Associations between diabetic retinopathy, mortality, disease, and mental health: an umbrella review of observational meta-analyses

Association Between Retinopathy and Systemic Sclerosis: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES

Studies have indicated a potential link between retinopathy and systemic sclerosis (SSc), but the precise nature of this association remains unclear. This systematic review and meta-analysis aims to synthesize available evidence to evaluate the relationship between SSc and retinopathy.

METHODS

A systematic search was conducted across four major databases and gray literature to collect all relevant studies. The quality of the selected articles was assessed for risk of bias using standardized tools. A meta-analysis was performed using standardized mean difference (Std. Mean Difference) to estimate the association between retinopathy and SSc. Additional analyses for heterogeneity, sensitivity, subgroups, and publication bias were also conducted.

RESULTS

Twelve studies (359 cases, 314 controls) were included in the systematic review. A meta-analysis of eight studies found a nonsignificant and negligible association (pooled Std. Mean Difference = 0.08; 95% CI = -0.31 to 0.48; p = 0.67) between SSc and retinopathy, with no publication bias (p = 0.5362). Differences in Std. Mean Difference were observed in subgroup analyses but did not sufficiently explain the heterogeneity.

CONCLUSIONS

The findings suggest no strong association between retinopathy and SSc. While some subgroup analyses revealed potential variations, they did not fully clarify the observed heterogeneity. Further research with larger, well-designed studies is necessary to determine whether retinopathy could serve as a biomarker for SSc.

SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO)

CRD42024529644 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=529644.

Association between controlling nutritional status score and diabetic retinopathy: Data from National Health and Nutrition Examination Survey

ObjectiveThis study aimed to examine the association between controlling nutritional status (CONUT) score and diabetic retinopathy (DR) risk, as well as investigate the impact of CONUT score on mortality risk among DR patients.MethodsThis retrospective study included 5,256 patients with diabetes from National Health and Nutrition Examination Surveys. These participants were classified into two groups: the DR group (n = 641) and the non-DR group (n = 4,615). We used weighted univariate and multivariate logistic regression models to assess the correlation of CONUT score and DR risk. Weighted univariate and multivariate Cox models were adopted to explore the association of CONUT score with all-cause mortality and cardiovascular disease (CVD)-related mortality in patients with DR.Results305 patients diagnosed with DR had died by the end of the follow-up period, among whom 111 individuals died due to CVD. After adjusting all potential confounding factors, there was an association between CONUT score and DR development in patients with diabetes [odd ratio (OR) = 1.18, 95% confidence interval (CI): 1.05-1.33]. Additionally, CONUT score was found to be associated with all-cause mortality of patients with DR [hazard ratio (HR) = 1.11, 95%CI: 1.01-1.22, P= 0.041]. However, there was no significant difference in the CONUT score and CVD-related mortality of patients with DR.ConclusionsCONUT score may be a valuable tool for assessing the risk of developing DR, and predicting prognosis in patients with DR. However, as this was a cross-sectional study, we cannot infer the causality of CONUT score and DR risk.

Construction of a nomogram for predicting the risk of all-cause mortality in patients with diabetic retinopathy

Background

Diabetic retinopathy (DR) not only leads to visual impairment but also increases the risk of death in type 2 diabetes patients. This study aimed to construct a nomogram to assess the risk of all-cause mortality in patients with DR.

Methods

This cross-sectional study included 1004 patients from the National Health and Nutrition Examination Survey database (NHANES) between 1999-2018. Participants were randomized in a 7:3 ratio into a training set and a test set. We selected predictors by LASSO regression and multifactorial Cox proportional risk regression analysis and constructed nomograms, guided by established clinical guidelines and expert consensus as the gold standard. We used the concordance index (C-index), receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA) to evaluate the nomogram's discriminative power, calibration quality, and clinical use.

Results

The training and test sets consisted of 703 and 301 participants with a median age of 64 and 63 years, respectively. The study identified seven predictors, including age, marital status, congestive heart failure (CHF), coronary heart disease (CHD), stroke, creatinine level, and taking insulin. The C-index of the nomogram model constructed from the training set was 0.738 (95% CI: 0.704-0.771), while the C-index of the test set was 0.716 (95% CI: 0.663-0.768). In the training set, the model's AUC values for predicting all-cause mortality risk at 3 years, 5 years, and 10 years were 0.739, 0.765, and 0.808, respectively. In the test set, these AUC values were 0.737, 0.717, and 0.732, respectively. The ROC curve, calibration curve, and DCA curve all demonstrated excellent predictive performance, confirming the model's effectiveness and reliability in clinical applications.

Conclusions

Our nomogram demonstrates high clinical predictive accuracy, enabling clinicians to effectively predict the overall mortality risk in patients with DR, thereby significantly improving their prognosis.

Diabetic retinopathy further increases risk of cardiovascular disease mortality in a high-risk cohort

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and is strongly linked with systemic vascular comorbidities. This study investigated if DR predicts risk of cardiovascular disease (CVD) mortality in a high CVD risk cohort. This was a prospective cohort study of 1582 adult participants who presented to a tertiary Australian hospital for evaluation of acute coronary syndrome by coronary angiography. Participants were concurrently examined for DR from mydriatic fundus photographs which were mask-graded according to International Clinical Classification categories of no DR, mild non-proliferative DR, moderate-to-severe NPDR, and proliferative DR. Coronary artery disease was graded from coronary angiograms using the Gensini score. CVD mortality follow-up was assessed 9 years after baseline examination using linkage with the Australian National Death Index. At baseline, 355 (22.4%) participants had any DR. There were 181 (11.4%) fatal CVD events after 9-years follow-up. After controlling for age, sex, BMI, diabetes, total cholesterol, smoking status, hypertension, previous myocardial infarction and stroke, any DR was associated with 1.8-fold higher risk of CVD mortality (Hazard Ratio [HR] 1.84, 95% Confidence Interval [95% CI: 1.30-2.61]). Mild non-proliferative DR (1.85 [1.26-2.72]) and proliferative DR (5.27 [2.32-12.00]) were associated with greater CVD mortality risk. Further adjustment for coronary artery disease using Gensini scores and excluding patients without diabetes had minimal impact on the association. The increased risk of CVD mortality was significant in both men (2.25 [1.60-3.19]) and women (2.38 [1.24-4.58]) with any DR. In individuals with high CVD risk, presence of DR independently predicts increased CVD mortality. This likely reflects additional contribution of microvascular disease to CVD mortality. Individuals with DR may benefit from a comprehensive cardiovascular risk assessment, lifestyle changes, more intensive cardiovascular management and follow-up to minimise risk of death from CVD events.

Prevalence and risk factors of anxiety and depression in diabetic retinopathy patients: A cross-sectional study using multiple scales

OBJECTIVE

To investigate the prevalence of anxiety and depression, and explore their related factors in all types of diabetic retinopathy (DR) patients more precisely and accurately by multiple scales.

METHODS

Beck anxiety inventory (BAI), self-rating anxiety scale (SAS), beck depression inventory (BDI), and self-rating depression scale (SDS) scores were assessed in 247 DR patients and 250 non-retinopathic diabetes mellitus (NRDM) patients.

RESULTS

In DR patients, there were 32 patients with proliferative DR and 115 patients with impaired visual acuity. The prevalences (95% confidence interval) of anxiety were 38.5% (32.4%-44.6%) and 32.0% (26.2%-37.8%) by BAI and SAS, while those for depression were 31.6% (25.8%-37.4%) and 25.1% (19.7%-30.5%) by BDI and SDS in DR patients. BAI score (P = 0.003), BAI-defined anxiety rate (P = 0.010), SAS score (P = 0.001), SAS-defined anxiety rate (P = 0.006), BDI score (P = 0.005), BDI-defined depression rate (P = 0.028), and SDS score (P = 0.001) were increased in DR patients versus NRDM patients. In DR patients, proliferative DR independently related to BAI-defined anxiety (P < 0.001) and SAS-defined anxiety (P < 0.001). Female (P = 0.016) and proliferative DR (P < 0.001) independently associated with BDI-defined depression; female (P = 0.007), DM duration (P = 0.025), triglyceride (TG) (P = 0.026), and proliferative DR (P = 0.014) independently associated with SDS-defined depression. The combination of these independent factors showed acceptable abilities in predicting BAI-defined anxiety, SAS-defined anxiety, BDI-defined depression, or SDS-defined depression in DR patients, with area under curves of 0.626, 0.656, 0.696, and 0.741, respectively (all P < 0.001).

CONCLUSION

Anxiety and depression are prevalent; meanwhile, proliferative DR, female, DM duration, and TG independently relate to anxiety or depression in DR patients.

Association of vitamin B6 intake with the risk and prognosis of diabetic retinopathy: a NHANES-based study

CLINICAL RELEVANCE

Investigating the role of dietary vitamin B6 intake in the risk and prognosis of diabetic retinopathy (DR) could facilitate the management of DR.

BACKGROUND

This study aimed to assess the association between dietary vitamin B6 intake and the risk of DR and further explore the association between vitamin B6 intake and mortality in patients with DR.

METHODS

This retrospective cohort study gained data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 and 2007-2008. The intake of dietary vitamin B6 was assessed by two 24-h dietary recall interviews. Mortality information in the National Death Index was recorded from the date of survey participation through 31 December 2019. Multivariate regression analyses were employed to assess the association between vitamin B6 intake and the risk of DR, and the association between vitamin B6 intake and the risk of mortality in patients with DR.

RESULTS

A total of 5559 subjects were included, of which 693 (12.47%) had DR. Among these patients with DR, 429 (61.90%) were survivors. Multivariate analyses showed that the intake of vitamin B6 was negatively associated with the risk of DR (odds ratio = 0.81, 95% confidence level: 0.69-0.95, p = 0.012), and patients with DR with an increased intake of vitamin B6 had a significantly decreased risk of all-cause death (hazard ratio = 0.81, 95% confidence level: 0.66-0.99, p = 0.041) or cardiovascular disease-related death (hazard ratio = 0.76, 95% confidence level: 0.58-0.98, p = 0.037).

CONCLUSION

The intake of vitamin B6 was negatively associated with the risk of DR, and in patients with DR, a higher intake of vitamin B6 was associated with a lower risk of all-cause death and cardiovascular disease-related death, indicating the possible protective role of increased vitamin B6 intake.

Impact of the COVID-19 Pandemic on Mental Health among Patients with Chronic Ocular Conditions

The COVID-19 pandemic had significant impacts on the mental and visual health of patients. This cross-sectional, survey-based, multicentric study evaluates the state of mental and visual health among patients with chronic ocular diseases such as glaucoma, neovascular age-related macular degeneration, diabetic retinopathy, or chronic uveitis during the lockdown period of the COVID-19 pandemic. Mental health was assessed using three questionnaires: the Patient Health Questionnaire-9 (PHQ-9), the Impact of Event Scale-Revised (IES-R), and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25). A total of 145 patients completed the questionnaires. The PHQ-9 showed that most respondents (n = 89, 61%) had none or minimal depressive symptoms, while 31 (21%) had mild depressive symptoms, 19 (13%) had moderate depressive symptoms, 5 (3%) had moderately severe depressive symptoms, and 1 (1%) had severe depressive symptoms. Regarding stress surrounding the pandemic, the median IES-R showed mild distress in 16 (11%), moderate distress in 7 (5%), and severe distress in 4 (3%). The COVID-19 pandemic lockdowns had a negative impact on patients' mental health with close to 20% of the patients reporting at least moderately depressive symptoms and 19% reporting at least mildly distressful symptoms.

Spermidine Attenuates High Glucose-Induced Oxidative Damage in Retinal Pigment Epithelial Cells by Inhibiting Production of ROS and NF-κB/NLRP3 Inflammasome Pathway

Diabetic retinopathy (DR) is the leading cause of vision loss and a critical complication of diabetes with a very complex etiology. The build-up of reactive oxygen species (ROS) due to hyperglycemia is recognized as a primary risk factor for DR. Although spermidine, a naturally occurring polyamine, has been reported to have antioxidant effects, its effectiveness in DR has not yet been examined. Therefore, in this study, we investigated whether spermidine could inhibit high glucose (HG)-promoted oxidative stress in human retinal pigment epithelial (RPE) cells. The results demonstrated that spermidine notably attenuated cytotoxicity and apoptosis in HG-treated RPE ARPE-19 cells, which was related to the inhibition of mitochondrial ROS production. Under HG conditions, interleukin (IL)-1β and IL-18's release levels were markedly increased, coupled with nuclear factor kappa B (NF-κB) signaling activation. However, spermidine counteracted the HG-induced effects. Moreover, the expression of nucleotide-binding oligomerization domain-like receptor (NLR) protein 3 (NLRP3) inflammasome multiprotein complex molecules, including TXNIP, NLRP3, ASC, and caspase-1, increased in hyperglycemic ARPE-19 cells, but spermidine reversed these molecular changes. Collectively, our findings demonstrate that spermidine can protect RPE cells from HG-caused injury by reducing ROS and NF-κB/NLRP3 inflammasome pathway activation, indicating that spermidine could be a potential therapeutic compound for DR treatment.