abnormalities and serve as a useful non-invasive assessment to predict and monitor the progression of renal function.
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Affiliation(s)
- Linbin Wu
- The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Xia Gong
- Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, China
| | - Lei Zhang
- The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Jiachen Zhou
- The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Xi Ming
- The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Meng Yuan
- Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, China
| | - Wenyong Huang
- Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wenyong Huang,
| | - Lanhua Wang
- Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, China
- Lanhua Wang,
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Vora KA, Munns CF, Donaghue KC, Craig ME, Briody J, Benitez‐Aguirre P. Childhood type 1 diabetes is associated with abnormal bone development. Pediatr Diabetes 2022; 23:773-782. [PMID: 35603554 PMCID: PMC9543480 DOI: 10.1111/pedi.13367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 03/22/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe bone mineral density (BMD), bone structure, and fracture prevalence in adolescents with type 1 diabetes (T1D) and explore their associations with glycemic control and microvascular complications. RESEARCH DESIGN AND METHODS Cross sectional study of 64 adolescents (38 males) with T1D duration >10 years who underwent dual-energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), fracture survey, plantar fascia thickness, and microvascular complications assessment. RESULTS Mean age was 16.6 ± 2.1 years, diabetes duration 12.8 ± 2.2 years and HbA1c 8.9 ± 1.7% (74 mmol/mol). Fracture prevalence was 50%. DXA areal BMD (Z-score) was reduced for femoral neck (-0.5 ± 1.3, p = 0.008) and arm (-0.4 ± 1.0, p < 0.001), while total areal BMD and lumbar spine BMD were normal. In pQCT (Z-score), trabecular volumetric BMD (vBMD) was reduced for tibia (-0.4 ± 0.8, p < 0.001) and radius (-0.8 ± 1.4, p < 0.001) whereas cortical vBMD was increased at both sites (tibia: 0.5 ± 0.6, p < 0.001, radius: 0.7 ± 1.5, p < 0.001). Muscle cross-sectional area (CSA) was reduced for upper (-0.6 ± 1.2, p < 0.001) and lower (-0.4 ± 0.7, p < 0.001) limbs. DXA total areal BMD was positively correlated with BMI (p < 0.01) and age at T1D diagnosis (p = 0.04). Lower radial bone CSA, total and lumbar spine BMD were associated with autonomic nerve dysfunction. HbA1c, diabetes duration, fracture history and other microvascular complications were not significantly associated with bone parameters. CONCLUSIONS Adolescents with childhood-onset T1D have site-specific bone deficits in upper and lower limbs but normal total and lumbar spine BMD. T1D appears to have differential effects on trabecular and cortical bone compartments. Future longitudinal analysis is warranted to examine whether these changes translate in to increased fracture risk.
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Affiliation(s)
- Komal Ashokbhai Vora
- Department of Paediatric EndocrinologyJohn Hunter Children's HospitalNew Lambton HeightsNew South WalesAustralia,School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia,Children's Hospital Westmead Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Craig F. Munns
- Children's Hospital Westmead Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia,Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Kim C. Donaghue
- Children's Hospital Westmead Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia,Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Maria E. Craig
- Children's Hospital Westmead Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia,Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia,School of Women's and Child's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Julie Briody
- Children's Hospital Westmead Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia,Department of Nuclear MedicineThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Paul Benitez‐Aguirre
- Children's Hospital Westmead Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia,Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
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Scanlon PH. Improving the screening of risk factors in diabetic retinopathy. Expert Rev Endocrinol Metab 2022; 17:235-243. [PMID: 35730170 DOI: 10.1080/17446651.2022.2078305] [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: 02/05/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION In 2002, Diabetic Retinopathy was reported as the leading cause of blindness in the working age group. The introduction of systematic screening programs in the UK has reduced visual loss and blindness due to diabetic retinopathy, but it does still occur with catastrophic consequences for the individual. AREAS COVERED The author conducted an ongoing search for articles relating to diabetic retinopathy since 2000 utilizing Zetoc Alert with keywords and contents page lists from relevant journals. This review covers the risk factors for loss of vision due to diabetic retinopathy and discusses ways in which the awareness of these risk factors can be used to further reduce visual loss. Some risk factors such as glycemic and B/P control are well known from landmark trials. This review has included these factors but concentrated more on the evidence behind those risk factors that are not so clearly defined or so well known. EXPERT OPINION The major risk factors are well known, but one continues to find that people with diabetes lose vision in situations in which a better awareness of the risks by both the individual with diabetes and the health workers involved may have prevented the visual loss.
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Affiliation(s)
- Peter H Scanlon
- Consultant Ophthalmologist, Department of Ophthalmologist, Gloucestershire Hospitals NHS Foundation Trust Cheltenham, UK
- National Clinical Lead, NHS Diabetic Eye Screening Programme (Ophthalmology), Public Health Commissioning and Operations, England
- Associate Professor, Nuffield Department of Clinical Neuroscience, University of Oxford, UK
- Visiting Professor, School of Health and Social Care, University of Gloucestershire, UK
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Aronov M, Allon R, Stave D, Belkin M, Margalit E, Fabian ID, Rosenzweig B. Retinal Vascular Signs as Screening and Prognostic Factors for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Current Evidence. J Pers Med 2021; 11:jpm11070665. [PMID: 34357132 PMCID: PMC8307097 DOI: 10.3390/jpm11070665] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The substantial burden of kidney disease fosters interest in new ways of screening for early disease diagnosis, especially by non-invasive imaging. Increasing evidence for an association between retinal microvascular signs and kidney disease prompted us to investigate the relevant current literature on such an association systematically by performing a meta-analysis of our findings. METHODS We scrutinized the current literature by searching PubMed and Embase databases from for clinical studies of the association between retinal microvascular signs and prevalent or incident kidney disease. After excluding cases that did not meet our criteria, we extracted relevant data from 42 published studies (9 prospective, 32 cross-sectional, and 1 retrospective). RESULTS Our investigation yielded significant associations between retinal vascular changes (including retinopathy and retinal vascular diameter) and kidney dysfunction (including chronic kidney disease (CKD), end-stage renal disease (ESRD), albuminuria, and estimated glomerular filtration rate (eGFR) decline). According to our meta-analysis, retinopathy was associated with ESRD (hazard ratio (HR) 2.12 (95% confidence interval CI; 1.39-3.22)) and with CKD prevalence in the general population (odds ratio (OR) 1.31 (95% CI; 1.14-1.50)), and specifically in type 2 diabetic patients (OR 1.68 (95% CI; 1.68-2.16)). CRAE was associated with prevalent CKD (OR 1.41 (95% CI; 1.09-1.82)). CONCLUSIONS Our findings suggest that the retinal microvasculature can provide essential data about concurrent kidney disease status and predict future risk for kidney disease development and progression.
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Affiliation(s)
- Michael Aronov
- SPRING Biomed Vision Ltd. 8, Haneviim St., Haifa 3350109, Israel; (R.A.); (D.S.); (E.M.)
- Correspondence: ; Tel.: +972-77-2009796
| | - Raviv Allon
- SPRING Biomed Vision Ltd. 8, Haneviim St., Haifa 3350109, Israel; (R.A.); (D.S.); (E.M.)
| | - Danielle Stave
- SPRING Biomed Vision Ltd. 8, Haneviim St., Haifa 3350109, Israel; (R.A.); (D.S.); (E.M.)
| | - Michael Belkin
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer 5262000, Israel; (M.B.); (I.D.F.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Eyal Margalit
- SPRING Biomed Vision Ltd. 8, Haneviim St., Haifa 3350109, Israel; (R.A.); (D.S.); (E.M.)
| | - Ido Didi Fabian
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer 5262000, Israel; (M.B.); (I.D.F.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Barak Rosenzweig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Urology, Sheba Medical Center, Tel Hashomer 5262000, Israel;
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11
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Januszewski AS, Cho YH, Joglekar MV, Farr RJ, Scott ES, Wong WKM, Carroll LM, Loh YW, Benitez-Aguirre PZ, Keech AC, O'Neal DN, Craig ME, Hardikar AA, Donaghue KC, Jenkins AJ. Insulin micro-secretion in Type 1 diabetes and related microRNA profiles. Sci Rep 2021; 11:11727. [PMID: 34083567 PMCID: PMC8175359 DOI: 10.1038/s41598-021-90856-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/13/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this cross-sectional study was to compare plasma C-peptide presence and levels in people without diabetes (CON) and with Type 1 diabetes and relate C-peptide status to clinical factors. In a subset we evaluated 50 microRNAs (miRs) previously implicated in beta-cell death and associations with clinical status and C-peptide levels. Diabetes age of onset was stratified as adult (≥ 18 y.o) or childhood (< 18 y.o.), and diabetes duration was stratified as ≤ 10 years, 10–20 years and > 20 years. Plasma C-peptide was measured by ultrasensitive ELISA. Plasma miRs were quantified using TaqMan probe-primer mix on an OpenArray platform. C-peptide was detectable in 55.3% of (n = 349) people with diabetes, including 64.1% of adults and 34.0% of youth with diabetes, p < 0.0001 and in all (n = 253) participants without diabetes (CON). C-peptide levels, when detectable, were lower in the individuals with diabetes than in the CON group [median lower quartile (LQ)–upper quartile (UQ)] 5.0 (2.6–28.7) versus 650.9 (401.2–732.4) pmol/L respectively, p < 0.0001 and lower in childhood versus adult-onset diabetes [median (LQ–UQ) 4.2 (2.6–12.2) pmol/L vs. 8.0 (2.3–80.5) pmol/L, p = 0.02, respectively]. In the childhood-onset group more people with longer diabetes duration (> 20 years) had detectable C-peptide (60%) than in those with shorter diabetes duration (39%, p for trend < 0.05).
Nine miRs significantly correlated with detectable C-peptide levels in people with diabetes and 16 miRs correlated with C-peptide levels in CON. Our cross-sectional study results are supportive of (a) greater beta-cell function loss in younger onset Type 1 diabetes; (b) persistent insulin secretion in adult-onset diabetes and possibly regenerative secretion in childhood-onset long diabetes duration; and (c) relationships of C-peptide levels with circulating miRs. Confirmatory clinical studies and related basic science studies are merited.
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Affiliation(s)
- Andrzej S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia. .,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
| | - Yoon Hi Cho
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Mugdha V Joglekar
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Ryan J Farr
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Emma S Scott
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Wilson K M Wong
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Luke M Carroll
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Yik W Loh
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Paul Z Benitez-Aguirre
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - David N O'Neal
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Maria E Craig
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anandwardhan A Hardikar
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia.,Department of Science and Environment, Roskilde University, Copenhagen, Denmark
| | - Kim C Donaghue
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia. .,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
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12
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Quinn N, Jenkins A, Ryan C, Januszewski A, Peto T, Brazionis L. Imaging the eye and its relevance to diabetes care. J Diabetes Investig 2021; 12:897-908. [PMID: 33190401 PMCID: PMC8169343 DOI: 10.1111/jdi.13462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
Diabetes is a major cause of vision loss globally, yet this devastating complication is largely preventable. Early detection and treatment of diabetic retinopathy necessitates screening. Ocular imaging is widely used clinically, both for the screening and management of diabetic retinopathy. Common eye conditions, such as glaucoma, cataracts and retinal vessel thrombosis, and signs of systemic conditions, such as hypertension, are frequently revealed. As well as imaging by a skilled clinician during an eye examination, non-ophthalmic clinicians, such as general practitioners, endocrinologists, nurses and trained health workers, can also can carry out diabetic eye screening. This process usually comprises local imaging with remote grading, mostly human grading. However, grading incorporating artificial intelligence is emerging. In a clinical research context, retinal vasculature analyses using semi-automated software in many populations have identified associations between retinal vessel geometry, such as vessel caliber, and the risk of diabetic retinopathy and other chronic complications of type 1 and type 2 diabetes. Similarly, evaluation of corneal nerves by corneal confocal microscopy is revealing diabetes-related abnormalities, and associations with and predictive power for other chronic diabetes complications. As yet, the value of retinal vessel geometry and corneal confocal microscopy measures at an individual level is uncertain. In this article, targeting non-ocular clinicians and researchers, we review existent and emerging ocular imaging and grading tools, including artificial intelligence, and their associations between ocular imaging findings and diabetes and its chronic complications.
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Affiliation(s)
- Nicola Quinn
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Alicia Jenkins
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Chris Ryan
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Andrzej Januszewski
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Tunde Peto
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Laima Brazionis
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
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13
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Hu G, Wu H, Kuang L, Zee BCY, Huang Y, Huang Z, He L, Zeng Y, Gao Y, Wang H. Clinical study of diabetic peripheral neuropathy screening by retinal vascular geometric parameters. Sci Rep 2021; 11:6784. [PMID: 33762602 PMCID: PMC7990935 DOI: 10.1038/s41598-021-85831-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 03/02/2021] [Indexed: 11/09/2022] Open
Abstract
To investigate the relationship between geometrical changes of retinal vessels and diabetic peripheral neuropathy (DPN), and to determine the effectiveness of retinal vascular geometry analysis and vibration perception threshold (VPT) for DPN assessment. Type 2 diabetes patients (n = 242) were categorized by stage of DPN. VPT and fundus photography was performed to obtain retinal vascular geometry parameters. The risk factors for DPN and the correlation between DPN stages were analyzed. The efficiency of the retinal vascular geometric parameters obtained with VPT as a diagnostic tool for DPN was examined. Stages of DPN showed a linear correlation with VPT (r = 0.818), central retinal vein equivalent (CRVE) (r = 0.716), and fractal dimension arterioles (DFa) (r = - 0.769). VPT, CRVE, DFa, and fractal dimension veins (DFv) showed high sensitivity (80%, 55%, 82%, and 67%, respectively) and specificity (92%, 93%, 82%, and 80%, respectively) for DPN diagnosis. Good agreement was observed between combined use of geometric parameters (CRVE, DFa and DFv) and VPT (Kappa value 0.430). The detection rate of DPN with combined use of geometric parameters of retinal vessels (64.88%) was significantly higher than that with use of VPT (47.52%). Retinal vascular geometry changes demonstrated significant correlation with DPN severity. VPT, CRVE, DFa, and DFv may provide insights for understanding DPN.
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Affiliation(s)
- Guotao Hu
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China
| | - Hongmei Wu
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China
| | - Lei Kuang
- Department of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Benny Chung-Ying Zee
- Department of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Ying Huang
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China
| | - Zhen Huang
- Department of Laboratory, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Li He
- Department of Nursing, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Yuanhong Zeng
- Department of Ophthalmology, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Yongbo Gao
- Department of Stomatology, Longgang Central Hospital, Shenzhen, 518116, Guangdong, China
| | - Hailan Wang
- Department of Endocrinology, Longgang Central Hospital, Shenzhen 1228 Longgang Road, Shenzhen, 518116, Guangdong, China.
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14
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Jacoba CMP, Celi LA, Silva PS. Biomarkers for Progression in Diabetic Retinopathy: Expanding Personalized Medicine through Integration of AI with Electronic Health Records. Semin Ophthalmol 2021; 36:250-257. [PMID: 33734908 DOI: 10.1080/08820538.2021.1893351] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The goal of personalized diabetes eye care is to accurately predict in real-time the risk of diabetic retinopathy (DR) progression and visual loss. The use of electronic health records (EHR) provides a platform for artificial intelligence (AI) algorithms that predict DR progression to be incorporated into clinical decision-making. By implementing an algorithm on data points from each patient, their risk for retinopathy progression and visual loss can be modeled, allowing them to receive timely treatment. Data can guide algorithms to create models for disease and treatment that may pave the way for more personalized care. Currently, there exist numerous challenges that need to be addressed before reliably building and deploying AI algorithms, including issues with data quality, privacy, intellectual property, and informed consent.
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Affiliation(s)
- Cris Martin P Jacoba
- Joslin Diabetes Centre, Beetham Eye Institute, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Leo Anthony Celi
- Division of Pulmonary, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Laboratory for Computational Physiology, Harvard-MIT Health Sciences and Technology Division, Cambridge, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paolo S Silva
- Joslin Diabetes Centre, Beetham Eye Institute, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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15
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O'Neill RA, Maxwell AP, Kee F, Young I, McGuinness B, Hogg RE, Gj M. Association of retinal venular tortuosity with impaired renal function in the Northern Ireland Cohort for the Longitudinal Study of Ageing. BMC Nephrol 2020; 21:382. [PMID: 32883218 PMCID: PMC7469276 DOI: 10.1186/s12882-020-02031-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previous studies have identified retinal microvascular features associated with renal dysfunction. Biopsies are necessary to confirm kidney microvascular damage and retinal imaging may enable evaluation of microangiopathic characteristics reflecting renal changes associated with chronic kidney disease (CKD). We evaluated retinal microvascular parameters (RMPs) for associations with renal function in a cross-sectional analysis of the Northern Ireland Cohort for the Longitudinal Study of Ageing. METHODS RMPs (central retinal arteriolar/ venular equivalents [CRAE/CRVE], arteriolar to venular ratio [AVR], fractal dimension and tortuosity) were measured from optic disc centred fundus images using semi-automated software. Associations were assessed with multivariable regression analyses between RMPs and estimated glomerular filtration rate (eGFR) defined by serum creatinine (eGFRscr) and cystatin C (eGFRcys) and also CKD status characterised by eGFR < 60 mL/min/1.73m2. Regression models were adjusted for potential confounders including age, sex, diabetes, smoking status, educational attainment, cardiovascular disease, body mass index, antihypertensive medication, systolic blood pressure, triglycerides, high- and low-density lipoprotein levels. RESULTS Data were included for 1860 participants that had measures of renal function and retinal fundus images of sufficient quality for analysis. Participants had a mean age of 62.0 ± 8.5 yrs. and 53% were female. The mean eGFR for scr and cys were 82.2 ± 14.9 mL/min/1.73m2 and 70.7 ± 18.6 mL/min/1.73m2 respectively. eGFRcys provided lower estimates than eGFRscr resulting in a greater proportion of participants categorised as having CKD stages 3-5 (eGFRcys 26.8%; eGFRscr 7.9%). Multivariable regression analyses showed that increased venular tortuosity (OR = 1.30; 95%CI: 1.10, 1.54; P < 0.01) was associated with CKD stages 3-5 characterised by eGFRscr < 60 mL/min/1.73 m2. No additional associations between CKD status characterised by eGFRscr or with eGFRcys, were detected (P > 0.05). Multivariable regression failed to detect associations between CRAE, CRVE, AVR, fractal dimension or tortuosity and eGFRscr or eGFRcys (P > 0.05). CONCLUSION Increased retinal venular tortuosity was associated with CKD stages 3-5 defined by eGFRscr < 60 mL/min/1.73 m2, in an older population independent of potential confounding factors. These retinal measures may provide non-invasive microvascular assessment of associations with CKD.
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Affiliation(s)
- R A O'Neill
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - A P Maxwell
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - F Kee
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - I Young
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - B McGuinness
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - R E Hogg
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - McKay Gj
- Centre for Public Health, Queens University Belfast, Belfast, UK.
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16
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Xiong Y, Lin L, Chen Y, Salerno S, Li Y, Zeng X, Li H. Prediction of gestational diabetes mellitus in the first 19 weeks of pregnancy using machine learning techniques. J Matern Fetal Neonatal Med 2020; 35:2457-2463. [PMID: 32762275 DOI: 10.1080/14767058.2020.1786517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Our objective was to develop a first 19 weeks risk prediction model with several potential gestational diabetes mellitus (GDM) predictors including hepatic and renal and coagulation function measures. METHODS A total of 490 pregnant women, 215 with GDM and 275 controls, participated in this case-control study. Forty-three blood examination indexes including blood routine, hepatic and renal function, and coagulation function were obtained. Support vector machine (SVM) and light gradient boosting machine (lightGBM) were applied to estimate possible associations with GDM and build the predict model. Cutoff points were estimated using receiver operating characteristic curve analysis. RESULTS It was observed that a cutoff of Prothrombin time (PAT-PT) and Activated partial thromboplastin time (PAT-APTT) could reliably predict GDM with sensitivity of 88.3% and specificity of 99.47% (AUC of 94.2%). If we only use hepatic and renal function examination, a cutoff of DBIL and FPG with sensitivity of 82.6% and specificity of 90.0% (AUC of 91.0%) was obvious and a negative correlation with PAT-PT (r=-0.430549) and patient activated partial thromboplastin time (PAT-APTT) (r=-0.725638). A negative correlation with direct bilirubin (DBIL) (r=-0.379882) and positive correlation with fasting plasma glucose (FPG) (r = 0.458332) neglect coagulation function examination. CONCLUSION The results of this study point out the possible roles of PAT-PT and PAT-APTT as potential novel biomarkers for the prediction and earlier diagnosis of GDM. A first 19 weeks risk prediction model, which incorporates novel biomarkers, accurately identifies women at high risk of GDM, and relevant measures can be applied early to achieve the prevention and control effects.
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Affiliation(s)
- Yan Xiong
- College of Mechanical Engineering, Sichuan University, Chengdu, China
| | - Lu Lin
- College of Mechanical Engineering, Sichuan University, Chengdu, China
| | - Yu Chen
- Department of Applied Mechanics, Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China
| | - Stephen Salerno
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Xiaoxi Zeng
- Medical Big Data Center, Sichuan University, Chengdu, China
| | - Huafeng Li
- West China Second University Hospital, Sichuan University, Chengdu, China
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17
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Zhu Z, Liao H, Wang W, Scheetz J, Zhang J, He M. Visual Impairment and Major Eye Diseases in Chronic Kidney Disease: The National Health and Nutrition Examination Survey, 2005-2008. Am J Ophthalmol 2020; 213:24-33. [PMID: 31945332 DOI: 10.1016/j.ajo.2020.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the prevalence and associations of visual impairment (VI) and major eye diseases with chronic kidney disease (CKD) in the United States. DESIGN Cross-sectional study. METHODS We investigated the prevalence and associations of VI and major eye diseases with CKD among 5,518 participants aged 40 years or older in the 2005-2008 National Health and Nutrition Examination Survey. An estimated glomerular filtration rate of lower than 60 mL/min/1.73 m2 was defined as CKD. Corrected visual acuity of worse than 20/40 in the better-seeing eye was defined as VI. Major eye diseases, including any ocular disease, any objectively determined ocular disease, cataract surgery, any retinopathy, diabetic retinopathy (DR), age-related macular degeneration (AMD), and glaucoma were evaluated from questionnaire or retinal photographs using standardized grading protocols. RESULTS The prevalence of VI and major eye diseases were approximately 2- to 7-fold higher in participants with CKD than in those without (all P < .05). After controlling for multiple confounders, the presence of CKD was associated with VI (odds ratio [OR]: 2.01, 95% confidence interval [CI]: 1.14-3.54), any ocular disease (OR: 1.65, 95% CI: 1.22-2.22), any objectively determined ocular disease (OR: 1.52, 95% CI: 1.06-2.19), any retinopathy (OR: 1.70, 95% CI: 1.18-2.45), and DR (OR: 2.34, 95% CI: 1.23-4.42). There was no association of CKD with cataract surgery, AMD, or glaucoma. A significant association between CKD and any ocular disease was observed among nondiabetic participants. The presence of CKD was closely related to VI and any retinopathy among diabetic participants. CONCLUSIONS This nationally representative sample of the US population demonstrated high prevalence and strong associations of VI and major eye diseases with CKD, highlighting the importance of ocular screening among CKD patients and potential common pathogenesis underlying these conditions.
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Affiliation(s)
- Zhuoting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Huan Liao
- Neural Regeneration Group, Institute of Reconstructive Neurobiology, University of Bonn, Bonn, Germany
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jane Scheetz
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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18
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19
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Hsieh AR, Huang YC, Yang YF, Lin HJ, Lin JM, Chang YW, Wu CM, Liao WL, Tsai FJ. Lack of association of genetic variants for diabetic retinopathy in Taiwanese patients with diabetic nephropathy. BMJ Open Diabetes Res Care 2020; 8:8/1/e000727. [PMID: 31958309 PMCID: PMC7039583 DOI: 10.1136/bmjdrc-2019-000727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/11/2019] [Accepted: 01/04/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Diabetic nephropathy (DN) and diabetic retinopathy (DR) comprise major microvascular complications of diabetes that occur with a high concordance rate in patients and are considered to potentially share pathogeneses. In this case-control study, we sought to investigate whether DR-related single nucleotide polymorphisms (SNPs) exert pleiotropic effects on renal function outcomes among patients with diabetes. RESEARCH DESIGN AND METHODS A total of 33 DR-related SNPs were identified by replicating published SNPs and via a genome-wide association study. Furthermore, we assessed the cumulative effects by creating a weighted genetic risk score and evaluated the discriminatory and prediction ability of these genetic variants using DN cases according to estimated glomerular filtration rate (eGFR) status along with a cohort with early renal functional decline (ERFD). RESULTS Multivariate logistic regression models revealed that the DR-related SNPs afforded no individual or cumulative genetic effect on the nephropathy risk, eGFR status or ERFD outcome among patients with type two diabetes in Taiwan. CONCLUSION Our findings indicate that larger studies would be necessary to clearly ascertain the effects of individual genetic variants and further investigation is also required to identify other genetic pathways underlying DN.
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Affiliation(s)
- Ai-Ru Hsieh
- Department of Statistics, Tamkang University, Taipei, Taiwan
| | - Yu-Chuen Huang
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Human Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Fei Yang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hui-Ju Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Wen Chang
- Human Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ming Wu
- Human Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Center for Personalized Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Human Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
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20
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Appaji A, Nagendra B, Chako DM, Padmanabha A, Jacob A, Hiremath CV, Varambally S, Kesavan M, Venkatasubramanian G, Rao SV, Webers CAB, Berendschot TTJM, Rao NP. Retinal vascular tortuosity in schizophrenia and bipolar disorder. Schizophr Res 2019; 212:26-32. [PMID: 31466896 DOI: 10.1016/j.schres.2019.08.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/23/2019] [Accepted: 08/18/2019] [Indexed: 11/20/2022]
Abstract
The micro-vasculature of retina and brain share common morphological, physiological, and pathological properties. Retina being easily accessible, retinal vascular examination provides an indirect assessment of cerebral vasculature. Considering the high prevalence of vascular morbidity in SCZ and BD a few studies have examined retinal vascular caliber and have reported increased retinal venular caliber in schizophrenia (SCZ). Retinal vascular tortuosity could serve as a better structural measure than caliber as it is static and less susceptible to pulse period variations. However, to date, no study has examined retinal vascular tortuosity in SCZ and bipolar disorder (BD). Hence, we examined retinal vascular tortuosity in comparison with healthy volunteers (HV). We included 255 subjects (78 HV, 79 SCZ, and 86 BD) in the age range of 18 to 50 years. Trained personnel acquired images using a non-mydriatic fundus camera. To measure the average retinal arteriolar tortuosity index (RATI) and retinal venular tortuosity index (RVTI), we used a previously validated, semi-automatic algorithm. The results showed significant differences across the three groups in RATI but not in RVTI; both BD and SCZ had significantly increased RATI compared to HV. There was also a significant difference between SCZ and BD, with BD having higher RATI. If shown to be of predictive utility in future longitudinal studies, it has the potential to identify patients at risk of development of adverse vascular events. As retinal vascular imaging is non-invasive and inexpensive, it could serve as a proxy marker and window to cerebral vasculature.
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Affiliation(s)
- Abhishek Appaji
- Department of Medical Electronics, B.M.S. College of Engineering, Bangalore, India; University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Bhargavi Nagendra
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dona Maria Chako
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ananth Padmanabha
- Department of Medical Electronics, B.M.S. College of Engineering, Bangalore, India
| | - Arpitha Jacob
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chaitra V Hiremath
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shivarama Varambally
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Muralidharan Kesavan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Shyam Vasudeva Rao
- Department of Medical Electronics, B.M.S. College of Engineering, Bangalore, India; University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Carroll A B Webers
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Naren P Rao
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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21
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Li LJ, Tan KH, Aris IM, Man REK, Gan ATL, Chong YS, Saw SM, Gluckman P, Wong TY, Lamoureux E. Retinal vasculature and 5-year metabolic syndrome among women with gestational diabetes mellitus. Metabolism 2018; 83:216-224. [PMID: 29051041 DOI: 10.1016/j.metabol.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/03/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) are at greater risk of metabolic syndrome (MetS). We studied the association between second-trimester retinal microvasculature and 5-year MetS incidence in women with GDM. METHODS A total of 142 mothers with GDM were recruited and followed up 5years after delivery. Retinal photography was performed at 26-28weeks gestation and metabolic outcomes were assessed at the 5-year postpartum follow-up visit. GDM and MetS were defined based on World Health Organization (WHO) guidelines and Adults Treatment Panel (ATP) III guidelines, respectively. Modified-Poisson regression was applied to study the association between second-trimester retinal microvasculature and incident 5-year maternal MetS, after adjusting for major confounders. Area under the curve (AUC) was calculated based on the final model. RESULTS Our prospective cohort reported a 9.2% incidence rate of 5-year MetS among women with GDM. After adjusting for maternal age, ethnicity, college degree, pre-pregnancy BMI and fasting glucose at 26-28week gestation, each 10μm widening in retinal venular caliber was associated with an increased relative risk of 1.6 (95% confidence interval [CI]: 1.0, 2.8) in incident MetS. In addition to traditional risks of pre-pregnancy BMI and fasting glucose level at 26-28week gestation, retinal venular caliber mildly increased the prediction of 5-year maternal MetS by 1.8%. CONCLUSIONS Second-trimester retinal venular widening was associated with incident 5-year maternal MetS in women with GDM. Our study suggests that mother with GDM at risk of future MetS development may have already presented retinal microvascular abnormalities during pregnancy.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore.
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Yap Seng Chong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Growth, Development & Metabolism, Singapore
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
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22
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Benitez-Aguirre PZ, Wong TY, Craig ME, Davis EA, Cotterill A, Couper JJ, Cameron FJ, Mahmud FH, Jones TW, Hodgson LAB, Dalton RN, Dunger DB, Donaghue KC. The Adolescent Cardio-Renal Intervention Trial (AdDIT): retinal vascular geometry and renal function in adolescents with type 1 diabetes. Diabetologia 2018; 61:968-976. [PMID: 29396691 PMCID: PMC6447498 DOI: 10.1007/s00125-017-4538-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/07/2017] [Indexed: 01/10/2023]
Abstract
AIMS/HYPOTHESIS We examined the hypothesis that elevation in urinary albumin creatinine ratio (ACR) in adolescents with type 1 diabetes is associated with abnormal retinal vascular geometry (RVG) phenotypes. METHODS A cross-sectional study at baseline of the relationship between ACR within the normoalbuminuric range and RVG in 963 adolescents aged 14.4 ± 1.6 years with type 1 diabetes (median duration 6.5 years) screened for participation in AdDIT. A validated algorithm was used to categorise log10 ACR into tertiles: upper tertile ACR was defined as 'high-risk' for future albuminuria and the lower two tertiles were deemed 'low-risk'. RVG analysis, using a semi-automated computer program, determined retinal vascular calibres (standard and extended zones) and tortuosity. RVG measures were analysed continuously and categorically (in quintiles: Q1-Q5) for associations with log10 ACR and ACR risk groups. RESULTS Greater log10 ACR was associated with narrower vessel calibres and greater tortuosity. The high-risk group was more likely to have extended zone vessel calibres in the lowest quintile (arteriolar Q1 vs Q2-Q5: OR 1.67 [95% CI 1.17, 2.38] and venular OR 1.39 [0.98, 1.99]) and tortuosity in the highest quintile (Q5 vs Q1-Q4: arteriolar OR 2.05 [1.44, 2.92] and venular OR 2.38 [1.67, 3.40]). The effects of retinal vascular calibres and tortuosity were additive such that the participants with the narrowest and most tortuous vessels were more likely to be in the high-risk group (OR 3.32 [1.84, 5.96]). These effects were independent of duration, blood pressure, BMI and blood glucose control. CONCLUSIONS/INTERPRETATION Higher ACR in adolescents is associated with narrower and more tortuous retinal vessels. Therefore, RVG phenotypes may serve to identify populations at high risk of diabetes complications during adolescence and well before onset of clinical diabetes complications.
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Affiliation(s)
- Paul Z Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, 170 Hawkesbury Rd, Locked Bag 4001, Westmead, NSW, 2145, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
| | - Tien Y Wong
- Centre for Eye Research Australia, Melbourne, VIC, Australia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, 170 Hawkesbury Rd, Locked Bag 4001, Westmead, NSW, 2145, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | | | - Jennifer J Couper
- Endocrinology and Diabetes Centre, Women's and Children's Hospital, Adelaide, SA, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Fergus J Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Farid H Mahmud
- Division of Endocrinology, Hospital for Sick Children, Toronto, ON, Canada
| | - Tim W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | | | - R Neil Dalton
- WellChild Laboratory, St Thomas' Hospital, King's College London, London, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, 170 Hawkesbury Rd, Locked Bag 4001, Westmead, NSW, 2145, Australia.
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.
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23
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Kee AR, Wong TY, Li LJ. Retinal vascular imaging technology to monitor disease severity and complications in type 1 diabetes mellitus: A systematic review. Microcirculation 2018; 24. [PMID: 27749000 DOI: 10.1111/micc.12327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/11/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) is a major disease affecting a large number of young patients. In the recent years, retinal vascular imaging has provided an objective assessment of vascular health in patients with T1DM. Our study aimed to review the current literature on retinal vascular parameters in young patients with T1DM in order to understand the following: (i) How retinal vessels are affected in T1DM (ii) How such vascular changes can be predictive of future diabetic microvascular complications METHODS: We performed a systematic review and extracted relevant data from 17 articles. RESULTS We found significant correlations between retinal vessel changes and diabetes-related risk factors (eg, hypertension, hyperlipidemia, and obesity), diabetes-related features (eg, diabetes duration and glycemic control), and diabetes-related microvascular complications (eg, diabetic retinopathy, nephropathy, and neuropathy). CONCLUSION Our findings suggest that retinal microvasculature is associated with both disease severity and complications in young patients with T1DM.
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Affiliation(s)
- Ae Ra Kee
- Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - Ling-Jun Li
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,DUKE-NUS Graduate Medical School, Singapore, Singapore
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24
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Benitez-Aguirre PZ, Januszewski AS, Cho YH, Craig ME, Jenkins AJ, Donaghue KC. Early changes of arterial elasticity in Type 1 diabetes with microvascular complications - A cross-sectional study from childhood to adulthood. J Diabetes Complications 2017; 31:1674-1680. [PMID: 28941950 DOI: 10.1016/j.jdiacomp.2017.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/01/2023]
Abstract
AIM To examine the trajectory of small artery elasticity (SAE) and pulse pressure (PP) in people with Type 1 diabetes and non-diabetic controls across the lifespan, and explore associations with microvascular complications (CX+). METHODS This cross-sectional study included 477 Type 1 diabetes patients (188 with CX+, 289 without CX-) and 515 controls. Relationships between SAE and PP and age were evaluated using segmented linear regression. Logistic regression was used to assess the associations between microvascular complications (retinopathy and/or nephropathy) and SAE and PP. RESULTS SAE peaked significantly later among controls than diabetic patients CX- vs. CX+ (21.2 vs. 20.4 vs. 17.6 years respectively, p < 0.001). In adults, mean SAE was significantly lower in CX+ vs. CX- vs. controls (6.8 vs. 7.8 vs. 8.0 ml/mm Hg × 10; p < 0.0001), and mean PP was significantly higher in CX+ vs CX- and controls (60 vs. 55 vs. 53 mm Hg; p < 0.0001). CONCLUSION Type 1 diabetes CX+ subjects have an earlier peak and decline in SAE relative to CX- and controls, who did not differ. Lower SAE and higher PP were associated with increased odds of Type 1 diabetes complications in adults. These clinically applicable techniques demonstrate an association between accelerated vascular aging and vascular complications in diabetes.
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Affiliation(s)
- P Z Benitez-Aguirre
- Discipline of Paediatrics and Child Health, University of Sydney, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - A S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia
| | - Y H Cho
- Discipline of Paediatrics and Child Health, University of Sydney, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - M E Craig
- Discipline of Paediatrics and Child Health, University of Sydney, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Australia
| | - A J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia
| | - K C Donaghue
- Discipline of Paediatrics and Child Health, University of Sydney, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
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25
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Xiao W, Guo X, Ding X, He M. Serum lipid profiles and dyslipidaemia are associated with retinal microvascular changes in children and adolescents. Sci Rep 2017; 7:44874. [PMID: 28317946 PMCID: PMC5357954 DOI: 10.1038/srep44874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/15/2017] [Indexed: 01/12/2023] Open
Abstract
The present study aims to assess the relationship between serum lipid parameters and retinal microvascular calibres in children and adolescents. A total of 950 participants aged 7 to 19 years were recruited. Central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were measured from digital retinal images. Serological testing was performed to obtain lipid profiles. Dyslipidaemia was defined according to the US national expert panel guideline. After adjusted for age, sex, mean arterial blood pressure, axial length, body mass index and the fellow retinal vascular calibre, no significant association was found between retinal vascular diameters and any lipid parameters (all P > 0.05) in children younger than 12 years. Among the adolescents 12 years and older, increased triglycerides, total cholesterol, low-density lipoprotein cholesterol, and apoB were associated with decrease in CRAE (β = −1.33, −1.83, −1.92 and −7.18, P = 0.031, 0.003, 0.006, and 0.009, respectively). Compared with normolipidemic counterparts, adolescents with dyslipidaemia had significantly narrower retinal arteriolar diameters. No significant relationship between lipid subclass levels and CRVE was revealed in adolescents. The present findings suggest that the elevation of atherogenic lipids in adolescents is closely related to the adverse changes of retinal arterioles. Dyslipidaemia may affect systemic microvasculature from childhood on.
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Affiliation(s)
- Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xinxing Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaohu Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre for Eye Research Australia, University of Melbourne, Australia
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26
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Keel S, Itsiopoulos C, Koklanis K, Vukicevic M, Cameron F, Brazionis L. Retinal Vascular Caliber and Kidney Function in Children and Adolescents with Type 1 Diabetes. Ophthalmic Epidemiol 2017; 24:204-208. [PMID: 28287899 DOI: 10.1080/09286586.2016.1267230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the relationship between retinal vascular caliber and kidney function in a cohort of Australian children and adolescents with type 1 diabetes. METHODS This was a cross-sectional study of 483 children and adolescents with type 1 diabetes, aged 7-18 years. An audit of medical files of participants who attended the Royal Children's Hospital, Melbourne, between January 2009 and March 2014 was performed. Albumin to creatinine ratio (ACR) was acquired through spot urine samples and microalbuminuria was classified as ACR >3.5 mg/mmol in females and >2.5 mg/mmol in males. Retinal vascular caliber was measured using a standardized protocol and later summarized as central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE). RESULTS CRAE was significantly narrower in participants with microalbuminuria compared to those with normo-albuminuria in crude analysis (mean ± standard deviation 159.07 ± 9.90µm vs 164.49 ± 12.45 µm; p = 0.006). After adjustment for key confounders and known or potential mediators of microalbuminuria (age, sex, ethnicity, hemoglobin A1c, systolic blood pressure, total cholesterol, body mass index, duration of diabetes and CRVE) the association between narrower CRAE and microalbuminuria was attenuated and was no longer significant (95% confidence interval 0.94-1.02, p = 0.222). No significant associations between CRVE or arteriole-to-venule ratio and microalbuminuria were observed in univariate or multivariate models. CONCLUSIONS After adjustment for potential confounding variables, retinal vascular caliber was not significantly associated with microalbuminuria in this sample of children and adolescents with type 1 diabetes. Future prospective longitudinal research is warranted to further evaluate these findings.
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Affiliation(s)
- Stuart Keel
- a Department of Clinical Vision Sciences , Latrobe University , Melbourne , Australia
| | | | - Konstandina Koklanis
- a Department of Clinical Vision Sciences , Latrobe University , Melbourne , Australia
| | - Meri Vukicevic
- a Department of Clinical Vision Sciences , Latrobe University , Melbourne , Australia
| | - Fergus Cameron
- c Department of Endocrinology and Diabetes , Royal Children's Hospital , Parkville , Australia
| | - Laima Brazionis
- d Department of Medicine , University of Melbourne, St Vincent's Hospital , Melbourne , Australia
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27
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Yang JK, Wang YY, Liu C, Shi TT, Lu J, Cao X, Yang FY, Feng JP, Chen C, Ji LN, Xu A. Urine Proteome Specific for Eye Damage Can Predict Kidney Damage in Patients With Type 2 Diabetes: A Case-Control and a 5.3-Year Prospective Cohort Study. Diabetes Care 2017; 40:253-260. [PMID: 27903615 DOI: 10.2337/dc16-1529] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/16/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The predictive value of microalbuminuria (MAU) for kidney damage is limited in type 2 diabetes (T2D). We studied whether a urine proteome specific for sight-threatening proliferative diabetic retinopathy (PDR) is an indicator to predict chronic renal insufficiency (CRI) in patients with T2D. RESEARCH DESIGN AND METHODS A shotgun urine proteomic analysis was performed in patients with MAU and PDR (case subjects) and in patients with MAU and a duration of T2D for >10 years but without any degree of retinopathy (control subjects). In the cohort study, 210 patients with T2D with an estimated glomerular filtration rate (eGFR) ≥80 mL/min/1.73 m2 were followed for a median of 5.3 years. Urine proteins specific for PDR were used for predicting CRI (eGFR <60 mL/min/1.73 m2). RESULTS The top two urine proteins with the highest difference in ratio of case subjects to control subjects were haptoglobin (8.7 times; P < 0.0001) and α-2-macroglobulin (5.7 times; P < 0.0001). In the cohort study, patients with baseline urinary haptoglobin ≥20 ng/min (haptoglobinuria) had a higher incidence of CRI than those without (hazard ratio [95% CI] 3.27 [1.41-7.58]; P = 0.006). The overall CRI rate was 3.2% for patients without haptoglobinuria or MAU, 9.5% for those with MAU, and 13.3% for those with haptoglobinuria. The highest rate for CRI (22.4%) was in patients with both MAU and haptoglobinuria (P < 0.001). CONCLUSIONS Urine haptoglobin, which is specific for PDR, is a novel biomarker and complement to urine albumin for predicting kidney damage in patients with T2D.
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Affiliation(s)
- Jin-Kui Yang
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying-Ying Wang
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Shi
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Lu
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xi Cao
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fang-Yuan Yang
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jian-Ping Feng
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chen Chen
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Li-Nong Ji
- Endocrinology and Metabolism Department, Peking University People's Hospital, Beijing, China
| | - Aimin Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Medicine, University of Hong Kong, Hong Kong
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28
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Li LJ, Kramer M, Tapp RJ, Man REK, Lek N, Cai S, Yap F, Gluckman P, Tan KH, Chong YS, Koh JY, Saw SM, Cheung YB, Wong TY. Gestational diabetes mellitus and retinal microvasculature. BMC Ophthalmol 2017; 17:4. [PMID: 28100181 PMCID: PMC5241913 DOI: 10.1186/s12886-016-0398-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/16/2016] [Indexed: 12/17/2022] Open
Abstract
Background Small-vessel dysfunction may be an important consequence of chronic hyperglycemia. We examined the association between gestational diabetes mellitus (GDM), a state of transient hyperglycemia during pregnancy, and retinal microvascular changes in pregnant women at 26–28 weeks of pregnancy. Methods A total of 1136 pregnant women with singleton pregnancies were recruited during their first trimester at two major Singapore maternity hospitals in an on-going birth cohort study. Participants underwent an oral glucose tolerance test and retinal imaging at 26–28 weeks gestation (n = 542). We used the 1999 World Health Organization (WHO) criteria to define GDM: ≥7.0 mmol/L for fasting glucose and/or ≥7.8 mmol/L for 2-h post-glucose. Retinal microvasculature was measured using computer software (Singapore I Vessel Analyzer, SIVA version 3.0, Singapore Eye Research Institute, Singapore) from the retinal photographs. Results In a multiple linear regression model adjusting for age, ethnicity and maternal education, mothers with GDM had narrower arteriolar caliber (−1.6 μm; 95% Confidence Interval [CI]: −3.1 μm, −0.2 μm), reduced arteriolar fractal dimension (−0.01 Df; 95% CI: −0.02 Df, −0.001 Df;), and larger arteriolar branching angle (1.8°; 95% CI: 0.3°, 3.3°) than mothers without GDM. After further adjusting for traditional risks of GDM, arteriolar branching angle remained significantly larger in mothers with GDM than those without GDM (2.0°; 95% CI: 0.5°, 3.6°). Conclusions GDM was associated with a series of retinal arteriolar abnormalities, including narrower caliber, reduced fractal dimension and larger branching angle, suggesting that transient hyperglycemia during pregnancy may cause small-vessel dysfunction.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Michael Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Robyn J Tapp
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Ngee Lek
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore
| | - Shirong Cai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Fabian Yap
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Growth, Development & Metabolism, Singapore, Singapore
| | - Jia Yu Koh
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore. .,Department for International Health, University of Tampere, Tampere, Finland.
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore. .,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
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Rasmussen ML, Broe R, Frydkjaer-Olsen U, Olsen BS, Mortensen HB, Peto T, Grauslund J. Retinal vascular geometry and its association to microvascular complications in patients with type 1 diabetes: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). Graefes Arch Clin Exp Ophthalmol 2016; 255:293-299. [PMID: 27520462 DOI: 10.1007/s00417-016-3454-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To examine associations between retinal vascular geometry (tortuosity, branching coefficient [BC] and length-diameter ratio [LDR]) and diabetic proliferative retinopathy (PDR), nephropathy, and peripheral neuropathy in patients with type 1 diabetes mellitus (T1DM). METHODS A cohort of patients with T1DM participated in a clinical examination in 2011. Blood and urine analyses were done and retinal images taken. PDR was defined as Early Treatment Diabetic Retinopathy Study level 61 or above, nephropathy as albumin-creatinin ratio ≥300 mg/g, and neuropathy as vibration perception threshold >25 Volt. Retinal vessel parameters were measured using semi-automated software. Multiple logistic regressions were performed to investigate correlations between retinal vascular parameters and outcomes. Models were adjusted for other variables (sex, age, duration of diabetes, systolic and diastolic blood pressure, HbA1c, and presence of microvascular complications). Odds ratios were given per standard deviation in retinal vascular parameter. RESULTS Retinal vascular analyses were performed in 181 patients. Mean age and duration of diabetes were 37.0 years and 29.4 years respectively, and 50.8% were male. Prevalence of PDR, nephropathy, and neuropathy were 26.5%, 6.8%, and 10.1% , respectively. Patients with increased arteriolar BC had a higher risk of nephropathy (OR: 3.10, 95% CI: [1.01-9.54]). Patients with increased venular BC had a higher risk of neuropathy (OR: 2.11, 95% CI: [1.11-4.03]). No associations were found in patients with PDR. CONCLUSIONS By analyzing the retinal vascular tree in patients with T1DM, we found a higher risk of complications in kidneys and nerves when BC was increased. This might indicate a suboptimal construction of the vascular tree in these patients.
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Affiliation(s)
- M L Rasmussen
- Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.
- The Clinical Research Institute, University of Southern Denmark, Odense, Denmark.
| | - R Broe
- Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark
- The Clinical Research Institute, University of Southern Denmark, Odense, Denmark
- OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - U Frydkjaer-Olsen
- Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark
- The Clinical Research Institute, University of Southern Denmark, Odense, Denmark
| | - B S Olsen
- Department of Pediatrics E, Herlev and Gentofte Hospital, Arkaden, entrance 115, Herlev Ringvej 75, Herlev, 2730, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H B Mortensen
- Department of Pediatrics E, Herlev and Gentofte Hospital, Arkaden, entrance 115, Herlev Ringvej 75, Herlev, 2730, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - T Peto
- The Clinical Research Institute, University of Southern Denmark, Odense, Denmark
- The NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Rd, London, EC1V 2PD, UK
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark
- The Clinical Research Institute, University of Southern Denmark, Odense, Denmark
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30
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Newman AR, Andrew NH, Casson RJ. Review of paediatric retinal microvascular changes as a predictor of cardiovascular disease. Clin Exp Ophthalmol 2016; 45:33-44. [DOI: 10.1111/ceo.12773] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Alexander R Newman
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Nicholas H Andrew
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Robert J Casson
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital; Adelaide South Australia Australia
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31
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Li LJ, Ikram MK, Wong TY. Retinal vascular imaging in early life: insights into processes and risk of cardiovascular disease. J Physiol 2015; 594:2175-203. [PMID: 26435039 DOI: 10.1113/jp270947] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/28/2015] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. In recent years, studies have shown that the origins of CVD may be traced to vascular and metabolic processes in early life. Retinal vascular imaging is a new technology that allows detailed non-invasive in vivo assessment and monitoring of the microvasculature. In this systematic review, we described the application of retinal vascular imaging in children and adolescents, and we examined the use of retinal vascular imaging in understanding CVD risk in early life. We reviewed all publications with quantitative retinal vascular assessment in two databases: PubMed and Scopus. Early life CVD risk factors were classified into four groups: birth risk factors, environmental risk factors, systemic risk factors and conditions linked to future CVD development. Retinal vascular changes were associated with lower birth weight, shorter gestational age, low-fibre and high-sugar diet, lesser physical activity, parental hypertension history, childhood hypertension, childhood overweight/obesity, childhood depression/anxiety and childhood type 1 diabetes mellitus. In summary, there is increasing evidence supporting the view that structural changes in the retinal microvasculature are associated with CVD risk factors in early life. Thus, the retina is a useful site for pre-clinical assessment of microvascular processes that may underlie the future development of CVD in adulthood.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Mohammad Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
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32
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Jenkins AJ, Joglekar MV, Hardikar AA, Keech AC, O'Neal DN, Januszewski AS. Biomarkers in Diabetic Retinopathy. Rev Diabet Stud 2015; 12:159-95. [PMID: 26676667 DOI: 10.1900/rds.2015.12.159] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There is a global diabetes epidemic correlating with an increase in obesity. This coincidence may lead to a rise in the prevalence of type 2 diabetes. There is also an as yet unexplained increase in the incidence of type 1 diabetes, which is not related to adiposity. Whilst improved diabetes care has substantially improved diabetes outcomes, the disease remains a common cause of working age adult-onset blindness. Diabetic retinopathy is the most frequently occurring complication of diabetes; it is greatly feared by many diabetes patients. There are multiple risk factors and markers for the onset and progression of diabetic retinopathy, yet residual risk remains. Screening for diabetic retinopathy is recommended to facilitate early detection and treatment. Common biomarkers of diabetic retinopathy and its risk in clinical practice today relate to the visualization of the retinal vasculature and measures of glycemia, lipids, blood pressure, body weight, smoking, and pregnancy status. Greater knowledge of novel biomarkers and mediators of diabetic retinopathy, such as those related to inflammation and angiogenesis, has contributed to the development of additional therapeutics, in particular for late-stage retinopathy, including intra-ocular corticosteroids and intravitreal vascular endothelial growth factor inhibitors ('anti-VEGFs') agents. Unfortunately, in spite of a range of treatments (including laser photocoagulation, intraocular steroids, and anti-VEGF agents, and more recently oral fenofibrate, a PPAR-alpha agonist lipid-lowering drug), many patients with diabetic retinopathy do not respond well to current therapeutics. Therefore, more effective treatments for diabetic retinopathy are necessary. New analytical techniques, in particular those related to molecular markers, are accelerating progress in diabetic retinopathy research. Given the increasing incidence and prevalence of diabetes, and the limited capacity of healthcare systems to screen and treat diabetic retinopathy, there is need to reliably identify and triage people with diabetes. Biomarkers may facilitate a better understanding of diabetic retinopathy, and contribute to the development of novel treatments and new clinical strategies to prevent vision loss in people with diabetes. This article reviews key aspects related to biomarker research, and focuses on some specific biomarkers relevant to diabetic retinopathy.
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Affiliation(s)
- Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Sydney, Australia
| | - Mugdha V Joglekar
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Sydney, Australia
| | | | - Anthony C Keech
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Sydney, Australia
| | - David N O'Neal
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Sydney, Australia
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Williams MA, McGowan AJ, Cardwell CR, Cheung CY, Craig D, Passmore P, Silvestri G, Maxwell AP, McKay GJ. Retinal microvascular network attenuation in Alzheimer's disease. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2015; 1:229-235. [PMID: 26634224 PMCID: PMC4629099 DOI: 10.1016/j.dadm.2015.04.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cerebral small-vessel disease has been implicated in the development of Alzheimer's disease (AD). The retinal microvasculature enables the noninvasive visualization and evaluation of the systemic microcirculation. We evaluated retinal microvascular parameters in a case-control study of AD patients and cognitively normal controls. METHODS Retinal images were computationally analyzed and quantitative retinal parameters (caliber, fractal dimension, tortuosity, and bifurcation) measured. Regression models were used to compute odds ratios (OR) and confidence intervals (CI) for AD with adjustment for confounders. RESULTS Retinal images were available in 213 AD participants and 294 cognitively normal controls. Persons with lower venular fractal dimension (OR per standard deviation [SD] increase, 0.77 [CI: 0.62-0.97]) and lower arteriolar tortuosity (OR per SD increase, 0.78 [CI: 0.63-0.97]) were more likely to have AD after appropriate adjustment. DISCUSSION Patients with AD have a sparser retinal microvascular network and retinal microvascular variation may represent similar pathophysiological events within the cerebral microvasculature of patients with AD.
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Affiliation(s)
| | - Amy J McGowan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Carol Y Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore ; Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - David Craig
- Southern Health and Social Care Trust, Craigavon Hospital, Craigavon, UK
| | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Giuliana Silvestri
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Bjornstad P, Maahs DM. Diabetes Complications in Childhood Diabetes-New Biomarkers and Technologies. CURRENT PEDIATRICS REPORTS 2015; 3:177-186. [PMID: 26425403 DOI: 10.1007/s40124-015-0081-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A major challenge in preventing vascular complications in diabetes is the inability to identify high-risk patients at an early stage, emphasizing the importance of discovering new risk factors, technologies and therapeutic targets to reduce the development and progression of complications. Promising biomarkers which may improve risk stratification and serve as therapeutic targets, include: uric acid, insulin sensitivity, copeptin, SGLT-2 and Klotho/FGF-23. Non-invasive measures of macrovasuclar disease in youth, include: 1) pulse wave velocity to examine arterial stiffness; 2) carotid intima-media thickness to evaluate arterial thickness; 3) cardiac MRI to investigate cardiac function and structure. Novel microvascular measures include: GFR by iohexol clearance using filter paper to directly measure GFR, retinal vascular geometry to predict early retinal changes and corneal confocal microscopy to improve detection of early nerve loss to better predict diabetic neuropathy. Herein we will review technologies, novel biomarkers, and therapeutic targets in relation to vascular complications of diabetes.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States ; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - David M Maahs
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States ; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States
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35
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Guimarães P, Rodrigues P, Celorico D, Serranho P, Bernardes R. Three-dimensional segmentation and reconstruction of the retinal vasculature from spectral-domain optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:016006. [PMID: 25565582 DOI: 10.1117/1.jbo.20.1.016006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/05/2014] [Indexed: 05/24/2023]
Abstract
We reconstruct the three-dimensional shape and location of the retinal vascular network from commercial spectral-domain (SD) optical coherence tomography (OCT) data. The two-dimensional location of retinal vascular network on the eye fundus is obtained through support vector machines classification of properly defined fundus images from OCT data, taking advantage of the fact that on standard SD-OCT, the incident light beam is absorbed by hemoglobin, creating a shadow on the OCT signal below each perfused vessel. The depth-wise location of the vessel is obtained as the beginning of the shadow. The classification of crossovers and bifurcations within the vascular network is also addressed. We illustrate the feasibility of the method in terms of vessel caliber estimation and the accuracy of bifurcations and crossovers classification.
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Affiliation(s)
- Pedro Guimarães
- University of Coimbra, Faculty of Medicine, Institute for Biomedical Imaging and Life Sciences, Azinhaga Santa Comba, 3000-548 Coimbra, PortugalbUniversity of Padova, Department of Information Engineering, Via Gradenigo, 6/b, 35131 Padova, Italy
| | - Pedro Rodrigues
- Association for Innovation and Biomedical Research in Light and Image, Azinhaga Santa Comba, 3000-548 Coimbra, PortugaldUniversity of Coimbra, Institute of Systems and Robotics, Pinhal de Marrocos-Polo II, 3030 Coimbra, Portugal
| | - Dirce Celorico
- Association for Innovation and Biomedical Research in Light and Image, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal
| | - Pedro Serranho
- University of Coimbra, Faculty of Medicine, Institute for Biomedical Imaging and Life Sciences, Azinhaga Santa Comba, 3000-548 Coimbra, PortugaleUniversidade Aberta, Mathematics Section, Department of Science and Technology, Rua da Escola Politécnica 141-
| | - Rui Bernardes
- University of Coimbra, Faculty of Medicine, Institute for Biomedical Imaging and Life Sciences, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal
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Lockhart CJ, McCann AJ, Pinnock RA, Hamilton PK, Harbinson MT, McVeigh GE. Multimodal functional and anatomic imaging identifies preclinical microvascular abnormalities in type 1 diabetes mellitus. Am J Physiol Heart Circ Physiol 2014; 307:H1729-36. [PMID: 25281566 DOI: 10.1152/ajpheart.00372.2014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Structural and functional changes in the microcirculation in type 1 diabetes mellitus predict future end-organ damage and macrovascular events. We explored the utility of novel signal processing techniques to detect and track changes in ocular hemodynamics in patients with this disease. Twenty-four patients with uncomplicated type 1 diabetes mellitus and eighteen age- and sex-matched control subjects were studied. Doppler ultrasound was used to interrogate the carotid and ophthalmic arteries, and digital photography was used to image the retinal vasculature. Frequency analysis algorithms were applied to quantify velocity waveform structure and retinal photographic data at baseline and after inhalation of 100% O2. Frequency data were compared between groups. No significant differences were found in the resistive index between groups at baseline or after inhaled O2. Frequency analysis of Doppler flow velocity waveforms identified significant differences in bands 3-7 between patients and control subjects in data captured from the ophthalmic artery (P < 0.01 for each band). In response to inhaled O2, changes in frequency band amplitudes were significantly greater in control subjects compared with patients (P < 0.05). Only control subjects demonstrated a positive correlation (R = 0.61) between changes in retinal vessel diameter and frequency band amplitudes derived from ophthalmic artery waveform data. The use of multimodal signal processing techniques applied to Doppler flow velocity waveforms and retinal photographic data identified preclinical changes in the ocular microcirculation in patients with uncomplicated diabetes mellitus. An impaired autoregulatory response of the retinal microvasculature may contribute to the future development of retinopathy in such patients.
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Affiliation(s)
- C J Lockhart
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland; and
| | - A J McCann
- Regional Medical Physics Service, Northern Ireland, Royal Victoria Hospital, Belfast, Northern Ireland
| | - R A Pinnock
- Regional Medical Physics Service, Northern Ireland, Royal Victoria Hospital, Belfast, Northern Ireland
| | - P K Hamilton
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland; and
| | - M T Harbinson
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland; and
| | - G E McVeigh
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland; and
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Pham-Short A, C Donaghue K, Ambler G, K Chan A, Hing S, Cusumano J, E Craig M. Early elevation of albumin excretion rate is associated with poor gluten-free diet adherence in young people with coeliac disease and diabetes. Diabet Med 2014; 31:208-12. [PMID: 24117620 DOI: 10.1111/dme.12329] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/06/2013] [Accepted: 09/19/2013] [Indexed: 12/18/2022]
Abstract
AIMS There are conflicting data on microvascular complications in coexisting Type 1 diabetes and coeliac disease. We compared complications rates in youth with or without coeliac disease and examined the association between gluten-free diet adherence and complications. METHODS This was a comparative study of adolescents (2510 without coeliac disease, 129 with coeliac disease); 60 (47%) did not adhere to a gluten-free diet--defined as elevated anti-tissue transglutaminase or endomysial immunoglobulin A titres. Retinopathy was detected using 7-field fundal photography and albumin excretion rate by timed overnight urine collections, with early elevation defined as albumin excretion rate ≥ 7.5 μg/min. Logistic regression was used to examine the association between complications and explanatory variables, including coeliac disease vs. no coeliac disease, gluten-free diet adherence vs. non-adherence, diabetes duration and HbA1c . RESULTS Median age at last assessment was 16.5 years. Those with coeliac disease vs. those without were younger at diabetes diagnosis (7.1 vs. 8.6 years, P < 0.001) and had longer diabetes duration (9.3 vs. 7.2 years, P < 0.001). HbA1c was lower in those with coeliac disease vs. those without (67 vs. 70 mmol/mol, 8.3 vs. 8.6%, P = 0.04) and adherence to a gluten-free diet vs. non-adherence (66 vs. 72 mmol/mol, 8.2 vs. 8.7%, P = 0.003). There were no differences in complication rates between those with coeliac disease vs. those without (retinopathy 22 vs. 23%, elevated albumin excretion rate 31 vs. 28%). Non-adherence to a gluten-free diet was associated with elevated albumin excretion rate (40 vs. 23%, P = 0.04). In multivariable logistic regression, elevated albumin excretion rate was associated with non-adherence to a gluten-free diet (odds ratio 2.37, 95% CI 1.04-5.40, P = 0.04) and diabetes duration (odds ratio 1.13, 95% CI 1.02-1.25, P = 0.03), but not HbA1c . CONCLUSIONS While glycaemic control is better in patients with coeliac disease, non-adherence to a gluten-free diet is associated with elevated albumin excretion rate. The possible protection of a gluten-free diet on complications warrants further investigation.
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Affiliation(s)
- A Pham-Short
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead; Discipline of Paediatrics and Child Health, University of Sydney, Sydney
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Kalitzeos AA, Lip GYH, Heitmar R. Retinal vessel tortuosity measures and their applications. Exp Eye Res 2012; 106:40-6. [PMID: 23146682 DOI: 10.1016/j.exer.2012.10.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 10/05/2012] [Accepted: 10/30/2012] [Indexed: 10/27/2022]
Abstract
Structural retinal vascular characteristics, such as vessel calibers, tortuosity and bifurcation angles are increasingly quantified in an objective manner, slowly replacing subjective qualitative disease classification schemes. This paper provides an overview of the current methodologies and calculations used to compute retinal vessel tortuosity. We set out the different parameter calculations and provide an insight into the clinical applications, while critically reviewing its pitfalls and shortcomings.
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Affiliation(s)
- Angelos A Kalitzeos
- Aston University, School of Life and Health Sciences, Aston Triangle, Birmingham B4 7ET, UK
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Zorena K, Kula M, Malinowska E, Raczyńska D, Myśliwiec M, Raczyńska K. Threshold serum concentrations of tumour necrosis factor alpha (TNFα) as a potential marker of the presence of microangiopathy in children and adolescents with type 1 diabetes mellitus (T1DM). Hum Immunol 2012; 74:75-81. [PMID: 23073299 DOI: 10.1016/j.humimm.2012.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 09/12/2012] [Accepted: 10/03/2012] [Indexed: 11/18/2022]
Abstract
The aim of this study was to estimate the threshold serum concentrations of advanced glycation end products (AGEs) and their soluble receptors (sRAGE) as well as tumour necrosis factor alpha (TNFα), vascular endothelial growth factor(165) (VEGF(165)) and interleukin-12 (IL-12) in predicting the occurrence of microangiopathy in children and adolescents with type 1 diabetes mellitus (T1DM). We studied 88 children and adolescents (age range: 6-20 yrs) with T1DM and 32 control subjects (age range: 7-20 yrs). All study participants had their daily urinary albumin excretion, HbA1c and serum creatinine levels measured, and underwent an eye examination and 24-h blood pressure monitoring. Moreover, serum concentrations of AGEs, sRAGE, TNFα, VEGF(165) and IL-12 were measured. In order to calculate the threshold values of the studied parameters, the Receiver Operating Characteristic (ROC) curve analysis was used. The results of our study have shown that among all the studied parameters a discriminative ability was found for TNFα, VEGF(165), duration of the disease, serum AGEs concentrations and daily urinary albumin excretion. However, the highest value of the area under the ROC curve (AUC(ROC)) in predicting the occurrence of diabetic microangiopathy was found for serum TNFα concentrations with its threshold value of 1.7 pg/ml [AUC(ROC) = 0.88 (95% CI: 0.79-0.97)]. The sensitivity and specificity for this variable was at the level of 85.7% and 94.3%, respectively. In conclusion, according to our results serum TNFα concentrations over 1.7 pg/ml may point to the presence of diabetic microangiopathy in children and adolescents T1DM.
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Affiliation(s)
- Katarzyna Zorena
- Department of Clinical and Experimental Endocrinology, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Poland.
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40
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Magge SN. Cardiovascular Risk in Children and Adolescents with Type 1 and Type 2 Diabetes Mellitus. CURRENT CARDIOVASCULAR RISK REPORTS 2012; 6:591-600. [PMID: 23293697 DOI: 10.1007/s12170-012-0274-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Rising rates of both type 1 and type 2 diabetes mellitus in children have led to increased concern regarding cardiovascular disease (CVD) risk during childhood. Diabetic children face prolonged exposure to hyperglycemia, and have increased risk of both microvascular and macrovascular disease. These circumstances may result in a generation of young adults presenting with cardiovascular outcomes, a tremendous personal and public health toll. In this article, we review CVD risk in type 1 and type 2 diabetes, discuss aspects of pathophysiology, and review current methods of CVD risk assessment. We also identify crucial areas in need of future research in order to devise effective prevention and treatment of CVD risk in children.
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Affiliation(s)
- Sheela N Magge
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia; Perelman School of Medicine at the University of Pennsylvania
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