Prevalence, risk factors and burden of diabetic retinopathy in China: a systematic review and meta-analysis

Chinese burdens and trends of diabetic retinopathy 1990-2021 and 15 years forecast: results from the Global Burden of Disease Study 2021

Objectives

To assess the Chinese burden of diabetic retinopathy (DR) between 1990 and 2021, considering variations by year, age, and gender, as well as to forecast the trends over the next 15 years.

Methods

We evaluated the burden of DR in China based on data from the GBD 2021, examining prevalence, years lived with disability (YLDs), age-standardized YLDs rates (ASYR), and age-standardized prevalence rates (ASPR) over the period 1990 to 2021. Furthermore, we utilized joinpoint analysis and the Bayesian age-period-cohort model to explore the epidemiological patterns of the disease and forecast its impact for the years 2022 to 2036.

Results

In 2021, the number of YLDs and prevalence attributed to DR were 86,317 (95% UI: 56,595 to 125,565) and 1.37 million (95% UI: 1.04 to 1.78), respectively. Over the period 1990 to 2021, the AAPC of ASYR and ASPR for DR rose by 0.71 (95% CI: 0.28, 1.14) and 0.43 (95% CI: 0.20, 0.66) in China. Older adults and women experienced a greater burden. Aging and demographic changes are key risk factors for DR, and future trends suggest a decrease in ASYR and ASPR.

Conclusion

The Chinese burden of DR has increased during the years 1990 to 2021. Despite the anticipated decline in the burden of DR between 2022 and 2036, the importance of bolstering efforts in DR prevention and control should not be underestimated.

Machine Learning-Driven Identification of Hematological and Immunological Biomarkers for Predicting Proliferative Diabetic Retinopathy Progression

PURPOSE

Proliferative Diabetic Retinopathy (PDR) is a severe complication of diabetes characterized by neovascularization and retinal detachment, leading to significant vision loss. This study investigates the predictive power of hematological and immunological markers in PDR progression.

METHODS

Data from 126 patients were analyzed using advanced machine learning techniques, including LASSO regression, elastic net modeling, and backward stepwise regression.

RESULTS

The findings identified age, gender, IL-1, and lymphocyte count (LYM) as significant predictors of PDR, with a high AUC value of 0.839 from the ROC curve analysis. These markers, particularly cytokines in the aqueous humor and peripheral blood, offer a convenient and rapid method for early detection and risk assessment of PDR.

CONCLUSIONS

Despite the limitations of being a cross-sectional study with a relatively small sample size, the results highlight the clinical significance of these biomarkers and underscore the need for further validation in larger, more diverse populations. This study contributes to the development of targeted interventions and improved management strategies for diabetic retinopathy, emphasizing the importance of immunological health in disease progression.

Combining Network Pharmacological Analysis and Animal Experiments to Explore the Pharmacological Mechanism of Zhangyanming Tablets in Diabetic Retinopathy

Background

Zhangyanming Tablets (ZYMT) is a proprietary Chinese medicine containing a variety of traditional Chinese medicines, which can be used to treat a wide range of eye diseases, but its exact effect on diabetic retinopathy (DR) and the specific mechanism are still unclear. This study aims to investigate the ameliorative effects and specific mechanisms of ZYMT on DR.

Methods

Key regulatory genes and potential therapeutic targets of ZYMT for DR were evaluated using network pharmacological analysis. Diabetic db/db mice were given low-dose ZYMT (330 mg/kg) and high-dose ZYMT (660 mg/kg), and relevant metabolic indices were tested. Histochemical staining and optical coherence tomography angiography (OCTA) were used to evaluate the histopathological structure of mice retina, RT-qPCR, TUNEL staining and immunofluorescence staining were used to evaluate the anti-apoptosis and anti-angiogenesis effect of ZYMT on DR.

Results

The results of network topology analysis showed that the top 10 Traditional Chinese Medicine (TCM) ingredients of ZYMT were quercetin, luteolin, kaempferol, wogonin, naringenin, β-sitosterol, baicalein, isorhamnetin, acacetin, and stigmasterol. ZYMT treats DR through key nodes such as AKT1, TNF, MAPK8, RELA, VEGFA, HIF1A, IL6, CASP3, BCL2, STAT3, and ICAM1. ZYMT has a direct effect on DR rather than secondary improvement of metabolic indices. Tissue staining demonstrated that ZYMT improved retinal vascular morphology and delayed retinal thinning in db/db mice. The OCTA imaging also showed that ZYMT increased blood flow density in db/db mice. TUNEL staining and RT-qPCR results showed that ZYMT could reduce the apoptosis of retinal cells in db/db mice, and RT-qPCR and immunofluorescence staining showed that ZYMT could inhibit retinal neovascularization.

Conclusion

This study found the potential target of ZYMT to ameliorate DR through network pharmacological analysis, and verified that ZYMT can improve DR by exerting anti-apoptosis and anti-neovascularization.

Association of hemoglobin with decreased prevalence of diabetic retinopathy among Tibetan male patients

INTRODUCTION

It has been reported that hemoglobin (Hb) levels are negatively associated with the prevalence of diabetic retinopathy (DR). This study aims to investigate the relationship between Hb levels and DR prevalence among highlanders, who exhibit elevated Hb levels as an adaptive response to hypoxia.

METHODS

This cross-sectional, hospital-based study utilized data from 645 Tibetan male patients with type 2 diabetes (T2D) between 2018 and 2020. Patients were divided into two groups based on Hb level (group 1: 12.0 ≤ Hb < 16.0 g/dL; group 2: Hb ≥ 16.0 g/dL). DR was diagnosed based on fundus photographs and fundus fluorescein angiography.

RESULTS

Among the study participants, 140 were diagnosed with DR. An inverse relationship was observed between Hb levels and the prevalence of DR. Each 1.0-g/dL increase in Hb concentration was associated with an 18% reduction in the prevalence of DR (95% confidence interval [CI]: 0.71-0.95). Multiple logistic regression analysis confirmed that patients with higher Hb levels had an adds ratio of 0.48 (95% CI, 0.29-0.79) for DR after adjusting for confounders, compared to those with lower Hb levels.

CONCLUSIONS

Our findings indicate that the inverse relationship between Hb levels and DR prevalence observed in lowland populations is also applicable to high-altitude individuals.

Frequency of Tumor Necrosis Factor-α, Interleukin-6, and Interleukin-10 Gene Polymorphisms in Mexican Patients with Diabetic Retinopathy and Diabetic Kidney Disease

BACKGROUND/OBJECTIVES

Two of the microvascular complications in type 2 diabetes (T2D) are diabetic retinopathy (DR), which is the most common cause of non-traumatic blindness, and diabetic kidney disease (DKD); the latter generally requires renal replacement therapy. The aim of the present study was to determine the frequency of polymorphisms of Tumor Necrosis Factor-α, interleukin-6, and interleukin-10 (TNF-α, IL-10, and IL-6), as well as to describe the clinical and laboratory characteristics of T2D association with these microvascular complications.

METHODS

This study included 203 patients with T2D, of which 102 had microvascular complications: 95 with DR, 50 with DKD, and 15 with diabetic neuropathy (the latter were not included in the statistical analysis); those with T2D without confirmed microvascular complications were considered as controls. Clinical and laboratory data were collected from the patient's medical records. Polymorphism typing of TNF-α rs361525 and rs1800629 and IL-10 rs1800872 and rs1800871 were obtained using MALDI-TOF MS. IL-10 rs1800896 and IL-6 rs1800795 were typed using a quantitative real-time polymerase chain reaction.

RESULTS

The results of age, HbA1c, fasting glucose, and arterial hypertension are significantly associated in every group. The TNF-α rs1800629A allele and TNF-α rs1800629G/A genotype were associated with microvascular complications and DR. For IL-10-rs1800896, all the models were associated in DKD. The TNF-α rs361525-rs1800629GA haplotype was associated with microvascular complications and DR, while the IL-10 haplotype, rs1800872-rs1800871-rs1800896 GGC, showed susceptibility in every group.

CONCLUSIONS

Our results show the contributions of the variants of these cytokines to these microvascular complications, but more studies are required to reach relevant conclusions.

Differences in prevalence and risk factors of diabetic retinopathy among rural and urban residents with diabetes in South China: a cross-sectional study

OBJECTIVE

To determine the prevalence of diabetic retinopathy (DR) and associated risk factors among rural and urban people diagnosed with type 1 or type 2 diabetes mellitus (PwDM) in southern China.

DESIGN

This is a cross-sectional study.

SETTING

The study was conducted at primary health centres from 2 September to the end of December 2019.

PARTICIPANTS

All the 3646 PwDM being registered in Qujiang District, aged ≥18 years were informed, of whom 2677 attended the screening and were recruited.

PRIMARY AND SECONDARY OUTCOME MEASURES

The presence of DR was determined by trained graders using criteria of the UK National Health Service Diabetic Eye Screening Programme. Multiple logistic regression analyses were used to assess potential risk factors for the presence of DR.

RESULTS

The mean age of the participants (73.4% of the 3646 invited people) was 63.4 years (SD 10.1 years), 1503 (56.2%) were female, 1749 (65.3%) were rural residents, 1654 (71.0%) participants had glycated haemoglobin (HbA1c)≥6.5%, 1773 (66.3%) had high blood pressure and the median duration of diabetes mellitus (DM) was <5 years. Although half (52.0%) of these participants had brief (<5 years) exposure to DM, 831 (31.3%, 95% CI: 29.3 to 32.8%) had DR, among whom 412 (49.6%) had sight-threatening DR. Men (33.1%) had a significantly higher prevalence of any DR than women (29.4%, p<0.05). There were no significant differences in DR prevalence at any level between rural and urban residents. In multivariate regression models, risk factors for any DR were HbA1c>6.5% (OR=1.58, p<0.01), using insulin and antihyperglycaemic medications (OR=1.76, p<0.01), longer duration of DM and higher systolic blood pressure (OR=1.01 for each mm Hg, p<0.01).

CONCLUSIONS

The high prevalence of DR, hyperglycaemia and high blood pressure highlight the need for better management of non-communicable diseases in China.

High BMI, silicone oil tamponade, and recurrent vitreous hemorrhage predict poor visual outcomes after pars plana vitrectomy in proliferative diabetic retinopathy

BACKGROUND

Proliferative diabetic retinopathy (PDR) is a serious microvascular complication of diabetes and a leading cause of global vision loss. Pars plana vitrectomy (PPV) is the primary surgical treatment for PDR, but visual outcomes vary due to multiple influencing factors. This study aims to evaluate the factors predicting visual prognosis in patients with PDR after PPV.

METHODS

A retrospective analysis was performed on 112 eyes from 87 patients with PDR who underwent PPV between May 2020 and May 2024. Data collected included patient demographics, preoperative and postoperative best-corrected visual acuity (BCVA), and other baseline clinical data. Data analysis was performed with IBM SPSS Statistics Version 24.0. Univariate and multivariate linear regression models were applied to assess the relationship between the final BCVA and various clinical parameters.

RESULTS

The mean BCVA improved significantly, from 1.94 ± 0.89 logMAR preoperative to 0.76 ± 0.70 logMAR postoperatively (P < 0.001). Multivariate linear regression identified body mass index (BMI) (B = 0.035; 95% CI 0.003-0.066; P = 0.033), silicone oil (SO) tamponade (B = 0.354; 95% CI 0.005-0.643; P = 0.029), and recurrent vitreous hemorrhage (VH) (B = 0.585; 95% CI 0.304-0.867; P < 0.001) as significant negative predictors of final BCVA.

CONCLUSIONS

While PPV improves visual outcomes in PDR patients, factors such as high BMI, SO tamponade, and recurrent VH negatively affect prognosis and could serve as predictors of poor visual outcomes following the procedure. This study emphasizes the importance of tailored management strategy for PDR, including early intervention, optimal BMI control, and minimizing SO tamponade duration.

Predicting diabetic retinopathy based on routine laboratory tests by machine learning algorithms

OBJECTIVES

This study aimed to identify risk factors for diabetic retinopathy (DR) and develop machine learning (ML)-based predictive models using routine laboratory data in patients with type 2 diabetes mellitus (T2DM).

METHODS

Clinical data from 4259 T2DM inpatients at Beijing Tongren Hospital were analyzed, divided into a model construction data set (N = 3936) and an external validation data set (N = 323). Using 39 optimal variables, a prediction model was constructed using the eXtreme Gradient Boosting (XGBoost) algorithm and compared with four other algorithms: support vector machine (SVM), gradient boosting decision tree (GBDT), neural network (NN), and logistic regression (LR). The Shapley Additive exPlanation (SHAP) method was employed to interpret the XGBoost model. External validation was performed to assess model performance.

RESULTS

DR was present in 47.69% (N = 1877) of T2DM patients in the model construction data set. Among the models tested, the XGBoost model performed best with an AUC of 0.831, accuracy of 0.757, sensitivity of 0.754, specificity of 0.759, and F1-score of 0.752. SHAP explained feature importance for XGBoost model and identified key risk factors for DR. External validation yielded an accuracy of 0.650 for the XGBoost model.

CONCLUSIONS

The XGBoost-based prediction model effectively assesses DR risk in T2DM patients using routine laboratory data, aiding clinicians in identifying high-risk individuals and guiding personalized management strategies, especially in medically underserved areas.

UPLC-Q-TOF-MS and network pharmacology to reveal the mechanism of Guizhi Gegen decoction against type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease. Clinical studies have shown that the incidence and prevalence of T2DM has been on the rise globally in recent years, and the mortality rate is also increasing. Chinese herbs is multiple target for disease. Guizhi Gegen decoction (GZGGD) is one of the most alternative treatment for T2DM. However, the treatment mechanism is unclear. The composition of the GZGGD was determined by ultra-high-performance liquid chromatography with quadrupole time-of-flight mass spectrometry. The key targets and pathways were predicted by network pharmacology and molecular docking. In vivo experiments were performed to further verify and reveal the potential mechanism of action. We identified 44 active components of GZGGD (genistein, 26-hydroxyporicoic acid DM, puerarin, eugenol, and gentiobiose). Network pharmacology predicted key targets such as TNF, AKT1, TP53, EGFR, and STAT3, and AGE-RAGE, IL-17 signaling pathways were enriched. Molecular docking showed that the active components of GZGGD have good binding activity with the potential targets of T2DM. In vivo animal experiments showed improvement in white blood, fasting blood glucose, and inflammatory factor levels (INS, TC, TNF-α, and IL-6). This study clarifies the potential role of GZGGD in T2DM, which can help in the study of T2DM.

Role of Tau Protein Hyperphosphorylation in Diabetic Retinal Neurodegeneration

Diabetic retinal neurodegeneration (DRN) is an early manifestation of diabetic retinopathy (DR) characterized by neurodegeneration that precedes microvascular abnormalities in the retina. DRN is characterized by apoptosis of retinal ganglion cells (involves alterations in retinal ganglion cells [RGCs], photoreceptors, amacrine cells and bipolar cells and so on), reactive gliosis, and reduced retinal neuronal function. Tau, a microtubule-associated protein, is a key mediator of neurotoxicity in neurodegenerative diseases, with functions in phosphorylation-dependent microtubule assembly and stabilization, axonal transport, and neurite outgrowth. The hyperphosphorylated tau (p-tau) loses its ability to bind to microtubules and aggregates to form paired helical filaments (PHFs), which further form neurofibrillary tangles (NFTs), leading to abnormal cell scaffolding and cell death. Studies have shown that p-tau can cause degeneration of RGCs in DR, making tau pathology a new pathophysiological model for DR. Here, we review the mechanisms by which p-tau contribute to DRN, including insulin resistance or lack of insulin, mitochondrial damage such as mitophagy impairment, mitochondrial axonal transport defects, mitochondrial bioenergetics dysfunction, and impaired mitochondrial dynamics, Abeta toxicity, and inflammation. Therefore, this article proposes that tau protein hyperphosphorylation plays a crucial role in the pathogenesis of DRN and may serve as a novel therapeutic target for combating DRN.

Elevated Triglyceride-Glucose Index as a Risk Stratification Marker for Diabetic Retinopathy in Type 2 Diabetes Mellitus: The Influence of Glycemic Control

Background

Diabetic retinopathy (DR) is a common microvascular complication observed in people with type 2 diabetes mellitus (T2DM). The triglyceride-glucose (TyG) index, an indicator of insulin resistance, has an uncertain role in glycemic management in T2DM patients at risk for DR. This study aimed to evaluate the association between the TyG index and DR risk across different glycemic control status.

Methods

A total of 4,372 T2DM in-patients from Beijing Tongren Hospital (2013-2024) were included in this study. The patients were categorized into four groups based on TyG index quartiles (Q1-Q4). Participants were stratified by TyG index quartiles (Q1-Q4) and glycemic control status (HbA1c <7%, 7-9%, and >9%). Restricted cubic spline (RCS) analysis, logistic regression, and subgroup analyses were employed to explore the associations among the TyG index, glycemic control and DR risk.

Results

Overall, there were positive association of the TyG index and DR risk. The highest TyG Q4 was significantly associated with an increased risk of DR (odds ratio [OR]: 1.289; 95% confidence interval [CI]: 1.008-1.648, P<0.05), compared with the lowest TyG Q1. Significant interaction was observed between the TyG index and glycemic control (P for interaction <0.05). Notably, the association was strongest in patients with HbA1c >9%.

Conclusion

The relationship between high TyG index and DR risk was more pronounced in patients with HbA1c >9% group, indicating that TyG index may serve as a useful tool for making risk stratification on glycemic control in T2DM patients.

Natural remedies proposed for the management of diabetic retinopathy (DR): diabetic complications

Diabetic retinopathy (DR) represents a significant and serious complication associated with diabetes mellitus (DM), often resulting in considerable visual impairment or even blindness. The intricate pathological processes underlying DR complicate the effectiveness of current treatment modalities. Studies have highlighted the potential of natural products in the treatment of DR via several beneficial effects including anti-inflammatory, antioxidant, anti-neovascular, and anti-apoptotic properties. Flavonoids, saponins, saccharides, and alkaloids exhibited various beneficial effects in DR in in vivo and in vitro studies. However, the clinical utilization of these natural compounds is hindered by issues such as inadequate specificity, low bioavailability, and potential toxicity. Therefore, there is a pressing need for rigorous clinical studies to confirm the efficacy of natural products in preventing or mitigating the progression of DR.

Impact of systemic hypertension on inner retinal layer thickness and macular microvasculature in patients with diabetic retinopathy

AIM

To investigate the effects of hypertension (HTN) on inner retinal thickness and macular microvasculature in patients with diabetic retinopathy (DR).

METHODS

Subjects were classified into three groups: patients with type 2 diabetes mellitus (T2DM) (T2DM group), patients with DR (DR-HTN group), and patients with DR and HTN (DR + HTN group). The ganglion cell complex (GCC) thicknesses and the macular vessel density (VD) were compared. Linear regression analyses were performed to identify factors associated with the VD in the DR + HTN group.

RESULTS

The mean GCC thicknesses were 112.2 ± 12.3, 109.2 ± 13.7, and 106.2 ± 11.2 μm in the T2DM, DR-HTN, and DR + HTN groups, respectively (P = 0.045). The mean VDs were 25.4 ± 5.0, 24.3 ± 8.9, and 21.2 ± 7.1% (P = 0.014) for the superficial capillary plexus (SCP) and 25.9 ± 4.3, 22.9 ± 8.5, and 20.2 ± 6.6% (P < 0.001) for the deep capillary plexus (DCP) in the T2DM, DR-HTN, and DR + HTN groups, respectively. In multivariate analyses, the duration of HTN was a significant factor associated with the VD of both SCP (B = -0.24, P = 0.010) and DCP (B = -0.21, P = 0.016).

CONCLUSIONS

Patients with both DR and HTN had a thinner GCC and lower VDs of SCP and DCP than those with DR alone. These outcomes could be associated with the synergistic ischemic effects in DR patients with HTN. Moreover, the duration of HTN in DR patients was significantly associated with macular VD in both SCP and DCP.

Capsiate Improves Glucose Metabolism by Improving Insulin Sensitivity in Diabetic Retinopathy Mice

PURPOSE

Capsiate (cap) is a metabolite that affects a number of biological processes, and diabetic retinopathy (DR) is now known to be the primary cause of end-stage eye illness.

METHODS

In order to examine the effects of the cap intervention on body weight, nutritional intake, changes in body weight composition, glucose metabolism levels, retinopathy, and oxidative stress levels, we proposed using a mouse model of diabetic retinopathy caused by STZ.

RESULTS

Our findings demonstrated that, in addition to increasing lean body mass and lowering fat body mass content, cap intervention significantly improved body weight and dietary consumption in STZ mice. Additionally, our results on glucose metabolism revealed that cap had a significant impact on insulin resistance and the stabilization of OGTT levels. In conclusion, we examined the levels of oxidative stress and retinopathy. We discovered that the cap intervention greatly reduced the levels of MDA and significantly improved the levels of VEGF and retinopathy. In contrast, the STZ group's levels of SOD, CAT, and GSH were significantly higher.

CONCLUSIONS

According to our research, the Cap intervention improved the damage caused by diabetic retinopathy by reversing the levels of oxidative stress and the disrupted state of glucose metabolism, which in turn decreased the levels of VEGF.

Oxidative stress and retinopathy: evidence from epidemiological studies

BACKGROUND

Previous studies have suggested oxidative stress may play a key role in the pathogenesis of retinopathy, while evidence from observational studies directly linking oxidative biomarkers to clinically relevant outcomes has been limited. This study aims to investigate the association between oxidative balance score (OBS) and prevalence of retinopathy in a nationally representative sample of U.S. adults, including both those with and without diabetes.

METHODS

Data were obtained from the NHANES 2005-2008, including 3,287 participants. OBS was calculated from 16 dietary and 4 lifestyle components and categorized into tertiles. Weighted logistic regression was used to assess the association between OBS and retinopathy in the overall, diabetic, and non-diabetic populations, and Cox proportional hazards models evaluated the link between OBS and all-cause mortality in those with retinopathy. Restricted cubic spline (RCS) analysis explored the dose-response relationship between OBS and retinopathy. Subgroup analyses and interaction tests were conducted based on age, sex, race, BMI, education level, and diabetes status.

RESULTS

Participants in the highest OBS tertile had a 28% lower risk of retinopathy compared to those in the lowest tertile (OR 0.72, 95% CI 0.54-0.95, P = 0.023). RCS analysis showed a significant overall association between higher OBS and reduced retinopathy risk, without a nonlinear pattern. In participants with retinopathy, higher OBS was linked to a 60% reduction in all-cause mortality (HR 0.40, 95% CI 0.24-0.66, P < 0.001). Subgroup analysis revealed stronger inverse associations between OBS and retinopathy in younger individuals and those with higher education, with a significant interaction between OBS and age (P for interaction < 0.05).

CONCLUSION

Our study provides evidence that higher cumulative antioxidant exposure assessed by OBS is associated with a reduced risk and severity of retinopathy and lower all-cause mortality in U.S. adults with retinopathy, highlighting the importance of maintaining a favorable oxidative balance in retinal health.

Early postoperative bevacizumab for preventing neovascular glaucoma in phacovitrectomy for proliferative diabetic retinopathy

To evaluate the effectiveness of postoperative intravitreal bevacizumab (IVB) in preventing neovascular glaucoma (NVG) and identify associated risk factors in patients with proliferative diabetic retinopathy (PDR) undergoing phacovitrectomy. Patients with PDR who underwent phacovitrectomy were enrolled and categorized into two subgroups based on their postoperative treatment regimen: one group received IVB within 2 months following phacovitrectomy (Group 1); the other did not receive IVB during this period (Group 2). A comparative analysis evaluated the distinguishing characteristics of the two groups after 1:1 propensity score matching. Kaplan-Meier survival analysis was utilized to determine the incidence of NVG after phacovitrectomy. Multivariate analysis with the Cox proportional hazards model identified risk factors associated with NVG postphacovitrectomy. A total of 206 eyes of 206 patients were investigated in this study. NVG developed in 15 eyes (7.28%). The probabilities of NVG occurrence at 6, and 12 months following phacovitrectomy were 4.85%, and 7.28%, respectively. When comparing Groups 1 (n = 57) and 2 (n = 57), a significant difference was observed in the occurrence of NVG (P < 0.001). In Group 1, only one case of NVG (1.75%) were noted, whereas all other NVG cases occurred in Group 2 (9.39%). Male sex and high preoperative intraocular pressure (IOP) were associated with NVG occurrence following phacovitrectomy, and the administration of IVB within 2 months postphacovitrectomy demonstrated efficacy in preventing the development of NVG. Male sex and high preoperative IOP were associated with a higher incidence of NVG, and postoperative IVB had a protective effect against NVG occurrence.

Insights into the systemic risk factors associated with diabetic retinopathy in the Indian population: A comprehensive systematic review and meta-analysis

Diabetic retinopathy (DR) is a predominant cause of vision impairment globally. Understanding risk factors is crucial for effective planning. The aim of this study is to comprehensively investigate the risk factors in the Indian population contributing to the increased incidence of DR, which is a potentially sight-threatening complication among diabetic individuals. A comprehensive literature search was done on PubMed, Embase, and Google Scholar databases for epidemiological studies reporting risk factors in the adult Indian population in the English language. Joanna Briggs Institute's (JBI) critical appraisal tools were used to assess the quality of the included studies. Analysis was performed using R studio. I2 statistic was used for the assessment of heterogeneity. Results are expressed as odds ratio (OR) and standardized mean difference (SMD) along with a 95% confidence interval (CI). Overall, 20 studies enrolling 4,12,421 patients with 1,04,104 DR-positive and 3,08,317 DR-negative adults were analyzed. Being male (OR: 1.38, 95% CI: 1.11-1.72), intake of insulin (OR: 2.05, 95% CI: 1.02-4.14), higher HbA1c levels (MD: 0.50, 95% CI: 0.06-0.94), higher random (MD: 0.32, 95% CI: 0.10-0.55), and fasting blood glucose levels (MD: 0.51, 95% CI: 0.10-0.93) were found to be significantly associated with increased risks of DR among diabetic patients, while age, body mass index, hypertension, lipid profile, and smoking status did not indicate any association with DR. Good glycemic control remains the most important modifiable risk factor to reduce the risk of progression of DR and vision loss.

Network Pharmacology and Molecular Docking to Explore the Mechanism of Compound Qilian Tablets in Treating Diabetic Retinopathy

BACKGROUND

Diabetic Retinopathy (DR) is one of the common chronic complications of diabetes mellitus, which has developed into the leading cause of irreversible visual impairment in adults worldwide. The Compound Qilian Tablets (CQLT) were developed in China for the treatment and prevention of DR, but their mechanism of action still needs to be clarified.

OBJECTIVES

In the present study, network pharmacology, molecular docking, and in vivo validation experiments were used to investigate the active components and molecular mechanisms of CQLT against DR.

METHODS

The active components and targets of CQLT were collected through the TCSMP database, and the targets of DR were obtained from GeneCards, OMIM, and Drugbank databases. We established a protein-protein interaction network using the STRING database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted using the Metascape database. Molecular docking using AutoDock Vina was performed to investigate the interactions between components of CQLT and core targets. Moreover, we selected ZDF rats to establish a DR model for the experimental studies.

RESULTS

39 active components and 448 targets in CQLT were screened, among which 90 targets were shared with DR. KEGG pathway enrichment analysis identified 181 pathways. The molecular docking results demonstrated that the main active components had strong binding ability to the core targets. The results from animal experiments indicate that the mechanism of CQLT against DR is associated with inhibiting the retinal mTOR/HIF-1α/VEGF signaling pathway, alleviating the inflammatory response, suppressing retinal neovascularization, and protecting the function and morphology of the retina.

CONCLUSION

The present study preliminarily explored the mechanism of CQLT in treating DR and demonstrated that CQLT exerts anti-DR effects through multiple components, multiple targets, and multiple pathways. These findings suggest that CQLT shows promise as a potential therapeutic agent for DR and could contribute to developing novel treatments.

The relationship between long noncoding RNA H19 genotypes and the clinical features of diabetic retinopathy

Diabetic retinopathy (DR) is a microvascular complication of diabetes characterized by an inflammatory response. The H19 gene plays a role in regulating inflammation and is associated with chronic systemic inflammation. This study aims to investigate the potential correlation between single-nucleotide polymorphisms (SNPs) in the H19 gene and the development of DR. Five loci of H19 SNPs-rs3024270 (C/G), rs2839698 (C/T), rs3741219 (A/G), rs2107425 (C/T), and rs217727 (C/T)-were genotyped using TaqMan allelic discrimination in 454 individuals without DR and 272 DR participants. The results indicate that the H19 SNP rs3741219 AG (p = 0.030) and AG+GG (p = 0.037) alleles are significantly associated with an increased risk of developing DR in individuals with diabetes onset before the age of 45. Additionally, diabetic individuals with the H19 SNP rs3741219 AG+GG genotype also showed significantly higher serum creatinine (p = 0.034), lower glomerular filtration rate (GFR) (p = 0.013), higher total cholesterol/HDL ratio (p = 0.031), and higher triglycerides (p = 0.012). In an age-based subgroup analysis, GFR was significantly lower in diabetic patients with an onset of diabetes before 45 years and with the H19 SNP rs3741219 AG+GG genotype (p = 0.012). In conclusion, the presence of the H19 SNP rs3741219 variant is associated with a higher risk of DR in individuals with early-onset diabetes, and the relationship between the rs3741219 variant and decreased GFR is particularly pronounced in this population.

Narrative review of comprehensive management strategies for diabetic retinopathy: interdisciplinary approaches and future perspectives

This review examines the epidemiological trends, pathophysiologic mechanisms, and current and future therapeutic strategies for diabetic retinopathy (DR), focusing on innovative management countermeasures in the face of this global public health challenge. As the number of patients with diabetes continues to increase, DR, as one of its major complications, poses a significant threat to global visual health. This review not only summarises the latest advances in personalised treatment and emerging therapeutic modalities (such as anti-vascular endothelial growth factor therapy, laser treatment, surgical procedures and cutting-edge gene and stem cell therapies) but also emphasises the revolutionary potential of telemedicine technologies and digital health platforms to improve DR screening and adherence among people with diabetes. We show how these technological innovations, especially in resource-limited settings, can achieve early diagnosis and effective treatment, thereby significantly reducing the public health burden of DR. In addition, this article highlights the critical role of interdisciplinary teamwork in optimising the comprehensive management of DR, involving close collaboration among physicians, researchers, patient education specialists and policy-makers, as well as the importance of implementing these innovative solutions through societal engagement and policy support. By highlighting these innovative strategies and their specific impact on improving public health practices, this review offers new perspectives and strategies for the future management of DR, with the goal of promoting the prevention, diagnosis and treatment of DR worldwide, improving patient prognosis and enhancing quality of life.

Risk factors for diabetic retinopathy in young and middle-aged patients: a retrospective study

AIMS/INTRODUCTION

To investigate the related risk factors of retinopathy in young and middle-aged diabetic patients in order to improve the prognosis of patients.

MATERIALS AND METHODS

Using clinical practice data from a cohort study at our two research centers, we developed a bivariate logistic regression model to investigate the frightening risk factors potentially for retinopathy in young and middle-aged patients with diabetes, including diabetes type, physical activity level, treatment-related characteristics and laboratory tests.

RESULTS

A total of 453 patients with diabetes were investigated, 197 (43.5%) developed retinopathy. The risk of retinopathy was closely related to place of residence (OR: 0.275, 95% CI: 0.093-0.814), education level (OR: 0.522, 95% CI: 0.363-0.749), medical payment method (OR: 2.152, 95% CI: 1.308-3.539), BMI (OR: 1.187, 95% CI: 1.091-1.291), disease course (OR: 1.072, 95% CI: 1.028-1.118), hyperlipidemia (OR: 2.547, 95% CI: 1.260-5.150), physical activity level (OR: 0.312, 95% CI: 0.220-0.443), and dietary compliance (OR 0.871, 95% CI: 0.806-0.940). The area under the receiver operator characteristic curve was 0.915. Goodness of fit (Hosmer-Lemeshow) was 0.658.

CONCLUSIONS

The risk of young and middle-aged patients with increased as a result of certain patient characteristics and complications, especially lower dietary compliance and physical activity level.

Diabetic retinopathy: A review on its pathophysiology and novel treatment modalities

Diabetes mellitus (DM) is a chronic metabolic non-communicable disease with the ability to cause serious microvascular and macrovascular complications throughout the body, including in the eye. Diabetic retinopathy (DR), present in one-third of patients with diabetes, is a vision-threatening complication caused by uncontrolled diabetes, which greatly affects the retinal blood vessels and the light-sensitive inner retina, eventually leading to blindness. Several epidemiological studies elucidate that DR can vary by age of onset, duration, types of diabetes, and ethnicity. Recent studies show that the pathogenesis of diabetic retinopathy has spread its roots beyond merely being the result of hyperglycemia. The complexity of its etiopathology and diagnosis makes therapeutic intervention challenging. This review throws light on the pathological processes behind DR, the cascade of events that follow it, as well as the available and emerging treatment options.

Metabolomic studies reveal and validate potential biomarkers of diabetic retinopathy in two Chinese datasets with type 2 diabetes: a cross-sectional study

BACKGROUND

Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus and causes vision impairment and blindness. The presence of major risk factors for DR, such as high levels of HbA1c, does not predict all DR pathogenesis in the clinic, which suggests that uncovering the underlying mechanisms and identifying novel markers are needed. Previous evidence has shown that the serum metabolic signature of DR is unique and detectable compared with that of diabetes mellitus (DM). Here, we aimed to identify serum metabolites as reliable biomarkers for the presence of DR in type 2 DM (T2DM) patients.

METHODS

We performed untargeted and targeted metabolomic studies using liquid chromatography‒mass spectrometry (LC‒MS) and multiple reaction monitoring (MRM) methods on the serum samples of T2DM patients. For the discovery dataset, 39 DR patients and 39 non-DR (NDR) patients were included. For the validation dataset, 95 DR patients and 95 non-DR (NDR) patients were included. Receiver operating characteristic curve analysis was performed to evaluate the discriminating power of the metabolites. Binary logistic regression models were fit to evaluate the associations of metabolite peak areas or neurotransmitter concentrations with the presence of DR and adjusted for known risk factors.

RESULTS

A total of 7123 metabolites were tested. The 39 DR patients had a mean age of 56 years with an average diabetes duration of 12 years, and the 39 NDR patients had a mean age of 57 years with an average diabetes duration of 11 years. Nine serum candidate markers were further identified. Six out of nine markers were associated with DR after we adjusted for covariates, including blood pressure, HbA1c, diabetes duration, fasting blood glucose, triglyceride, eGFR etc. Among them, eicosapentaenoic acid (EPA) and L-tyrosine were validated in an independent, risk factor-matched sample set. The serum L-tyrosine concentration was decreased in DR group by 47% (-0.22 ± 0.87 vs. 0.48 ± 1.05, P < 0.001), of which the cutoff value was 0.10 mg/ml, with 86% sensitivity and 40% specificity (AUC = 0.62, 95% CI = 0.54-0.70, P = 0.005).

CONCLUSIONS

Low levels of circulating L-Tyrosine indicate retinopathy occurrence in T2DM population.

Nonlinear relationship between diabetes mellitus duration and diabetic retinopathy

To investigate the non-linear relationship between diabetes mellitus (DM) duration and the development of diabetic retinopathy (DR). By investigating the association between these variables, our goal is to contribute to the existing knowledge regarding the impact of DM duration on the development and severity of DR. A retrospective cross-sectional study was conducted on 420 patients in the Department of Endocrinology at Guangdong Provincial People's Hospital, who had undergone ophthalmic consultations from December 2017 to November 2018. The analysis of DM duration and DR utilized a generalized additive model to identify both linear and non-linear connections. The threshold effect was determined using a two-piece regression model. The study included a total of 420 patients, with a mean age of 58.7 years. Of these, 56.9% (239/420) were male. The prevalence of DR was 38.33% (161/420). After adjusting for confounding factors, a nonlinear relationship between DM duration and DR was observed, with a turning point at 8 years. On the left side of the turning point, the prevalence increased by 24% per 1-year increase in DM duration (OR: 1.24; 95% CI: 1.11-1.38; P<0.0001). However, no statistically significant differences were found on the right side of the turning point (OR: 1.02; 95% CI: 0.97-1.08; P = 0.4987). Our study identified a non-linear relationship between DM duration and DR in patients. When the DM duration is less than 8 years, a positive correlation exists between DM duration and DR. However, once the DM duration exceeds 8 years, the effect reaches saturation, and no significant correlation is observed.

Evaluation of systemic medications associated with diabetic retinopathy: a nested case-control study from the UK Biobank

AIMS

This study aims to investigate the associations between commonly used systemic medications and diabetic retinopathy (DR).

METHODS

Individuals with linked primary care prescription data from the UK Biobank were included. Cases were defined as individuals with a Hospital Episode Statistics-coded or primary care recorded diagnosis of DR or self-reported DR. Controls were matched for age, sex, glycosylated haemoglobin, duration of diabetes mellitus (DM), hypertension status and cardiovascular disease status. ORs and 95% CIs were calculated using conditional univariate and multivariable logistic regression models.

RESULTS

A total of 3377 case subjects with DR were included in the study and matched with 3377 control subjects. In multivariable logistic regression, increased odds of incident DR were observed for exposure to short-acting insulins (OR 1.63; 95% CI 1.22 to 2.18), medium-acting insulins (OR 2.10; 95% CI 1.60 to 2.75), sulfonylureas (OR 1.30; 95% CI 1.16 to 1.46). Instead, the use of fibrates (OR 0.71; 95% CI 0.53 to 0.94) and Cox-2 inhibitors (OR 0.68; 95% CI 0.58 to 0.79) was associated with decreased odds of incident DR. Dose-response relationships were observed for all five drug categories (all p<0.05).

CONCLUSIONS

This study comprehensively investigated the associations between systemic medication use and DR and found significant associations between the use of short-acting insulins, medium-acting insulins and sulfonylureas with increased odds of incident DR. In contrast, fibrates and Cox-2 inhibitors were associated with decreased odds of incident DR. These findings may provide valuable insights into DM medication management and serve as a reference for the prevention of DR in patients with DM.

Prevalence and its associated factors of diabetic retinopathy among type 1 and type 2 diabetic patients at public hospitals in Eastern Ethiopia, 2023: a hospital-based comparative cross-sectional study

Introduction

Diabetic retinopathy (DR) is a highly prevalent microvascular disease among diabetic patients, resulting in irreversible blindness. However, there is a dearth of evidence on diabetic retinopathy (DR) and its associated factors in eastern Ethiopia. The study aimed to determine the prevalence of diabetic retinopathy (DR) and its associated factors among type 1 and type 2 diabetic patients at public hospitals in eastern Ethiopia.

Method

A hospital-based comparative cross-sectional was conducted among 520 diabetic patients. Epidata software was used for data entry, and STATA version 17 was used for statistical analysis. Multivariate binary logistic regression was computed to identify factors associated with DR. The Hosmer and Lemeshow chi-square test assessed goodness of fit.

Results

The overall prevalence of DR was 43.5%. The prevalence of diabetic retinopathy among type 1 DM was 38.5%, and the prevalence of DR among type 2 DM was 48.5%. Age >60 [AOR = 4.64 95% CI (1.60, 13.51)], being male [AOR = 4.05 95% CI (1.51, 10.97)], and having complications [AOR = 0.01 95% CI (0.003, 0.04)] were significantly associated with DR among type 1 diabetes. Having a family history of DM [AOR = 1.57 95% CI (1.76, 3.24)], poor glycemic status [AOR = 1.91 95% CI (1.56, 2.83)], and having complications [AOR = 11.07 95% CI (4.89, 25.13)] were significantly associated with DR among type 2 diabetes.

Conclusions

In the current study, the prevalence of DR was 43.5%. The prevalence was higher among type 2 diabetes compared to type 1 diabetes. Factors such as poor glycemic control, older age, male sex, a family history of diabetes, and complications related to diabetes were significantly associated with DR. To minimize the impact of diabetics, it requires regular screening programs for diabetic patients, especially those with poor glycemic control and other identified risk factors.

Explainable machine learning model for predicting the risk of significant liver fibrosis in patients with diabetic retinopathy

BACKGROUND

Diabetic retinopathy (DR), a prevalent complication in patients with type 2 diabetes, has attracted increasing attention. Recent studies have explored a plausible association between retinopathy and significant liver fibrosis. The aim of this investigation was to develop a sophisticated machine learning (ML) model, leveraging comprehensive clinical datasets, to forecast the likelihood of significant liver fibrosis in patients with retinopathy and to interpret the ML model by applying the SHapley Additive exPlanations (SHAP) method.

METHODS

This inquiry was based on data from the National Health and Nutrition Examination Survey 2005-2008 cohort. Utilizing the Fibrosis-4 index (FIB-4), liver fibrosis was stratified across a spectrum of grades (F0-F4). The severity of retinopathy was determined using retinal imaging and segmented into four discrete gradations. A ten-fold cross-validation approach was used to gauge the propensity towards liver fibrosis. Eight ML methodologies were used: Extreme Gradient Boosting, Random Forest, multilayer perceptron, Support Vector Machines, Logistic Regression (LR), Plain Bayes, Decision Tree, and k-nearest neighbors. The efficacy of these models was gauged using metrics, such as the area under the curve (AUC). The SHAP method was deployed to unravel the intricacies of feature importance and explicate the inner workings of the ML model.

RESULTS

The analysis included 5,364 participants, of whom 2,116 (39.45%) exhibited notable liver fibrosis. Following random allocation, 3,754 individuals were assigned to the training set and 1,610 were allocated to the validation cohort. Nine variables were curated for integration into the ML model. Among the eight ML models scrutinized, the LR model attained zenith in both AUC (0.867, 95% CI: 0.855-0.878) and F1 score (0.749, 95% CI: 0.732-0.767). In internal validation, this model sustained its superiority, with an AUC of 0.850 and an F1 score of 0.736, surpassing all other ML models. The SHAP methodology unveils the foremost factors through importance ranking.

CONCLUSION

Sophisticated ML models were crafted using clinical data to discern the propensity for significant liver fibrosis in patients with retinopathy and to intervene early.

PRACTICE IMPLICATIONS

Improved early detection of liver fibrosis risk in retinopathy patients enhances clinical intervention outcomes.

Visit-to-visit variability of blood pressure and risk of diabetic retinopathy: a systematic review and meta-analysis

BACKGROUND

Diabetes mellitus (DM), a worldwide disease affecting more than 400 million people, is associated with high blood pressure (BP). In addition to macrovascular complications, high BP in DM patients is potentially linked to microvascular complications. More than 70% of DM patients have retinopathy. To our knowledge, no systematic review and meta-analysis has been conducted on the relationship between visit-to-visit variability in blood pressure and diabetic retinopathy risk.

METHODS

This systematic review and meta-analysis study was performed on the related articles. The search strategy, screening, and data selection were all checklist-based. A comprehensive search was done in three databases, including PubMed, Google Scholar, and Scopus. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were followed. English clinical studies published up to January 2023 contained diabetic patients as the population, retinopathy as the outcome, and visit-to-visit blood pressure as the intervention. Using the QUIPS technique, two authors independently quantify the risk of bias in included publications. The meta-analysis was conducted using R version 4.4.1. We calculated relative risk (RR) as the effect size, applying the random effect model. Standard deviation (SD) and coefficient of variation (CV), were used as measures of BP variability.

RESULTS

A total number of 8 studies with 743,315 participants were covered in this systematic review. After meta-analysis, we concluded that the group with higher SD of BP variability had 2 percent higher risk than the control group (RR = 1.02, 95% CI = 1.01-1.03, I-squared = 41%); however, results of our analysis for CV of BP variability showed no significant contrast with control group thus no increased risk was reported (RR = 1.04, 95% CI = 0.94-1.15, I-squared = 32%, P-value = 0.23).

CONCLUSION

In conclusion, an increased SD of BP variability significantly increased the relative risk for the development of retinopathy.

Cardiovascular Risk Factors as Independent Predictors of Diabetic Retinopathy in Type II Diabetes Mellitus: The Development of a Predictive Model

Background: Diabetic retinopathy (DR) is a leading cause of blindness in patients with type 2 diabetes mellitus (T2DM). Cardiovascular risk factors, such as hypertension, obesity, and dyslipidemia, may play a crucial role in the development and progression of DR, though the evidence remains mixed. This study aimed to assess cardiovascular risk factors as independent predictors of DR and to develop a predictive model for DR progression in T2DM patients. Methods: A retrospective cross-sectional study was conducted on 377 patients with T2DM who underwent a comprehensive eye exam. Clinical data, including blood pressure, lipid profile, BMI, and smoking status, were collected. DR staging was determined through fundus photography and classified as No DR, Non-Proliferative DR (NPDR), and Mild, Moderate, Severe, or Proliferative DR (PDR). A Multivariate Logistic Regression was used to evaluate the association between cardiovascular risk factors and DR presence. Several machine learning models, including Random Forest, XGBoost, and Support Vector Machines, were applied to assess the predictive value of cardiovascular risk factors and identify key predictors. Model performance was evaluated using accuracy, precision, recall, and ROC-AUC. Results: The prevalence of DR in the cohort was 41.6%, with 34.5% having NPDR and 7.1% having PDR. A multivariate analysis identified systolic blood pressure (SBP), LDL cholesterol, and body mass index (BMI) as independent predictors of DR progression (p < 0.05). The Random Forest model showed a moderate predictive ability, with an AUC of 0.62 for distinguishing between the presence and absence of DR XGBoost showing a better performance, featuring a ROC-AUC of 0.68, while SBP, HDL cholesterol, and BMI were consistently identified as the most important predictors across models. After tuning, the XGBoost model showed a notable improvement, with an ROC-AUC of 0.72. Conclusions: Cardiovascular risk factors, particularly BP and BMI, play a significant role in the progression of DR in patients with T2DM. The predictive models, especially XGBoost, showed moderate accuracy in identifying DR stages, suggesting that integrating these risk factors into clinical practice may improve early detection and intervention strategies for DR.

Identification of diabetic retinopathy classification using machine learning algorithms on clinical data and optical coherence tomography angiography

BACKGROUND

To apply machine learning (ML) algorithms to perform multiclass diabetic retinopathy (DR) classification using both clinical data and optical coherence tomography angiography (OCTA).

METHODS

In this cross-sectional observational study, clinical data and OCTA parameters from 203 diabetic patients (203 eye) were used to establish the ML models, and those from 169 diabetic patients (169 eye) were used for independent external validation. The random forest, gradient boosting machine (GBM), deep learning and logistic regression algorithms were used to identify the presence of DR, referable DR (RDR) and vision-threatening DR (VTDR). Four different variable patterns based on clinical data and OCTA variables were examined. The algorithms' performance were evaluated using receiver operating characteristic curves and the area under the curve (AUC) was used to assess predictive accuracy.

RESULTS

The random forest algorithm on OCTA+clinical data-based variables and OCTA+non-laboratory factor-based variables provided the higher AUC values for DR, RDR and VTDR. The GBM algorithm produced similar results, albeit with slightly lower AUC values. Leading predictors of DR status included vessel density, retinal thickness and GCC thickness, as well as the body mass index, waist-to-hip ratio and glucose-lowering treatment.

CONCLUSIONS

ML-based multiclass DR classification using OCTA and clinical data can provide reliable assistance for screening, referral, and management DR populations.

The influence of insulin on diabetic retinopathy and retinal vessel parameters in diabetes

AIM

To investigate the associations between insulin use and diabetic retinopathy (DR), and retinal vascular parameters in type 2 diabetes (T2DM).

METHODS

A total of 6,374 T2DM patients, consisting of 2,231 patients receiving insulin alone and 4143 patients without any hypoglycemic medication, were included in cross-sectional analyses. Among those without DR at baseline, 791 patients were followed for three years in longitudinal analyses. Fundus photography was taken to diagnose DR and calculate central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), arteriolar-to-venular ratio (AVR), and vascular tortuosity. Inverse probability treatment-weighted analyses were performed.

RESULTS

After adjusting for gender, age, body mass index, blood pressure, blood glucose, T2DM duration, smoking, and alcohol use, insulin users showed a higher risk of DR (odds ratio (OR) = 2.27, 95% confidence interval (95%CI) = 2.08-2.48, P < 0.001), larger CRVE (β = 3.92, 95%CI = 2.46-5.37, P < 0.001), smaller AVR (β=-0.0083, 95%CI=-0.0121- -0.0046, P < 0.001), and larger vascular curvature (β = 0.19, 95%CI = 0.05-0.33, P = 0.008). After 3 years, insulin users had a higher risk of developing DR (OR = 1.94; 95% CI = 1.37-2.73, P = 0.002), and greater change in CRVE (β = 3.92, 95%CI = 0.96-6.88, P = 0.009).

CONCLUSIONS

The impact of insulin on the retinal microvasculature provides support for linking insulin to the increased risk of DR, as well as cardiovascular events in T2DM.

Sex-based differences in the associations between abdominal obesity and diabetic retinopathy in diabetic patients with normal weight

Purpose

To investigate sex-specific differences in associations of abdominal obesity indexes, systemic factors, and diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) subjects with normal body mass index (BMI).

Methods

This cross-sectional study comprised 653 T2DM subjects (402 women and 251 men) with normal BMI (18.5 kg/m2

Results

In the multivariate logistic regressions, the presence of any DR was associated with a longer duration of T2DM (OR = 1.07, p = 0.007) and higher HbA1c (OR = 1.40, p = 0.001) in women, while any DR was associated with younger age at T2DM diagnosis (OR = 0.94, p = 0.020) and higher HbA1c (OR = 1.29, p = 0.011) in men. For women, we identified a positive association between WC (OR = 1.07, p = 0.011), WHR (OR = 1.67, p = 0.002), and WHtR (OR = 1.57, p = 0.004) with any DR after adjusting for confounders, and the third tertiles of WC (OR = 2.29, p = 0.028), WHR (OR = 3.03, p = 0.003), and WHtR (OR = 2.84, p = 0.007) were at high risk of any DR. For men, there were no associations between abdominal obesity indexes and any DR in either continuous variables or categorical variables (all p > 0.05).

Main conclusions

There were sex differences in the relationships between WC, WHR, WHtR, and DR in this T2DM population with normal BMI. Our findings provide new insight into a sex-specific mechanism of DR and management of the condition.

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Key Words

• Abdominal obesity
• Body mass index
• Diabetic retinopathy
• Sex differences

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Affiliation(s)

Yuan Liu State Key Laboratory of Ophthalmology, 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 510060, China
Kaiqun Liu State Key Laboratory of Ophthalmology, 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 510060, China
Liqiong Xie State Key Laboratory of Ophthalmology, 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 510060, China
Chengguo Zuo State Key Laboratory of Ophthalmology, 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 510060, China
Lanhua Wang State Key Laboratory of Ophthalmology, 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 510060, China
Wenyong Huang State Key Laboratory of Ophthalmology, 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 510060, China

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The Genetic Variants of Long Noncoding RNA MEG3 and Its Association to the Clinical Features of Diabetic Retinopathy

PURPOSE

This study aimed to investigate the potential correlation between the single-nucleotide polymorphism (SNP) of maternally expressed gene 3 (MEG3) and the clinical manifestations of diabetic retinopathy (DR).

METHODS

Five loci of MEG3 SNPs including rs4081134 (G/A), rs10144253 (T/C), rs7158663 (G/A), rs3087918 (T/G) and rs11160608 (A/C) were genotyped by TaqMan allelic discrimination in 457 non-DR patients and 280 DR individuals.

RESULTS

The distribution frequency of MEG3 SNP rs7158663 GA (AOR: 0.683, 95% CI: 0.478-0.975, p = 0.036) and MEG3 SNP rs7158663 GA + AA (AOR: 0.686, 95% CI: 0.487-0.968, p = 0.032) were significantly lower in the DR group. And the MEG3 SNP rs7158663 GA + AA (AOR: 0.610, 95% CI: 0.377-0.985, p = 0.043) demonstrated a significantly lower distribution frequency in the male DR group. Besides, the DR patients with MEG3 SNP rs7158663 GA + AA genotype showed a significantly lower HbA1c level than the DR patients with MEG3 SNP rs7158663 GG genotype (7.29 ± 1.23 versus 7.74 ± 1.49, p = 0.013). Moreover, in the analysis using data from gene expression data series database, a higher MEG3 level was significantly correlated to a lower miR-182 level in the database (p = 0.0114).

CONCLUSIONS

In this study, the distribution frequency of MEG3 SNP rs7158663 GA + AA genotype was lower in DR, while the DR would develop under lower HbA1c level in DM patients with this MEG3 SNP variant.

Prevalence of diabetic retinopathy and its risk factors in rural patients with type 2 diabetes referring to Beijing Huairou Hospital, China

BACKGROUND

China has the largest population of diabetic patients worldwide. A diverse population and regional discrepancy in access to health care and diabetes management may lead to unique risk factors for diabetic retinopathy (DR) in different regions of China. This study aimed to evaluate the prevalence and risk factors of DR in rural patients with type 2 diabetes.

METHODS

This hospital-based cross-sectional study recruited a sample of 704 type 2 diabetic patients from rural areas referred to Beijing Huairou Hospital, China, from June 1, 2022, to June 1, 2023. The medical history, demographic information, and results of laboratory examinations of patients were collected and analyzed. The diagnosis of DR were performed by experienced ophthalmologists using mydriatic fundus photography.

RESULTS

Out of all patients, 53.8% were male and 46.2% were female. The mean age of patients and duration of diabetes were 54.9 ± 13.0 and 6.2 ± 4.5 years, respectively. The DR prevalence was 16.8%. The independent risk factors for DR in multivariate analysis were diabetes duration > 10 years (OR = 9.16, 95%CI = 5.49-15.30), fasting plasma glucose ≥ 7.2 mmol/L (OR = 3.25, 95%CI = 1.42-7.42), glycosylated hemoglobin ≥ 7% (OR = 6.49, 95%CI = 2.59-16.23), hypertension (OR = 1.59, 95%CI = 1.05-2.40), hyperlipidemia (OR = 2.16, 95%CI = 1.30-3.59), diabetic nephropathy (OR = 1.95, 95%CI = 1.17-3.23), high uric acid level (OR = 3.57, 95%CI = 1.56-8.15), high albumin to creatinine ratio (OR = 2.48, 95%CI = 1.06-5.82), and insulin treatment (OR = 1.79, 95%CI = 1.12-2.88).

CONCLUSIONS

This study evaluated the DR prevalence and its associated risk factors among type 2 diabetic patients from rural areas in Beijing's Huairou District, China. Paying attention to these risk factors may be useful in screening high-risk diabetic patients for DR and adopting early preventive and therapeutic interventions.

Vitamin D deficiency and the risk of diabetic retinopathy in patients with type 2 diabetes in Tibet: a cross-sectional analysis

BACKGROUND

Diabetic retinopathy (DR) is one of the most common complications of diabetes worldwide. The aim of this study was to assess the prevalence of DR in hospitalized patients with type 2 diabetes (T2DM) in Tibet and to identify risk factors that may influence the occurrence of DR.

METHODS

This was a cross-sectional study conducted in a third-class hospital in the Tibet Autonomous Region. The prevalence of DR in hospitalized patients with T2DM was measured. Univariate and multivariate logistic regression, restricted cubic spline (RCS) analysis and receiver-operating characteristic curve analysis were used to investigate the risk factors for DR.

RESULTS

The prevalence of DR was 29.3%. The duration of diabetes; concentrations of 25-OH-VitD3, hemoglobin, fasting insulin, alanine aminotransferase, total bilirubin, and creatinine; and HOMA-IR were significantly different between DR patients and non-DR patients (all P < 0.05). Univariate and multivariate logistic regression revealed that a longer duration of diabetes and lower 25-OH-VitD3 levels were associated with increased DR risk. RCS analysis suggested overall positive associations of the duration of diabetes and 25-OH-VitD3 concentrations with DR risk (P nonlinearity < 0.05). The turning points for the duration of diabetes and 25-OH-VitD3 concentrations were 5.1 years and 10.6 ng/mL, respectively. The sensitivity, specificity, and area under the receiver-operating characteristic curve for the combination of the duration of diabetes and 25-OH-VitD3 levels were 79.4%, 69.4% and 0.764, respectively.

CONCLUSIONS

Given the high prevalence of DR in hospitalized patients with T2DM in Tibet, vitamin D supplementation seems to be important in the prevention of DR to some degree.

Risk evaluation for diabetic retinopathy in Chinese renal-biopsied type 2 diabetes mellitus patients

AIM

To investigate diabetic retinopathy (DR) prevalence in Chinese renal-biopsied type 2 diabetes mellitus (T2DM) patients with kidney dysfunction, and to further evaluate its relationship with diabetic nephropathy (DN) incidence and the risk factors for DR development in this population.

METHODS

A total of 84 renal-biopsied T2DM patients were included. Fundus and imaging examinations were employed for DR diagnosis. Demographic information and clinical measures along with renal histopathology were analyzed for comparisons between the DR and non-DR groups. Risk factors on DR development were analyzed with multiple logistic regression.

RESULTS

DR prevalence was 50% in total. The incidences of DN, non-diabetic renal disease (NDRD) and mixed-type pathology were 47.6%, 19.0% and 33.3% in the DR group respectively, while 11.9%, 83.3% and 4.8% in the non-DR group. Systolic blood pressure, ratio of urinary albumin to creatine ratio, urinary albumin, 24-hours urinary protein, the incidence and severity of DN histopathology were found statistically increased in the DR group. Multiple logistic regression analysis showed histopathological DN incidence significantly increased the risk of DR development [odds ratio (OR)=21.664, 95% confidential interval (CI) 5.588 to 83.991, P<0.001 for DN, and OR=45.475, 95%CI 6.949 to 297.611, P<0.001 for mixed-type, respectively, in reference to NDRD)], wherein DN severity positively correlated.

CONCLUSION

Renal histopathological evidence indicates DN incidence and severity increases the risk of DR development in Chinese T2DM patients inexperienced of regular fundus examinations.

The retinal oxygen metabolism and hemodynamics as a substitute for biochemical tests to predict nonproliferative diabetic retinopathy

Predicting the occurrence of nonproliferative diabetic retinopathy (NPDR) using biochemical parameters is invasive, which limits large-scale clinical application. Noninvasive retinal oxygen metabolism and hemodynamics of 215 eyes from 73 age-matched healthy subjects, 90 diabetic patients without DR, 40 NPDR, and 12 DR with postpanretinal photocoagulation were measured with a custom-built multimodal retinal imaging device. Diabetic patients underwent biochemical examinations. Two logistic regression models were developed to predict NPDR using retinal and biochemical metrics, respectively. The predictive model 1 using retinal metrics incorporated male gender, insulin treatment condition, diastolic duration, resistance index, and oxygen extraction fraction presented a similar predictive power with model 2 using biochemical metrics incorporated diabetic duration, diastolic blood pressure, and glycated hemoglobin A1c (area under curve: 0.73 vs. 0.70; sensitivity: 76% vs. 68%; specificity: 64% vs. 62%). These results suggest that retinal oxygen metabolic and hemodynamic biomarkers may replace biochemical parameters to predict the occurrence of NPDR .

Assessing the appropriateness and completeness of ChatGPT-4's AI-generated responses for queries related to diabetic retinopathy

OBJECTIVE

To evaluate the appropriateness of responses generated by an online chat-based artificial intelligence (AI) model for diabetic retinopathy (DR) related questions.

DESIGN

Cross-sectional study.

METHODS

A set of 20 questions framed from the patient's perspective addressing DR-related queries, such as the definition of disease, symptoms, prevention methods, treatment options, diagnostic methods, visual impact, and complications, were formulated for input into ChatGPT-4. Peer-reviewed, literature-based answers were collected from popular search engines for the selected questions and three retinal experts reviewed the responses. An inter-human agreement was analyzed for consensus expert responses and also between experts. The answers generated by the AI model were compared with those provided by the experts. The experts rated the response generated by ChatGPT-4 on a scale of 0-5 for appropriateness and completeness.

RESULTS

The answers provided by ChatGPT-4 were appropriate and complete for most of the DR-related questions. The response to questions on the adverse effects of laser photocoagulation therapy and compliance to treatment was not perfectly complete. The average rating given by the three retina expert evaluators was 4.84 for appropriateness and 4.38 for completeness of answers provided by the AI model. This corresponds to an overall 96.8% agreement among the experts for appropriateness and 87.6% for completeness regarding AI-generated answers.

CONCLUSION

ChatGPT-4 exhibits a high level of accuracy in generating appropriate responses for a range of questions in DR. However, there is a need to improvise the model to generate complete answers for certain DR-related topics.

Intravitreal conbercept injection with panretinal photocoagulation for high-risk proliferative diabetic retinopathy with vitreous hemorrhage

AIM

To assess the clinical efficacy and safety of combining panretinal photocoagulation (PRP) with intravitreal conbercept (IVC) injections for patients with high-risk proliferative diabetic retinopathy (HR-PDR) complicated by mild or moderate vitreous hemorrhage (VH), with or without diabetic macular edema (DME).

METHODS

Patients diagnosed with VH with/without DME secondary to HR-PDR and received PRP combined with IVC injections were recruited in this retrospective study. Upon establishing the patient's diagnosis, an initial IVC was performed, followed by prompt administration of PRP. In cases who significant bleeding persisted and impeded the laser operation, IVC was sustained before supplementing with PRP. Following the completion of PRP, patients were meticulously monitored for a minimum of six months. Laser therapy and IVC injections were judiciously adjusted based on fundus fluorescein angiography (FFA) results. Therapeutic effect and the incidence of adverse events were observed.

RESULTS

Out of 42 patients (74 eyes), 29 were male and 13 were female, with a mean age of 59.17±12.74y (33-84y). The diabetic history was between 1wk and 26y, and the interval between the onset of visual symptoms and diagnosis of HR-PDR was 1wk-1y. The affected eye received 2.59±1.87 (1-10) IVC injections and underwent 5.5±1.02 (4-8) sessions of PRP. Of these, 68 eyes received PRP following 1 IVC injection, 5 eyes after 2 IVC injections, and 1 eye after 3 IVC injections. Complete absorption of VH was observed in all 74 eyes 5-50wk after initial treatment, with resolution of DME in 51 eyes 3-48wk after initial treatment. A newly developed epiretinal membrane was noted in one eye. Visual acuity significantly improved in 25 eyes. No complications such as glaucoma, retinal detachment, or endophthalmitis were reported.

CONCLUSION

The study suggests that the combination of PRP with IVC injections is an effective and safe modality for treating diabetic VH in patients with HR-PDR.

Prevalence and co-prevalence of comorbidities among Chinese adult patients with type 2 diabetes mellitus: a cross-sectional, multicenter, retrospective, observational study based on 3B study database

Purpose

This study aimed to investigate the prevalence and co-prevalence of comorbidities among Chinese individuals with type 2 diabetes (T2DM).

Methods

Medical records were retrospectively retrieved from the 3B Study database, which provided a comprehensive assessment of comorbid conditions in Chinese adult outpatients with T2DM. Patient characteristics, laboratory measures, and comorbidities were summarized via descriptive analyses, overall and by subgroups of age (<65, 65-74, 75 years) and gender.

Results

Among 25,454 eligible patients, 53% were female, and the median age was 63 years. The median time of diabetes duration was 6.18 years. A total of 20,309 (79.8%) patients had at least one comorbid condition alongside T2DM. The prevalence of patients with one, two, three, and four or more comorbid conditions was 28.0%, 24.6%, 15.6%, and 11.6%, respectively. Comorbidity burden increased with longer T2DM duration. Older age groups also exhibited higher comorbidity burden. Females with T2DM had a higher overall percentage of comorbidities compared to males (42.7% vs. 37.1%). The most common comorbid conditions in T2DM patients were hypertension (HTN) in 59.9%, overweight/obesity in 58.3%, hyperlipidemia in 42.0%, retinopathy in 16.5%, neuropathy in 15.2%, cardiovascular disease (CVD) in 14.9%, and renal disease in 14.4%. The highest co-prevalence was observed for overweight/obesity and HTN (37.6%), followed by HTN and hyperlipidemia (29.8%), overweight/obesity and hyperlipidemia (27.3%), HTN and CVD (12.6%), HTN and retinopathy (12.1%), and HTN and renal disease (11.3%).

Conclusion

The majority of T2DM patients exhibit multiple comorbidities. Considering the presence of multimorbidity is crucial in clinical decision-making.

Systematic review registration

https://clinicaltrials.gov/, identifier NCT01128205.

Cellular communication network factor 1 promotes retinal leakage in diabetic retinopathy via inducing neutrophil stasis and neutrophil extracellular traps extrusion

BACKGROUND

Diabetic retinopathy (DR) is a major cause of blindness and is characterized by dysfunction of the retinal microvasculature. Neutrophil stasis, resulting in retinal inflammation and the occlusion of retinal microvessels, is a key mechanism driving DR. These plugging neutrophils subsequently release neutrophil extracellular traps (NETs), which further disrupts the retinal vasculature. Nevertheless, the primary catalyst for NETs extrusion in the retinal microenvironment under diabetic conditions remains unidentified. In recent studies, cellular communication network factor 1 (CCN1) has emerged as a central molecule modulating inflammation in pathological settings. Additionally, our previous research has shed light on the pathogenic role of CCN1 in maintaining endothelial integrity. However, the precise role of CCN1 in microvascular occlusion and its potential interaction with neutrophils in diabetic retinopathy have not yet been investigated.

METHODS

We first examined the circulating level of CCN1 and NETs in our study cohort and analyzed related clinical parameters. To further evaluate the effects of CCN1 in vivo, we used recombinant CCN1 protein and CCN1 overexpression for gain-of-function, and CCN1 knockdown for loss-of-function by intravitreal injection in diabetic mice. The underlying mechanisms were further validated on human and mouse primary neutrophils and dHL60 cells.

RESULTS

We detected increases in CCN1 and neutrophil elastase in the plasma of DR patients and the retinas of diabetic mice. CCN1 gain-of-function in the retina resulted in neutrophil stasis, NETs extrusion, capillary degeneration, and retinal leakage. Pre-treatment with DNase I to reduce NETs effectively eliminated CCN1-induced retinal leakage. Notably, both CCN1 knockdown and DNase I treatment rescued the retinal leakage in the context of diabetes. In vitro, CCN1 promoted adherence, migration, and NETs extrusion of neutrophils.

CONCLUSION

In this study, we uncover that CCN1 contributed to retinal inflammation, vessel occlusion and leakage by recruiting neutrophils and triggering NETs extrusion under diabetic conditions. Notably, manipulating CCN1 was able to hold therapeutic promise for the treatment of diabetic retinopathy.

Knowledge level and health information-seeking behavior of people with diabetes in rural areas: a multicenter cross-sectional study

Introduction

There is a lack of research on the current level of diabetes knowledge and health information-seeking behaviors among patients with diabetes in rural areas of China's economically underdeveloped regions during COVID-19, as well as a lack of up-to-date evidence on glycemic control and the incidence of complications among rural patients with diabetes.

Objectives

To investigate the prevalence of glycemic control and complications among patients with diabetes in rural areas, to explore the current status and correlation of diabetes knowledge level and health information-seeking behavior, and to analyze the factors affecting diabetes knowledge level.

Methods

From January 2022 to July 2022, we conducted a screening on diabetic complications and a questionnaire survey among 2,178 patients with diabetes in 15 county hospitals in rural areas of Guangxi Zhuang Autonomous Region. The patients' knowledge level and health information-seeking behavior were investigated. Spearman correlation analysis was used to assess the correlation between diabetes knowledge and health information-seeking behavior. Multiple linear regression analysis was used to test how demographic information and health information-seeking behavior influenced the level of diabetes knowledge.

Results

Of 2,178 patients with diabetes in rural areas, 1,684 (77.32%) had poor glycemic control, and the prevalence of diabetic complications was estimated to be 72.13%. Patients with diabetes had poor diabetes knowledge and health information-seeking behavior, and there is a strong positive correlation between them. Diabetes knowledge level was influenced by per capita household disposable income, occupational status, gender, age, ethnicity, family history of diabetes, insulin use, glycated hemoglobin, education level, number of complications and health information-seeking behavior.

Conclusion

Patients with diabetes in rural areas have poor glycemic control and a high incidence of diabetic complications. Patients with diabetes in rural areas have poor knowledge and inadequate health information-seeking behavior. Systematic and standardized education should be provided to improve patients' diabetes knowledge and thus improve their self-management ability.

Prevalence of retinal pathologies in people over 60 years: the Tehran Geriatrics Eye Study

AIM

To determine the prevalence of some retinal pathologies in people over 60y and their association with demographic and ocular factors.

METHODS

A cross-sectional study was conducted in Tehran using multistage cluster sampling. After selecting subjects aged 60 and over, optometric, and ophthalmic examinations were done. For retinal examination, a 90 D lens was used and indirect ophthalmoscopy was performed after instilling tropicamide drops. Biometry was done using the IOL Master for all participants.

RESULTS

Of 3791 people that were invited through cluster sampling, 3310 participated in the study (response rate=82%). The prevalence of retinal pigmented epithelium (RPE) change, drusen, geographic atrophy (GA), hypertensive retinopathy (HTR), nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), choroidal neovascularization (CNV), central retinal artery occlusion (CRAO), myopic retinopathy (MR), branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO) was 27.42%, 11.08%, 4.52%, 3.03%, 4.05%, 0.54%, 0.82%, 0.39%, 0.20%, 0.49%, and 0.19%, respectively. After removing the effect of age, the odds of NPDR were 1.68 times higher in women compared to men (P=0.014). After removing the effect of sex, the odds of drusen, RPE change, GA, CNV, BRVO, and CRVO increased with age.

CONCLUSION

There is a higher prevalence of RPE change, drusen, GA, CNV and a lower prevalence of MR and CRAO in the elderly population of Tehran aged over 60y compared to global average values. Considering the correlation of most of the diseases with age and their effects on vision, attention should be paid to these diseases and the related screening programs to prevent vision impairment.

Role of Hsa_circ_0000880 in the Regulation of High Glucose-Induced Apoptosis of Retinal Microvascular Endothelial Cells

Purpose

Circular RNAs (circRNAs) have been verified to participate in multiple biological processes and disease progression. Yet, the role of circRNAs in the pathogenesis of diabetic retinopathy (DR) is still poorly understood and deserves further study. This study aimed to investigate the role of circRNAs in the regulation of high glucose (HG)-induced apoptosis of retinal microvascular endothelial cells (RMECs).

Methods

Epiretinal membranes from patients with DR and nondiabetic patients with idiopathic macular epiretinal membrane were collected for this study. The circRNA microarrays were performed using high-throughput sequencing. Hierarchical clustering, functional enrichment, and network regulation analyses were used to analyze the data generated by high-throughput sequencing. Next, RMECs were subjected to HG (25 mM) conditions to induce RMECs apoptosis in vitro. A series of experiments, such as Transwell, the Scratch wound, and tube formation, were conducted to explore the regulatory effect of circRNA on RMECs. Fluorescence in situ hybridization (FISH), immunofluorescence staining, and Western blot were used to study the mechanism underlying circRNA-mediated regulation.

Results

A total of 53 differentially expressed circRNAs were found in patients with DR. Among these, hsa_circ_0000880 was significantly upregulated in both the diabetic epiretinal membranes and in an in vitro DR model of HG-treated RMECs. Hsa_circ_0000880 knockout facilitated RMECs vitality and decreased the paracellular permeability of RMECs under hyperglycemia. More importantly, silencing of hsa_circ_0000880 significantly inhibited HG-induced ROS production and RMECs apoptosis. Hsa_circ_0000880 acted as an endogenous sponge for eukaryotic initiation factor 4A-III (EIF4A3). Knockout of hsa_circ_0000880 reversed HG-induced decrease in EIF4A3 protein level.

Conclusions

Our findings suggest that hsa_circ_0000880 is a novel circRNA can induce RMECs apoptosis in response to HG conditions by sponging EIF4A3, offering an innovative treatment approach against DR.

Translational Relevance

The circRNAs participate in the dysregulation of microvascular endothelial function induced by HG conditions, indicating a promising therapeutic target for DR.

Extending the diabetic retinopathy screening intervals in Singapore: methodology and preliminary findings of a cohort study

BACKGROUND

The Diabetic Retinopathy Extended Screening Study (DRESS) aims to develop and validate a new DR/diabetic macular edema (DME) risk stratification model in patients with Type 2 diabetes (DM) to identify low-risk groups who can be safely assigned to biennial or triennial screening intervals. We describe the study methodology, participants' baseline characteristics, and preliminary DR progression rates at the first annual follow-up.

METHODS

DRESS is a 3-year ongoing longitudinal study of patients with T2DM and no or mild non-proliferative DR (NPDR, non-referable) who underwent teleophthalmic screening under the Singapore integrated Diabetic Retinopathy Programme (SiDRP) at four SingHealth Polyclinics. Patients with referable DR/DME (> mild NPDR) or ungradable fundus images were excluded. Sociodemographic, lifestyle, medical and clinical information was obtained from medical records and interviewer-administered questionnaires at baseline. These data are extracted from medical records at 12, 24 and 36 months post-enrollment. Baseline descriptive characteristics stratified by DR severity at baseline and rates of progression to referable DR at 12-month follow-up were calculated.

RESULTS

Of 5,840 eligible patients, 78.3% (n = 4,570, median [interquartile range [IQR] age 61.0 [55-67] years; 54.7% male; 68.0% Chinese) completed the baseline assessment. At baseline, 97.4% and 2.6% had none and mild NPDR (worse eye), respectively. Most participants had hypertension (79.2%) and dyslipidemia (92.8%); and almost half were obese (43.4%, BMI ≥ 27.5 kg/m2). Participants without DR (vs mild DR) reported shorter DM duration, and had lower haemoglobin A1c, triglycerides and urine albumin/creatinine ratio (all p < 0.05). To date, we have extracted 41.8% (n = 1909) of the 12-month follow-up data. Of these, 99.7% (n = 1,904) did not progress to referable DR. Those who progressed to referable DR status (0.3%) had no DR at baseline.

CONCLUSIONS

In our prospective study of patients with T2DM and non-referable DR attending polyclinics, we found extremely low annual DR progression rates. These preliminary results suggest that extending screening intervals beyond 12 months may be viable and safe for most participants, although our 3-year follow up data are needed to substantiate this claim and develop the risk stratification model to identify low-risk patients with T2DM who can be assigned biennial or triennial screening intervals.

Interplay of endothelial-mesenchymal transition, inflammation, and autophagy in proliferative diabetic retinopathy pathogenesis

Background

Assessment and validation of endothelial-mesenchymal transition (EndoMT) in the retinal endothelium of patients with proliferative diabetic retinopathy (PDR) at the level of retinal and vitreous specimens, and preliminary discussion of its regulatory mechanisms.

Methods

Transcriptome sequencing profiles of CD31+ cells from 9 retinal fibrovascular mem-branes (FVMs) and 4 postmortem retinas were downloaded from GEO databases to analyze EndoMT-related differentially expressed genes (DEGs). Then, 42 PDR patients and 34 idiopathic macular holes (IMH) patients were enrolled as the PDR and control groups, respectively. Vitreous humor (VH) samples were collected, and the expression of EndoMT-related proteins was quantified by enzyme-linked immunosorbent assay.

Results

A total of 5845 DEGs were identified, and we subsequently focused on the analysis of 24 EndoMT-related marker genes, including the trigger of EndoMT, endothelial genes, mesenchymal genes, transcription factors, inflammatory factors, and autophagy markers. Six of these genes were selected for protein assay validation in VH, showing increased mesenchymal marker (type I collagen α 2 chain, COL1A2) and decreased endothelial marker (VE-cadherin, CDH5) accompanied by increased TGFβ, IL-1β, LC3B and P62 in PDR patients. In addition, anti-VEGF therapy could enhance EndoMT-related phenotypes.

Conclusions

EndoMT may underlie the pathogenesis of PDR, and the induction and regulation correlate with autophagy defects and the inflammatory response.

Association of Visceral Obesity Indices With Incident Diabetic Retinopathy in Patients With Diabetes: Prospective Cohort Study

BACKGROUND

Visceral adipose tissue plays an active role in the pathogenesis of type 2 diabetes and vascular dysfunction. The lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese VAI (CVAI) have been proposed as simple and validated surrogate indices for measuring visceral adipose tissue. However, the evidence from prospective studies on the associations between these novel indices of visceral obesity and diabetic retinopathy (DR) remains scant.

OBJECTIVE

This study aimed to investigate the longitudinal associations of LAP, VAI, and CVAI with incident DR in Chinese patients with diabetes.

METHODS

This was a prospective cohort study conducted in Guangzhou in southern China. We collected baseline data between November 2017 and July 2020, while on-site follow-up visits were conducted annually until January 2022. The study participants consisted of 1403 patients with a clinical diagnosis of diabetes, referred from primary care, who were free of DR at baseline. The LAP, VAI, and CVAI levels were calculated by sex-specific equations based on anthropometric and biochemical parameters. DR was assessed using 7-field color stereoscopic fundus photographs and graded according to the modified Airlie House Classification scheme. Time-dependent Cox proportional hazard models were constructed to estimate the hazard ratios with 95% CIs. Restricted cubic spline curves were fitted to examine the dose-response relationship between the 3 indices of visceral obesity and new-onset DR. Subgroup analyses were performed to investigate the potential effect modifiers.

RESULTS

The mean age of study participants was 64.5 (SD 7.6) years, and over half (816/1403, 58.2%) were female. During a median follow-up of 2.13 years, 406 DR events were observed. A 1-SD increment in LAP, VAI, or CVAI was consistently associated with increased risk for new-onset DR, with a multivariable‑adjusted hazard ratio of 1.24 (95% CI 1.09-1.41; P=.001), 1.22 (95% CI 1.09-1.36; P<.001), and 1.48 (95% CI 1.19-1.85; P=.001), respectively. Similar patterns were observed across tertiles in LAP (P for trend=.001), VAI (P for trend<.001), and CVAI (P for trend=.009). Patients in the highest tertile of LAP, VAI, and CVAI had an 84%, 86%, and 82% higher hazard of DR, respectively, compared to those in the lowest tertile. A nonlinear dose-response relationship with incident DR was noted for LAP and VAI (both P for nonlinearity<.05), but not for CVAI (P for nonlinearity=.51). We did not detect the presence of effect modification by age, sex, duration of diabetes, BMI, or comorbidity (all P for interaction>.10).

CONCLUSIONS

Visceral obesity, as measured by LAP, VAI, or CVAI, is independently associated with increased risk for new-onset DR in Chinese patients with diabetes. Our findings may suggest the necessity of incorporating regular monitoring of visceral obesity indices into routine clinical practice to enhance population-based prevention for DR.

Exposure to volatile organic compounds is a risk factor for diabetes retinopathy: a cross-sectional study

Introduction

A few past experimental studies have indicated that exposure to volatile organic compounds (VOCs) might be a potential risk factor for diabetes retinopathy (DR). However, these findings lack substantial support from extensive epidemiological research. This large-scale cross-sectional study aimed to examine whether exposure to low levels of VOCs in the general population is associated with diabetes mellitus (DM) and DR.

Methods

The analytical data was from the National Health and Nutrition Examination Survey (NHANES) dataset (2011-2018). To minimize the potential impact of gender and age on the findings, propensity score matching was utilized to align the data selection. Relationships between blood VOCs and DM and DR were assessed in a sample of 2,932 adults using the logistic regression models. Additionally, Bayesian kernel machine regression (BKMR) models and Weighted Quantile Sum (WQS) were conducted for mixture exposure analysis.

Results

The result shows VOCs were positive associated with DM and DR in US adults, as assessed by WQS model, and the calculated odd ratios (ORs) [95% confidence interval (C.I)] were 53.91(34.11 ~ 85.22) and 7.38(3.65 ~ 14.92), respectively. Among the components of VOCs, 1,2-Dibromoethane, Carbon Tetrachloride and 2,5-Dimethylfuran were positive related with the DR, and ORs (95%C.I) were 2.91(2.29 ~ 3.70), 2.86(2.25 ~ 3.65) and 2.19(1.79 ~ 2.94), respectively. BKMR model shows that there was a dose-response relationship between combined VOCs and DR, although the relationship was non-linearly.

Conclusion

This study suggested that exposure to VOCs may increase the risk of DR, which had important public health implications.

Evaluation and Optimization of Diabetic Retinopathy Screenings for Uninsured Latinx Patients in a Resource-Limited Student-Run Free Clinic

Background

Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Student-run free clinics represent a valuable opportunity to provide DR screenings to high-risk populations. We characterized the patient population, evaluated the performance, and conducted a needs assessment of DR screenings at the University of California, San Diego Student-Run Ophthalmology Free Clinic, which provides care to predominantly uninsured, Latino patients.

Methods

Retrospective chart review was conducted of all patients seen at the free clinic since 2019 with a diagnosis of type II diabetes. Date and outcome of all DR-related screenings or visits from 2015 onward, demographics information, and DR risk factors such as A1c and insulin dependence were recorded. Predictors of diabetic retinopathy and frequency of DR screenings for each patient were analyzed using multiple logistic regression, t-test for equality of means, and Pearson's correlation.

Results

Of 179 uninsured diabetic patients receiving care at the free clinic, 71% were female and average age was 59. 83% had hypertension, 93% had hyperlipidemia, and 79% had metabolic syndrome. Prevalence of non-proliferative DR was 34% and that of proliferative DR was 15% in diabetic patients. The free clinic capacity in recent years plateaued at just under 50% of patients seen for DR screening or visit per year, though average wait time was over 2 years between visits. Patients with higher no-show rates had less frequent DR screenings. Chronic kidney disease and poor glycemic control were the strongest predictors of DR.

Conclusion

The student-run free ophthalmology clinic has been effective in providing screening and follow-up care for DR patients. Creation of a protocol to identify which patients are at highest risk of DR and should be seen more urgently, addressing no-shows, and implementation of a tele-retina program are potential avenues for improving clinic efficiency in a resource-limited setting for vulnerable populations.

Systemic Inflammatory Mediator Levels in Non-Proliferative Diabetic Retinopathy Patients with Diabetic Macular Edema

PURPOSE

To study the systemic inflammatory mediator levels in non-proliferative diabetic retinopathy (NPDR) patients with diabetic macular edema (DME) and explore the correlation between systemic inflammatory mediators and DME.

METHODS

In this prospective study, we included 25 patients without diabetes (control group) and 75 patients with type 2 diabetes mellitus (diabetic group). According to fundus examination, the diabetic group patients were divided into: diabetic patients without diabetic retinopathy (DR) (Non-DR group), NPDR patients without DME (Non-DME group), and NPDR patients with DME (DME group). Serum levels of a broad panel of inflammatory mediators were analysed by multiplex protein quantitative detection technology based on a flow cytometry detection system.

RESULTS

The interferon-γ (IFN-γ) levels were significantly higher in DME group and Non-DME group as compared to control group (p = 0.023 and p = 0.033) and Non-DR group (p = 0.009 and p = 0.015). Significantly higher values were obtained in DME group and Non-DME group as compared to control group for the interleukin-8 (IL-8) (p = 0.003 and p = 0.003). The IL-23 levels were significantly elevated in DME group and Non-DR group than in Non-DME group (p = 0.013 and p = 0.004). The diabetic group had significantly higher serum levels of IL-8 and IL-33 (p = 0.001 and p = 0.011), and lower serum levels of tumor necrosis factor-α (TNF-α) (p = 0.027) in comparison with control group.

CONCLUSIONS

The changed levels of serum inflammatory mediators suggest that the systemic inflammatory mediators are involved in the pathogenesis of NPDR patients with DME. Such effects can guide clinical monitoring, diagnostic and therapeutic approaches for DME patients at an early stage.