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Omar A, Williams RG, Whelan J, Noble J, Brent MH, Giunta M, Olivier S, Lhor M. Diabetic Disease of the Eye in Canada: Consensus Statements from a Retina Specialist Working Group. Ophthalmol Ther 2024; 13:1071-1102. [PMID: 38526804 DOI: 10.1007/s40123-024-00923-0] [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: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024] Open
Abstract
Despite advances in systemic care, diabetic disease of the eye (DDE) remains the leading cause of blindness worldwide. There is a critical gap of up-to-date, evidence-based guidance for ophthalmologists in Canada that includes evidence from recent randomized controlled trials. Previous guidance has not always given special consideration to applying treatments and managing DDE in the context of the healthcare system. This consensus statement aims to assist practitioners in the field by providing a spectrum of acceptable opinions on DDE treatment and management from recognized experts in the field. In compiling evidence and generating consensus, a working group of retinal specialists in Canada addressed clinical questions surrounding the four themes of disease, patient, management, and collaboration. The working group reviewed literature representing the highest level of evidence on DDE and shared their opinions on topics surrounding the epidemiology and pathophysiology of diabetic retinopathy and diabetic macular edema; diagnosis and monitoring; considerations around diabetes medication use; strategic considerations for management given systemic comorbidities, ocular comorbidities, and pregnancy; treatment goals and modalities for diabetic macular edema, non-proliferative and proliferative diabetic retinopathy, and retinal detachment; and interdisciplinary collaboration. Ultimately, this work highlighted that the retinal examination in DDE not only informs the treating ophthalmologist but can serve as a global index for disease progression across many tissues of the body. It highlighted further that DDE can be treated regardless of diabetic control, that a systemic approach to patient care will result in the best health outcomes, and prevention of visual complications requires a multidisciplinary management approach. Ophthalmologists must tailor their clinical approach to the needs and circumstances of individual patients and work within the realities of their healthcare setting.
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Affiliation(s)
- Amer Omar
- Medical Retina Institute of Montreal, 2170 René-Lévesque Blvd Ouest, Bureau 101, Montréal, QC, H3H 2T8, Canada.
| | - R Geoff Williams
- Calgary Retina Consultants, University of Calgary, Calgary, AB, Canada
| | - James Whelan
- Faculty of Medicine, Memorial University, St. John's, NF, Canada
| | - Jason Noble
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, Canada
| | - Michel Giunta
- Department of Ophthalmology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Sébastien Olivier
- Centre Universitaire d'ophtalmologie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Mustapha Lhor
- Medical and Scientific Affairs Ophthalmology, Bayer Inc., Mississauga, ON, Canada
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Xiaodong L, Xuejun X, Xiaojuan S, Yu H, Mingchao X. Characterization of peripheral blood inflammatory indicators and OCT imaging biological markers in diabetic retinopathy with or without nephropathy. Front Endocrinol (Lausanne) 2023; 14:1160615. [PMID: 37465123 PMCID: PMC10351984 DOI: 10.3389/fendo.2023.1160615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023] Open
Abstract
Objective To observe the distribution characteristics of peripheral blood inflammatory indexes and retinal macular area optical coherence tomography (OCT) imaging biomarkers in patients with diabetic retinopathy (DR) with or without diabetic nephropathy (DN), in order to seek clinical biomarkers that can predict the development of DR and DN. Methods A total of 169 inpatients with DR who visited the ophthalmology department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from October 2020 to June 2022 and had complete clinical data were collected, and the patients with DR were divided into two major groups, DR and DR/DN, according to whether they had DN, and then further divided into four subgroups, Non-proliferative DR(NPDR), proliferative DR(PDR), NPDR/DN and PDR/DN, according to the stage of DR. The distribution characteristics of peripheral blood inflammatory indexes [Neutrophil to lymphocyte ratio(NLR) and Platelet to neutrophil ratio(PLR)], renal function indexes [Cystatin-C(CYS-C), Creatinine(Crea), Uric acid(UA)and Urinary albumin to creatinine ratio(UACR)] and OCT imaging indexes [Hyperreflective foci(HRF), Disorgnization of retinal inner layers(DRIL), Outer retinal tubulations(ORTs), Central retinal thickness(CRT), Retinal nerve fiber layer(RNFL) and Ganglion cell layer(GCL)] were analyzed between the above subgroups. Results There was no difference between DR and DR/DN groups in terms of gender, family history of diabetes, duration of diabetes and Body mass index(BMI) (P>0.05), the mean age of the DR/DN group was significantly lower than that of the DR group (P<0.05), and the proportion of the DR/DN group with a history of hypertension was significantly higher than that of the DR group (P<0.05); there was no significant difference in hemoglobin A1C(HbA1c) between DR and DR/DN groups (P>0.05). (P>0.05), Hemoglobin(HGB) was significantly higher in the DR group than in the DR/DN group (P <0.05), NLR, PLR, Crea, UA and CYS-C were significantly higher in the DR/DN group than in the DR group (P<0.05); there was no significant difference in the comparison of HRF, DRIL, ORTs positive rate and CRT between the DR and DR/DN groups (P>0.05). RNFL and GCL thickness were significantly lower in the DR/DN group than in the DR group (P<0.05); history of hypertension (OR=2.759), NLR (OR=1.316), PLR (OR=1.009), Crea (OR=1.018), UA (OR=1.004), CYS-C (OR=3.742) were the independent (OR=0.951), age (OR=0.951), HGB (OR=0.976), RNFL (OR=0.909) and GCL (OR=0.945) were independent protective factors for DR/DN; RNFL (OR=0.899) and GCL (OR=0.935) were independent protective factors for NPDR/DN, RNFL (OR=0.852) and GCL (OR=0.928) were independent protective factors for PDR/DN. ROC curve analysis showed that the area under the curve (AUC) for CYS-C, PLR, Crea, UA and the combination of the four indicators to predict DR/DN were 0.717, 0.625, 0.647, 0.616 and 0.717, respectively. Conclusions (1) Low age combined with hypertension HGB, NLR, PLR, CYS-C, Crea and UA may be serum biological markers for predicting DN in DR; meanwhile, PLR, CYS-C, Crea, UA and the combination of the four indicators can be used for risk assessment and adjunctive diagnosis of DN in DR combined with hypertension. (2) The RNFL and GCL thickness in the temporal aspect of the central macular sulcus may be imaging biological markers for predicting DN in DR; meanwhile, GCL thickness may have important value for risk prediction and diagnosis of DN in combination with DR.
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Affiliation(s)
- Li Xiaodong
- Department of Ophthalmology, The First Affiliated Hospital of Guizhou University of Chinese Medicine, Chengdu, China
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xie Xuejun
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Su Xiaojuan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - He Yu
- Department of Ophthalmology, Chengdu First People’s Hospital, Chengdu, China
| | - Xu Mingchao
- Traditional Chinese Medicine Hospital of Meishan, Meishan, China
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Mertes B, Kuniss N, Piorkowski M, Mertes LP, Hammes HP. Screening Results for Diabetic Retinopathy in Germany in a Real-world Cohort in a Metropolitan Diabetes Care Center. Exp Clin Endocrinol Diabetes 2023; 131:182-186. [PMID: 37054716 DOI: 10.1055/a-2002-5116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND Retinal screening is mandatory to prevent vision loss and blindness due to diabetic retinopathy (DR). The aim of the study was to determine retinopathy screening rates and potential barriers in a German metropolitan diabetes care center. METHODS Between May and October 2019, 265 patients with diabetes mellitus (95% type 2 diabetes; age 62±13.2 years; diabetes duration 11.1±8.5 years, HbA1c 7.4±1.0%) were referred to an ophthalmologist (referral form with order "Fundoscopy in diabetes mellitus, findings requested," completed documentation form "General practitioner's/diabetologist's report to the ophthalmologist" and prepared documentation form "Ophthalmologist's report"). A structured interview was used to assess the level of compliance with the guidelines and to identify potential barriers to retinopathy screening in a real-world setting, including the quantification of extra payments. RESULTS All patients were interviewed at 7.9±2.5 months after the referral for retinopathy screening had been issued. According to patient reporting, fundoscopy was performed in 191 (75%) patients. Ophthalmological reports were obtained from 119/191 (62%) patients (46% of the entire cohort). 10/119 (8%) patients had been previously diagnosed with DR and 6/119 (5%) with new-onset DR. In 158/191 (83%) of patients, the referral had been accepted by the ophthalmology practice, of which 25,1% made a co-payment of 36.2±37.6 €. DISCUSSION Despite a high screening performance in a real-world setting, complete screening in compliance with German guidelines, including written reporting, was found in less than half of the cohort. The prevalence and incidence of DR are high. Even when referred according to the regulations, one-quarter of patients made a co-payment. Efficient solutions to current barriers can emerge with mutual time-saving information prior to examination and feedback about the implementation of findings into treatment.
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Affiliation(s)
- Bernardo Mertes
- Centre for Cardioangiology Bethanien, AGAPLESION Hospital Bethanien, Department for Diabetology
| | - Nadine Kuniss
- Jena University Hospital, Department of Internal Medicine III
| | - Michael Piorkowski
- Centre for Cardioangiology Bethanien, AGAPLESION Hospital Bethanien, Department for Diabetology
| | - Linus Paul Mertes
- Centre for Cardioangiology Bethanien, AGAPLESION Hospital Bethanien, Department for Diabetology
| | - Hans-Peter Hammes
- Universitätsmedizin Mannheim, University of Heidelberg, 5th Medical Department
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Lai J, Ouyang J, Lin W, Liu M, Yang Y, Wang R, Yang H, Meng Q, Dong J, Zhang J, Li L, He F. TRIB3 promoter 33 bp VNTR is associated with the risk of cerebrovascular disease in type 2 diabetic patients. Front Genet 2022; 13:916281. [PMID: 36105108 PMCID: PMC9464918 DOI: 10.3389/fgene.2022.916281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Previous studies have demonstrated that TRIB3 is closely related to insulin resistance, metabolic disorders and vascular diseases. Recently, it was reported that a 33 bp variable number of tandem repeats (VNTR) located in the TRIB3 promoter could considerably alter its transcriptional activity. Nonetheless, whether the shift of TRIB3 transcriptional activity has the effect of inducing diabetic vascular complications is still unclear. Therefore, in our study, we aimed to explore the relationship between the TRIB3 33bp VNTR and diabetic vascular complications. The TRIB3 33bp VNTR polymorphisms were determined by PCR and Sanger sequencing, a total of 798 eligible Chinese patients with type 2 diabetes (T2DM) were included in our study and then evaluated with clinical data. After adjusting for age, gender, BMI, smoking history, drinking history and duration of diabetes, we found that the high number of 33 bp tandem repeats (repeats>8) was significantly associated with an increase in the risk of cerebrovascular diseases compared with the low number of 33 bp tandem repeats (repeats≤6) in patients with T2DM(OR 2.66, 95% CI 1.29–5.47, p = 0.008). The intermediate number of 33bp tandem repeats (6 < repeat≤8) was markedly associated with a decreased risk of diabetic retinopathy compared with the low number of tandem repeats (OR 0.65, 95% CI 0.46–0.91, p = 0.012). Adjusting for gender, age and BMI, there was a significant difference in DBP levels among patients with the number of different 33 bp tandem repeats (Low vs. Intermediate vs. High, 81.6 ± 12.8 vs. 79.8 ± 12.4 vs. 78.7 ± 12.6 mmHg; p = 0.045). Subgroup analysis found that TRIB3 VNTR was significantly correlated with the difference in systolic blood pressure (SBP) in T2DM patients taking ACEI/ARB drugs (Low vs. Intermediate vs. High, 146.27 ± 18.23 vs. 140.01 ± 19.91 vs. 140.77 ± 18.64 mmHg; p = 0.018). Our results indicated that TRIB3 promoter 33bp VNTR is related to vascular diseases in T2DM patients, and may serve as a new biomarker for individualized prevention and therapy of T2DM.
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Affiliation(s)
- Jiaqi Lai
- Department of Pharmacy, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Jiaying Ouyang
- Department of Pharmacy, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Weijie Lin
- Department of Pharmacy, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Mouze Liu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Yang
- Department of Pharmacy, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Ruiqi Wang
- Department of Pharmacy, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Haikui Yang
- Department of Pharmacy, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Qian Meng
- Department of Pharmacy, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Jiamei Dong
- Department of Pharmacy, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Jianping Zhang
- College of Pharmacy, Jinan University, Guangzhou, China
- *Correspondence: Fazhong He, ; Ling Li, ; Jianping Zhang,
| | - Ling Li
- Department of Pharmacy, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- *Correspondence: Fazhong He, ; Ling Li, ; Jianping Zhang,
| | - Fazhong He
- *Correspondence: Fazhong He, ; Ling Li, ; Jianping Zhang,
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Cleemen C, Müller N, Lehmann T, Voigt UA, Meller D, Kloos C, Wolf G, Müller UA, Voigt M. Prevalence of Impairment of Visual Acuity and Severity of Retinopathy in Patients with Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2022; 130:652-659. [PMID: 35940177 DOI: 10.1055/a-1752-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS No information exists on the frequency of visual impairment in people with diabetes mellitus (DM) in Germany. In this study, the prevalence of vision impairment in those individuals was investigated. METHODS We retrospectively analyzed a cohort of 295 people (14221 consultations) at a university outpatient clinic with any type of DM and an available ETDRS-Score and visual acuity. The primary outcome was the prevalence of visual impairment, the secondary outcome was the correlation of the ETDRS-Score and limitations of visual acuity and the prevalence of higher ETDRS-Score with a visual impairment defined as a decimal-visus</=0.3. RESULTS The prevalence of visual impairment in participants with DM was 11.2%; among these individuals, 81.8% had no or non-proliferative retinopathy. In the DM2 subgroup, 81.5% (n=22) of the visually impaired participants had no DR, in contrast to only 16.7% (n=1) in the DM1 subgroup. Progression in ETDRS-Score led to worse visual acuity (r=-0.209; p<0.001). A significantly related covariates with impairment of the visual acuity for individuals with DM1 was the duration of diabetes (B=-0.007; p=0.001) and for individuals with DM2, the age (B=-0.008; p=0.009). CONCLUSIONS The prevalence of impaired vision in people with diabetes in our cohort was 11.2%,<20% of visual impairment in people with diabetes is caused by diabetic retinopathy, and 69.7% of participants with visual impairment had no DR. In our study patients without visual impairment showed a similar distribution of DR severity levels regardless of the type of diabetes.
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Affiliation(s)
- Constantin Cleemen
- Jena University Hospital, Department for Internal Medicine III, Jena, Germany
| | - Nicolle Müller
- Jena University Hospital, Department for Internal Medicine III, Jena, Germany
| | - Thomas Lehmann
- Jena University Hospital, Center for Clinical Studies, Jena, Germany
| | - Ulrich A Voigt
- Jena University Hospital, Center for Ophthalmology, Jena, Germany
| | - Daniel Meller
- Jena University Hospital, Center for Ophthalmology, Jena, Germany
| | - Christof Kloos
- Jena University Hospital, Department for Internal Medicine III, Jena, Germany
| | - Gunter Wolf
- Jena University Hospital, Department for Internal Medicine III, Jena, Germany
| | - Ulrich A Müller
- Practice for Endocrinology and Diabetology, Dr. Kielstein Ambulante Medizinische Betreuung GmbH, Jena, Germany
| | - Margarete Voigt
- Jena University Hospital, Department for Internal Medicine III, Jena, Germany
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Mazzuca D, Borselli M, Gratteri S, Zampogna G, Feola A, Della Corte M, Guarna F, Scorcia V, Giannaccare G. Applications and Current Medico-Legal Challenges of Telemedicine in Ophthalmology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095614. [PMID: 35565003 PMCID: PMC9101177 DOI: 10.3390/ijerph19095614] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The digital revolution is redesigning the healthcare model, and telemedicine offers a good example of the best cost-effectiveness ratio. The COVID-19 pandemic has catalysed the use of the telemedicine. The aim of this review is to describe and discuss the role and the main applications of telemedicine in the ophthalmic clinical practice as well as the related medico-legal aspects. METHODS 45 original articles and 5 reviews focused on this topic and published in English language from 1997 and 2021 were searched on the online databases of Pubmed, Scopus, Web of Sciences and Embase, by using the following key words: "telemedicine", "privacy", "ophthalmology", "COVID-19" and "informed consent". RESULTS Telemedicine is able to guarantee patient care using information and communication technologies. Technology creates an opportunity to link doctors with the aim of assessing clinical cases and maintaining high standards of care while performing and saving time as well. Ophthalmology is one of the fields in which telemedicine is most commonly used for patient management. CONCLUSIONS Telemedicine offers benefits to patients in terms of saving time and costs and avoiding physical contact; however, it is necessary to point out significant limitations such as the absence of physical examinations, the possibility of transmission failure and potential violations of privacy and confidentiality.
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Affiliation(s)
- Daniela Mazzuca
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Massimiliano Borselli
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
| | - Santo Gratteri
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Giovanna Zampogna
- Department of Law, Economics and Human Sciences (DIGIES), Mediterranea University of Reggio Calabria, Via dell’Università 25, 89124 Reggio Calabria, Italy;
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, Via Luciano Armanni 5, 80138 Naples, Italy;
| | - Marcello Della Corte
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Francesca Guarna
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Vincenzo Scorcia
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
- Correspondence: ; Tel.: +39-0961-3647-041; Fax: +39-0961-3647-094
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Zeng J, Chen M, Feng Q, Wan H, Wang J, Yang F, Cao H. The Platelet-to-Lymphocyte Ratio Predicts Diabetic Retinopathy in Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:3617-3626. [PMID: 36444389 PMCID: PMC9700435 DOI: 10.2147/dmso.s378284] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION As a severe and specific neurovascular complication of type 2 diabetes mellitus (T2DM), diabetic retinopathy (DR) remains the leading cause of vision loss and preventable blindness in adults aged 20 to 74. The pathogenesis of DR is not completely understood, however, studies indicate that chronic inflammation plays a significant role. Emerging evidence suggests that the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the monocyte-to-lymphocyte ratio (MLR) are novel potential inflammatory response markers. The purpose of this study was to investigate the relationships between the NLR, PLR, MLR, and DR. PATIENTS AND METHODS 290 patients who had been diagnosed with T2DM participated in the study. Patients were categorized into three groups: 142 control subjects with T2DM, 124 subjects with nonproliferative diabetic retinopathy (NPDR), and 24 patients with proliferative diabetic retinopathy (PDR). Characteristics, laboratory data, as well as NLR, PLR and MLR levels of the study groups were compared. RESULTS In patients with DR, the median NLR, PLR, and MLR were significantly higher than in patients without DR (p = 0.012, p < 0.001, and p = 0.043, respectively). In the post hoc analysis, there was no correlation between the severity of retinopathy and the increase in NLR or PLR. Multiple logistic regression revealed that the PLR was an independent risk factor for DR (odds ratio [OR]: 1.020, 95% confidence interval [CI]: 1.010-1.029 p = 0.026). Based on the receiver operating characteristic (ROC) curve, the cutoff value of PLR as an indicator for diagnosing DR was estimated to be 129.65, with a sensitivity and specificity of 53.4% and 76.1%, respectively, and an area under the curve of 0.668 (95% CI: 0.605-0.730, p < 0.001). CONCLUSION Our findings suggest that PLR may be an independent risk factor for evaluating DR in type 2 diabetes patients.
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Affiliation(s)
- Jing Zeng
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Min Chen
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Qiu Feng
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Haiyan Wan
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Jianbo Wang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Medical Record, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Fan Yang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Hongyi Cao
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
- Correspondence: Hongyi Cao; Fan Yang, Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), No. 33, Mashi Street, Wenjiang District, Chengdu, Sichuan, 611130, People’s Republic of China, Tel +86 13730683979, Fax +86 028-82713097, Email ;
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Ou Y, Zhang W, Chen S, Deng H. Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway. Open Med (Wars) 2021; 16:1286-1298. [PMID: 34541327 PMCID: PMC8415539 DOI: 10.1515/med-2021-0335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/21/2021] [Accepted: 08/06/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the effect of baicalin on diabetic nephropathy (DN) rats and podocytes and its mechanism. Methods The rat models with DN were established by high-fat and high-sugar diet and intraperitoneal injection of streptozotocin. The fasting blood glucose (FBG) and weight of rats in each group were measured at 0, 1, 2, 3, and 4 weeks. Their biochemical indicators, expression of inflammatory, and antioxidant factors were measured using an automatic biochemical analyzer together with ELISA. Hematoxylin-eosin staining and periodic acid-schiff staining were used to observe the morphological changes in the kidneys of rats in each group. Finally, the expressions of related molecules and PI3K/Akt/mTOR signaling pathway proteins in renal tissues and podocytes were examined by qRT-PCR and Western blot. Results Compared with the DN group, the FBG and weight, serum creatinine, blood urea nitrogen, total cholesterol, triacylglycerol, microalbumin, and albumin/creatinine ratio were all significantly decreased in the Baicalin treatment groups in a concentration-dependent manner. The levels of inflammatory factors in kidney tissue and podocytes were decreased. In addition, the activities of lactate dehydrogenase and malondialdehyde in tissue were decreased, while the superoxide dismutase was increased. The pathological sections showed that glomerular atrophy and glomerular basement membrane thickening caused by hyperglycemia were improved in the Baicalin treatment groups. Meanwhile, baicalin inhibited the downregulation of Nephrin and Podocin expressions and upregulation of Desmin expression caused by DN, and inhibited the expressions of p-PI3K, p-Akt, and p-mTOR proteins. Conclusion Baicalin slows down podocyte injury caused by DN by inhibiting the activity of PI3K/Akt/mTOR signaling pathway.
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Affiliation(s)
- Yi Ou
- Department of Endocrinology, Shenzhen Fuyong People's Hospital, Shenzhen, Guangdong 518103, China
| | - Wenjuan Zhang
- Department of Public Health and Preventive Medicine, School of Basic Medical Sciences, Jinan University, Guangzhou, Guangdong 510632, China
| | - Shaopeng Chen
- Department of Biomedicine, School of Medicine, Shenzhen University, Shenzhen, Guangdong 518061, China
| | - Haihua Deng
- Department of Neurology, Shenzhen Fuyong People's Hospital, Shenzhen, Guangdong 518103, China
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Abstract
Diabetic macular edema (DME) is a chronic retinal disease, which requires intensive clinical monitoring. Within the last ten years the intravitreal anti-VEGF (vascular endothelial growth factor) therapy has become the standard of care to improve and stabilize vision in patients with centre involving DME. Long-acting intravitreal corticosteroids can achieve similar visual results with fewer injection rates. Because of steroid-induced side effects (progression of cataract, glaucoma) these drugs are regarded as second-line medication. Since the introduction of anti-VEGF-medication the focal laser photocoagulation is no longer considered as first-line therapy for DME. However, a focal laser treatment can sometimes be a possible alternative in specific situations. In patients with proliferative diabetic retinopathy and DME, the intravitreal anti-VEGF therapy is approved for both conditions. In ischemic maculopathy the functional outcome is restricted. For the indication of anti-VEGF-treatment for DME with accompanying central ischemia not only visual acuity and optical coherence tomography parameters should be considered, the amount of ischemia seen on fluorescein angiography should also be taken into account. In tractional macular edema due to epiretinal membranes and vitreomacular adhesions a pars-plana vitrectomy with membrane peeling is indicated.
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Abstract
Diabetic retinopathy (DR) is a vision-threatening microvascular complication of diabetes and the leading cause of blindness in working-age people. At the beginning of the metabolic disorder and in early stages of DR the patient's eyesight is often not affected. Depending on the duration of diabetes and in more advanced stages of DR the vision is compromised through the presence of diabetic macular edema (DME) and/or proliferative retinal complications. The management of DR comprises regular ophthalmic examinations according to clinical guidelines, the targeted application of multimodal imaging, and the specific treatment of DME and proliferative DR including secondary disorders such as neovascular glaucoma or persistent vitreous haemorrhage. Innovative ocular imaging techniques like optical coherence tomography (OCT), OCT angiography (OCT-A) and ultrawide field imaging play an important role in the assessment of diabetic patients. Various non-invasive imaging modalities have become part of the routine clinical work-up and help to identify new biomarkers for early diagnosis and long-term prognosis. In early stages of DR, the multifactorial intervention including glucose level and blood pressure control as well as optimizing the patient's cardiovascular risk profile is essential. A specific ophthalmic therapy is available for DME and proliferative DR (PDR). In patients with PDR the treatment regime includes panretinal laser photocoagulation or alternatively intravitreal anti-VEGF (vascular endothelial growth factor)-injections accompanied by close-meshed clinical monitoring. In patients with both, DME and PDR, it is suggested to start with Anti-VEGF drugs. In severe PDR with persistent vitreous haemorrhage, tractional maculopathy or tractional retinal detachment vitreoretinal surgery is recommended.
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Barth T, Helbig H. Diabetische Retinopathie. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1262-3160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDie diabetische Retinopathie (DR) ist die häufigste Ursache für schwere
Sehbehinderung und Erblindung im erwerbstätigen Alter. Eine subjektive
Beeinträchtigung des Sehvermögens tritt häufig erst in fortgeschrittenen Stadien
der DR ein. Daher sind Screening-Maßnahmen asymptomatischer Patienten und eine
stadiengerechte Behandlung essenziell. Dieser Beitrag gibt einen praxisbezogenen
Überblick über diagnostische und therapeutische Prinzipien der
nicht-proliferativen und proliferativen Form.
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12
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Abstract
ZusammenfassungDas diabetische Makulaödem (DMÖ) ist für den Großteil der Visusminderungen bei Diabetikern verantwortlich. Eine Reduktion der Sehschärfe durch ein DMÖ kann schon im milden nicht-proliferativen Stadium der diabetischen Retinopathien (DR) auftreten 1. Der chronische Verlauf der diabetischen Makulopathie erfordert ein intensives klinisches Monitoring über einen langen Zeitraum. Dieser Beitrag gibt einen Überblick über das diagnostische und therapeutische Management beim Vorliegen eines DMÖ.
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Darwish NM, Elnahas YM, AlQahtany FS. Diabetes induced renal complications by leukocyte activation of nuclear factor κ-B and its regulated genes expression. Saudi J Biol Sci 2021; 28:541-549. [PMID: 33424337 PMCID: PMC7783672 DOI: 10.1016/j.sjbs.2020.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 01/08/2023] Open
Abstract
Type 2 diabetes mellitus (T2D) is a metabolic disorder characterized by inappropriate insulin function. Despite wide progress in genome studies, defects in gene expression for diabetes prognosis still incompletely identified. Prolonged hyperglycemia activates NF-κB, which is a main player in vascular dysfunctions of diabetes. Activated NF-κB, triggers expression of various genes that promote inflammation and cell adhesion process. Alteration of pro-inflammatory and profibrotic gene expression contribute to the irreversible functional and structural changes in the kidney resulting in diabetic nephropathy (DN). To identify the effect of some important NF-κB related genes on mediation of DN progression, we divided our candidate genes on the basis of their function exerted in bloodstream into three categories (Proinflammatory; NF-κB, IL-1B, IL-6, TNF-α and VEGF); (Profibrotic; FN, ICAM-1, VCAM-1) and (Proliferative; MAPK-1 and EGF). We analyzed their expression profile in leukocytes of patients and explored their correlation to diabetic kidney injury features. Our data revealed the overexpression of both proinflammatory and profibrotic genes in DN group when compared to T2D group and were associated positively with each other in DN group indicating their possible role in DN progression. In DN patients, increased expression of proinflammatory genes correlated positively with glycemic control and inflammatory markers indicating their role in DN progression. Our data revealed that the persistent activation NF-κB and its related genes observed in hyperglycemia might contribute to DN progression and might be a good diagnostic and therapeutic target for DN progression. Large-scale studies are needed to evaluate the potential of these molecules to serve as disease biomarkers.
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Key Words
- 2hPPBG, 2 h post prandial blood glucose.
- ACR, albumin creatinine ratio
- BMI, body mass index.
- DBP, Diastolic blood pressure.
- DN, diabetic nephropathy.
- FBS, fasting blood glucose.
- FN
- HDL, High density lipoprotein-cholesterol.
- HbA1c, Glycosylated hemoglobin.
- ICAM-1
- IL-1β
- IL-6
- LDL, Low density lipoprotein-cholesterol.
- M, male, F, female.
- NF-κB
- S.Cr, serum creatinine.
- SBP, Systolic blood pressure.
- T2D, type 2 diabetes mellitus without nephropathy.
- TC, total cholesterol.
- TGs, Triglyceride.
- TNF-α
- VCAM-1
- VEGF
- VLDL, Very low-density lipoprotein.
- e-GFR, estimated glomerular filtration rate.
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Affiliation(s)
- Noura M. Darwish
- Department of Biochemistry, Faculty of Science, Ain Shams University, 11566, Egypt
- Ministry of Health Laboratories, Tanta, Egypt
| | - Yousif M. Elnahas
- Department of Surgery, College of Medicine, King Saud University, Medical City, Riyadh 24251, Saudi Arabia
| | - Fatmah S. AlQahtany
- Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University, Medical City, King Saud University, Riyadh 24251, Saudi Arabia
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Zhao X, Huo L, Yu X, Zhang X. Association of Bone Metabolism Indices and Bone Mineral Density with Diabetic Retinopathy in Elderly Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Inpatient Study in China. J Diabetes Res 2021; 2021:8853622. [PMID: 33506053 PMCID: PMC7815418 DOI: 10.1155/2021/8853622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE This study is aimed at analyzing the association between bone metabolism indices and diabetic retinopathy (DR) in elderly patients with type 2 diabetes mellitus. METHODS Data of 352 men and 284 postmenopausal women, aged more than 50 years, with type 2 diabetes mellitus were retrospectively analyzed. Patients were divided into three groups based on the degree of DR: nondiabetic retinopathy (NDR) group, background diabetic retinopathy (BDR) group, and proliferative diabetic retinopathy (PDR) group. RESULTS (1) The diabetic duration and urinary albumin to creatinine ratio (UACR) were significantly higher in the PDR and BDR groups than in the NDR group (P < 0.05). The level of beta-C-terminal telopeptide (β-CTX) in male patients was lower in the PDR and BDR groups than in the NDR group (P < 0.05). In addition, the level of procollagen 1 intact N-terminal (P1NP) in female patients was higher in the PDR and BDR groups than in the NDR group (P < 0.05). (2) For men and postmenopausal women, the proportion of vitamin deficiency was higher in the PDR and BDR groups than in the NDR group (P < 0.05). (3) The logistic regression analysis in men and postmenopausal women showed that the diabetic duration and lower levels of UACR and 25(OH)D were independent risk factors for DR (P < 0.05). (4) The diabetic duration was also an independent risk factor for PDR (P < 0.05); however, no independent correlation was found between the level of 25(OH)D and PDR (P > 0.05). CONCLUSIONS A close association was observed between 25(OH)D level and DR in the elderly male patients and postmenopausal women with type 2 diabetes mellitus. P1NP and β-CTX levels might be closely related to DR in elderly male patients and postmenopausal women with type 2 diabetes mellitus.
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Affiliation(s)
- Xin Zhao
- Endocrinology Department, Peking University International Hospital, Beijing, China
| | - Lili Huo
- Endocrinology Department, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaofeng Yu
- Endocrinology Department, Peking University International Hospital, Beijing, China
| | - Xiaomei Zhang
- Endocrinology Department, Peking University International Hospital, Beijing, China
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Forrester JV, Kuffova L, Delibegovic M. The Role of Inflammation in Diabetic Retinopathy. Front Immunol 2020; 11:583687. [PMID: 33240272 PMCID: PMC7677305 DOI: 10.3389/fimmu.2020.583687] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022] Open
Abstract
Inflammation is central to pathogenic processes in diabetes mellitus and the metabolic syndrome and particularly implicates innate immunity in the development of complications. Inflammation is a primary event in Type 1 diabetes where infectious (viral) and/or autoimmune processes initiate disease; in contrast, chronic inflammation is typical in Type 2 diabetes and is considered a sequel to increasing insulin resistance and disturbed glucose metabolism. Diabetic retinopathy (DR) is perceived as a vascular and neurodegenerative disease which occurs after some years of poorly controlled diabetes. However, many of the clinical features of DR are late events and reflect the nature of the retinal architecture and its cellular composition. Retinal microvascular disease is, in fact, an early event pathogenetically, induced by low grade, persistent leukocyte activation which causes repeated episodes of capillary occlusion and, progressive, attritional retinal ischemia. The later, overt clinical signs of DR are a consequence of the retinal ischemia. Metabolic dysregulation involving both lipid and glucose metabolism may lead to leukocyte activation. On a molecular level, we have shown that macrophage-restricted protein tyrosine phosphatase 1B (PTP1B) is a key regulator of inflammation in the metabolic syndrome involving insulin resistance and it is possible that PTP1B dysregulation may underlie retinal microvascular disease. We have also shown that adherent CCR5+CD11b+ monocyte macrophages appear to be selectively involved in retinal microvascular occlusion. In this review, we discuss the relationship between early leukocyte activation and the later features of DR, common pathogenetic processes between diabetic microvascular disease and other vascular retinopathies, the mechanisms whereby leukocyte activation is induced in hyperglycemia and dyslipidemia, the signaling mechanisms involved in diabetic microvascular disease, and possible interventions which may prevent these retinopathies. We also address a possible role for adaptive immunity in DR. Although significant improvements in treatment of DR have been made with intravitreal anti-VEGF therapy, a sizeable proportion of patients, particularly with sight-threatening macular edema, fail to respond. Alternative therapies targeting inflammatory processes may offer an advantage.
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Affiliation(s)
- John V Forrester
- Institute of Medical Sciences, University of Aberdeen, Scotland, United Kingdom
| | - Lucia Kuffova
- Institute of Medical Sciences, University of Aberdeen, Scotland, United Kingdom.,Eye Clinic, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Mirela Delibegovic
- Institute of Medical Sciences, University of Aberdeen, Scotland, United Kingdom
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16
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Claessen H, Kvitkina T, Narres M, Trautner C, Bertram B, Icks A. Markedly decreasing incidence of cause-specific blindness in Saxony (Eastern Germany). Graefes Arch Clin Exp Ophthalmol 2020; 259:1089-1101. [PMID: 32974733 DOI: 10.1007/s00417-020-04885-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/24/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To analyze the recent time trend in Saxony. METHODS Data were based on administrative files in Saxony (Eastern Germany) to assess recipients of blindness allowance newly registered between January 1, 2009, and December 31, 2017. We estimated age-sex standardized incidence of all-cause and cause-specific blindness and used Poisson regression to examine age- and sex-adjusted time trends. RESULTS We identified 5114 new cases of blindness (63.3% female, 59.9% ≥ 80 years). We observed a markedly decrease in incidence of blindness: all-causes 2009: 15.7 per 100,000 person years [95% confidence interval: 14.6-17.0]; 2017: 8.9 [8.1-9.8]; age-related macular degeneration 2009: 6.9 [6.1-7.7], 2017: 3.8 [3.3-4.3]; glaucoma 2009: 2.6 [2.2-3.1], 2017: 1.8 [1.4-2.2]; diabetic retinopathy 2009: 1.5 [1.2-1.9], 2017: 0.7 [0.5-1.0]; myopia 2009: 0.7 [0.5-1.1], 2017: 0.4 [0.2-0.5]; optic atrophy 2009: 0.9 [0.6-1.2], 2017: 0.5 [0.3-0.7]; and cataract 2009: 0.5 [0.3-0.8], 2017: 0.1 [0.1-0.3]. The annual reduction was between 5 (glaucoma, relative risk 0.95 [0.92-0.98]) and 16% (cataract, relative risk 0.84 [0.78-0.91]). CONCLUSION The age- and sex-standardized incidence of blindness decreased among all common causes of blindness in Saxony in the last decade.
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Affiliation(s)
- Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany.
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Tatjana Kvitkina
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Maria Narres
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | | | | | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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17
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Danilova I, Medvedeva S, Shmakova S, Chereshneva M, Sarapultsev A, Sarapultsev P. Pathological changes in the cellular structures of retina and choroidea in the early stages of alloxan-induced diabetes. World J Diabetes 2018; 9:239-251. [PMID: 30588286 PMCID: PMC6304297 DOI: 10.4239/wjd.v9.i12.239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/11/2018] [Accepted: 11/03/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the temporal sequence of pathological changes in the cellular structures of retina and choroidea in the early stages of diabetes in laboratory animals.
METHODS Experimental type 1 diabetes was modeled by three intraperitoneal injections of an alloxan solution into 30 male nonlinear rats at 16 wk of age. The 30th and 60th days from the final alloxan injection were chosen as the endpoints. Light and electron microscopy and morphometric and immunohistochemical studies were performed on histological slices of eyeballs from experimental animals.
RESULTS Diabetic disturbances progressed to 60 d of the experiment. Thus, in the retina, a partial destruction of photoreceptors accompanied by interstitial edema was observed. The morphometric analysis revealed a reduction in the thickness of the retina. A reduction in the number of blood vessels of the choroid with disturbances of the endothelial cells and the vascular walls and a persistent reduction in the number of melanocytes were observed. The number of proliferating Ki-67 positive cells decreased, and the number of macrophages increased with diabetes development.
CONCLUSION The starting point in the development of destructive changes involves early reduction in the number of melanocytes of the choroidea and alterations in the retinal pigment epithelium.
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Affiliation(s)
- Irina Danilova
- Department of Biology and Fundamental Medicine, Institute of Natural Sciences and Mathematics, Ural Federal University Named After the First Pres. of Russia B.N. Yeltsin, Ekaterinburg 620002, Russia
- Laboratory of Morphology and Biochemistry, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
| | - Svetlana Medvedeva
- Department of Biology and Fundamental Medicine, Institute of Natural Sciences and Mathematics, Ural Federal University Named After the First Pres. of Russia B.N. Yeltsin, Ekaterinburg 620002, Russia
- Laboratory of Morphology and Biochemistry, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
| | - Svetlana Shmakova
- Department of Biology and Fundamental Medicine, Institute of Natural Sciences and Mathematics, Ural Federal University Named After the First Pres. of Russia B.N. Yeltsin, Ekaterinburg 620002, Russia
- Laboratory of Morphology and Biochemistry, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
| | - Margarita Chereshneva
- Laboratory of Immunophysiology and Immunopharmacology, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
| | - Alexey Sarapultsev
- Institute of Chemical Engineering, Ural Federal University Named After the First Pres. of Russia B.N. Yeltsin, Ekaterinburg 620002, Russia
- Laboratory of Immunophatophysiology, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
| | - Petr Sarapultsev
- Institute of Chemical Engineering, Ural Federal University Named After the First Pres. of Russia B.N. Yeltsin, Ekaterinburg 620002, Russia
- Laboratory of Immunophatophysiology, Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Ekaterinburg 620049, Russia
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18
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Epidemiologie der diabetischen Retinopathie. DIABETOLOGE 2018. [DOI: 10.1007/s11428-018-0403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Schmidt D. Important Risk Factors Were Not Included. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:288. [PMID: 28502314 PMCID: PMC5437262 DOI: 10.3238/arztebl.2017.0288a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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20
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Gabriele Schorr S. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:288. [PMID: 28502315 PMCID: PMC5437263 DOI: 10.3238/arztebl.2017.0288b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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21
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Jiang S, Chen X. HMGB1 siRNA can reduce damage to retinal cells induced by high glucose in vitro and in vivo. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:783-795. [PMID: 28352154 PMCID: PMC5359008 DOI: 10.2147/dddt.s129913] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diabetic retinopathy (DR), one of the most common complications of late-phase diabetes, is associated with many risk factors, among which continuous low-grade inflammation is one of the principal ones. As such, lowering inflammation levels and maintain the viability of human retinal endothelial cells (HRECs) are critical for DR therapy. HMGB1 is a well-known proinflammatory cytokine. However, whether HMGB1 small interfering RNA (siRNA) can protect retina cells under a high-glucose environment from morphological changes and functional abnormalities remain undetermined. We aimed to investigate the effect of HMGB1 siRNA on retinal cells in DR. MATERIALS AND METHODS A total of 80 adult Wistar rats were randomly divided into four groups (n=20 each): normal control, diabetes mellitus (DM), scrambled (Scr) siRNA, and HMGB1 siRNA. Rats in the DM, Scr siRNA, and siRNA groups were established by intraperitoneal injection of streptozotocin. At 16 weeks after injection, rats in the siRNA and Scr-siRNA groups were intravitreally injected with 2 μL HMGB1 siRNA and 2 μL Scr-siRNA, while rats in the control and DM groups were intravitreally injected with the same dose of sterile saline. At 1 week after injections, we performed the following experiments. Immunohistochemical staining and real-time quantitative polymerase chain reaction were performed to test HMGB1 protein and messenger RNA expression in retinas. We performed TUNEL assays to detect retinal cell apoptosis and electroretinography to detect retinal function. In HRECs treated with high glucose, proliferation, morphology, apoptosis, super-oxide dismutase (SOD), and reactive oxygen species production were detected. Western blot was applied to determine the expressions of HMGB1 and its related protein and apoptosis protein. RESULTS Intravitreal injection of HMGB1 siRNA reduced protein and messenger RNA expression of HMGB1 (both P<0.05). Intravitreal injection of HMGB1 siRNA reduced apoptosis of retinal cells (P<0.05), protected morphological changes in the retina, and improved the function of the retina (P<0.05). In HRECs treated with high glucose, HMGB1 siRNA pretreatment increased cell viability, reduced cell apoptosis, and reduced oxidative damage to cells (all P<0.05). Western blot detection found that HMGB1 siRNA pretreatment can inhibit the expression of cleaved caspase 3 and improve the expression of BCL2 (P<0.05). HMGB1 and NFκB expression increased in a time-dependent manner in the high-glucose environment and IKKβ and NFκB protein expression decreased significantly after HMGB1 silencing. CONCLUSION As a therapeutic target, HMGB1 siRNA can reduce retinal cell damage induced by high glucose in vitro and in vivo and delay DR progress through the HMGB1-IKKβ-NFκB signaling pathway.
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Affiliation(s)
- Shuang Jiang
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaolong Chen
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, China
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22
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Xue R, Gui D, Zheng L, Zhai R, Wang F, Wang N. Mechanistic Insight and Management of Diabetic Nephropathy: Recent Progress and Future Perspective. J Diabetes Res 2017; 2017:1839809. [PMID: 28386567 PMCID: PMC5366800 DOI: 10.1155/2017/1839809] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/16/2017] [Indexed: 12/14/2022] Open
Abstract
Diabetic nephropathy (DN) is the most serious microvascular complication of diabetes and the largest single cause of end-stage renal disease (ESRD) in many developed countries. DN is also associated with an increased cardiovascular mortality. It occurs as a result of interaction between both genetic and environmental factors. Hyperglycemia, hypertension, and genetic predisposition are the major risk factors. However, the exact mechanisms of DN are unclear. Despite the benefits derived from strict control of glucose and blood pressure, as well as inhibition of renin-angiotensin-aldosterone system, many patients continue to enter into ESRD. Thus, there is urgent need for improving mechanistic understanding of DN and then developing new and effective therapeutic approaches to delay the progression of DN. This review focuses on recent progress and future perspective about mechanistic insight and management of DN. Some preclinical relevant studies are highlighted and new perspectives of traditional Chinese medicine (TCM) for delaying DN progression are discussed in detail. These findings strengthen the therapeutic rationale for TCM in the treatment of DN and also provide new insights into the development of novel drugs for the prevention of DN. However, feasibility and safety of these therapeutic approaches and the clinical applicability of TCM in human DN need to be further investigated.
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Affiliation(s)
- Rui Xue
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Dingkun Gui
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Liyang Zheng
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ruonan Zhai
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Feng Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- *Feng Wang: and
| | - Niansong Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- *Niansong Wang:
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