Glycosylated hemoglobin and diabetic retinopathy

Estimation of glycosylated hemoglobin (HbA1c) levels by modified Fluckinger and Winterhalter's method was done in 25 normal persons, 25 diabetic patients without retinopathy, and 25 diabetic patients with retinopathy. The HbA1c values were significantly higher in diabetic patients with or without retinopathy than in the control group (P less than .001). In diabetic patients with retinopathy, the mean value of HbA1c was higher in proliferative retinopathy than in background retinopathy, but statistical analysis showed this was not significant (P greater than .6).     

Subclassification of preproliferative diabetic retinopathy and glycemic control: relationship between mean hemoglobin A1C value and development of proliferative diabetic retinopathy

PURPOSE: We evaluated the relationship between long-term glycemic control and the proportion of patients developing proliferative diabetic retinopathy (PDR) among cases with mild type preproliferative diabetic retinopathy (PPDR). METHODS: The relationship was evaluated between the mean hemoglobin A1C (HbA1C) value during a period of at least 2 years and the proportion of patients developing PDR among cases with mild type PPDR, based on our previously proposed subclassification. RESULTS: During follow-up, 27% of the total PPDR cases developed PDR. The mean HbA1C value in those patients who had developed PDR was 9.4% and was significantly higher than the 7.6% in those who had not developed PDR. The proportion developing PDR was 48% of the cases with a mean HbA1C value of 8.6% or more. By comparison, the proportion developing PDR was 8% among those with a mean HbA1C value below 8.6%. The proportion developing PDR was estimated to approximately double with each 1% increase in the mean HbA1C value. The cumulative occurrence rates of PDR at 2, 5, and 10 years were estimated to be 5%, 28%, and 60% in cases with a mean HbA1C value of 8.6% or more, and 0%, 7%, and 14% in those with a mean HbA1C value below 8.6%, respectively. CONCLUSION: Stricter systemic and ophthalmological control is indicated for cases with a mean HbA1C value exceeding 8.6%.     

糖尿病视网膜病变相关血液检测指标

目的:探询与糖尿病视网膜病变发生发展相关的可定量血液检测指标,以便对发生增殖性糖尿病视网膜病变的高危患者进行监测,为适时的预防性激光光凝治疗提供依据.方法:抽取无增殖期糖尿病视网膜病变的糖尿病患者、增殖期糖尿病视网膜病变患者及无糖尿患者群静脉血,检测糖化血红蛋白(HbA1c)、血清C反应蛋白(CRP)及血管粘附因子(sICAM-1)水平,比较各组之间统计学差异.结果:HbA1c水平在正常对照与糖尿病患者之间有显著性差异,在无增殖期糖尿病视网膜病变的糖尿病患者组与增殖期糖尿病视网膜病变患者组之间无显著性差异,正常对照分别与另两组比较均有显著性差异.CRP水平在增殖期糖尿病视网膜病变患者组与另两组均有统计学差异.sICAM-1水平各组比较无显著性统计学意义.结论:血HbA1c和CRP水平可能对糖尿病视网膜病变发生和发展有提示意义.     

Longitudinal study examining the risk factors for proliferative retinopathy and maculopathy in type-I diabetes: The Royal College of Physicians of Edinburgh Diabetes Register Group

PURPOSE: The aim of this study was to determine whether there were any differences in the risk factors for developing proliferative diabetic retinopathy or maculopathy in patients with type-I diabetes. METHOD: In all, 1632 patients aged 35 years or younger at diagnosis and treated with insulin, attending six hospital diabetes clinics in Scotland and included on the Royal College of Physicians of Edingburgh Diabetes Register were followed up for a median of 4.0 (2.5-5.5 years: interquartile range). All patients were screened at least annually for diabetic retinopathy using direct ophthalmoscopy, and positive findings were confirmed using slit lamp by an ophthalmologist. RESULTS: Duration of diabetes and HbA1c were the important risk factors for developing proliferative retinopathy, while the duration of diabetes, systolic blood pressure, and HbA1c were the important factors of maculopathy. The adjusted relative incidence for proliferative retinopathy with a HbA1c in the highest quartile was 26.7, while for maculopathy it was only 2.29. Carstairs deprivation score was not associated with either retinal pathology. There was a plateau effect for systolic blood pressure of 140 mmHg and for duration of diabetes of 16 years for developing either maculopathy or proliferative retinopathy. CONCLUSION: Duration of diabetes is a strong predictor for maculopathy and proliferative disease, but is relatively more important for proliferative disease. Raised systolic blood pressure is relatively more important for predicting maculopathy, while raised HbA1c is relatively more important for developing proliferative retinopathy.     

The prevalence of diabetic retinopathy in patients with screen‐detected type 2 diabetes in Denmark: the ADDITION study

Background: The prevalence of type 2 diabetes is increasing, but the exact prevalence of the disease and its accompanying late complications are unknown. In the Anglo‐Danish‐Dutch study of Intensive Treatment in People with Screen‐detected Diabetes in Primary Care (ADDITION study), patients with hitherto undiagnosed type 2 diabetes are identified using a stepwise screening strategy in selected general practices. This article reports the occurrence of diabetic retinopathy in this population. Methods: In Århus and Copenhagen counties, a total of 12 708 of the persons invited by mail were screened for diabetes mellitus. Consequently, 763 persons with type 2 diabetes were identified; 670 of these (335 from each of the two centres) underwent a general physical examination (including measurement of blood pressure and HbA1c) and an ophthalmological examination (including measurement of visual acuity and fundus photography). Retinopathy was graded from the photographs by counting all retinopathy lesions. Results: Forty‐five (6.8%) of the examined patients had any retinopathy, of which the majority was minimal. No patients had severe non‐proliferative or proliferative diabetic retinopathy. There was no significant difference between age, sex and visual acuity among patients with and without retinopathy. However, the patients with retinopathy had significantly higher HbA1c and systolic and diastolic blood pressure than the patients without retinopathy. Conclusion: Patients with screen‐detected diabetes have a low prevalence of diabetic retinopathy and no vision‐threatening lesions. Screening for diabetic retinopathy should be focused on those patients who have already been diagnosed with type 2 diabetes during routine clinical practice.     

C-反应蛋白、糖化血红蛋白与2型糖尿病视网膜病变的关系

目的探讨2型糖尿病患者(T2DM)中C-反应蛋白(CRP)和糖化血红蛋白(HbA1C)与糖尿病视网膜病变(DR)的关系。方法随即分组,检测20例正常对照组、20例糖尿病无视网膜病变(NDR)、20例非增生性糖尿病视网膜病变(NPDR)和20增生性糖尿病视网膜病变(PDR)患者中血清中CRP和HbA1C含量,并分析各组变化。结果 T2DM患者CRP和HbA1C随着DR的病变程度逐步增加,差异有显著性(P<0.05),两者之间成正相关。结论 CRP和HbA1C是DR发生、发展的危险因素,并能预测DR的风险和严重程度。     

Preproliferative diabetic retinopathy sub-classification and glycemic control--relationship between mean hemoglobin A1C value and development of proliferative diabetic retinopathy]

PURPOSE: We evaluated the relationship between long-term glycemic control and the proportion of patients developing proliferative diabetic retinopathy(PDR) in cases of mild preproliferative diabetic retinopathy(PPDR). MATERIALS AND METHODS: We evaluated the relationship between the mean hemoglobin A1C (HbA1C) value during a period of at least 2 years and the proportion of patients developing PDR in cases of mild PPDR, based on our previously proposed subclassification. RESULTS: During follow-up, 27% of all cases developed PDR. The mean HbA1C value in these cases was 9.4%, which was significantly higher than the 7.6% in cases which had not developed PDR. The proportion of patients developing PDR was 48% in cases with a mean HbA1C value 8.6% or more. In contrast, the proportion was 8% in cases with a mean HbA1C value below 8.6%. It was estimated that the proportion of patients developing PDR will approximately double if the mean HbA1C value increases by one percent. The cumulative occurrence rates of PDR at two, 5, and 10 years were estimated to be 5, 28, and 60% in cases with a mean HbA1C value 8.6% or more and 0, 7, and 10% in cases with a mean HbA1C value below 8.6%, respectively. CONCLUSION: Based on the above results, we conclude that more strict systemic and ophthalmological control is indicated for patients with a mean HbA1C value exceeding 8.6%.     

Determination of basal tear turnover in insulin-dependent diabetes mellitus patients by fluorophotometry

The tear turnover was determined by fluorophotometry in 25 insulin-dependent diabetes mellitus (IDDM) patients without retinopathy and 29 IDDM patients with (pre-)proliferative retinopathy. The results were compared with those in 34 healthy controls, to investigate the lacrimal gland function in diabetic patients. The tear turnover was calculated from the decay of the relative tear fluorescein concentration values measured after instillation of one L of fluorescein.The tear turnover values in both patient groups did not correlate significantly with age or diabetes duration (linear correlation coefficients: r < 0.3). The tear turnover values in patients both without retinoplathy and with (pre-)proliferative retinopathy did not differ significantly from those in healthy controls (mean ± SD in %/min: 13.7 ± 4.5, 14.7 ± 5.8 and 15.5 ± 5.1, respectively; P > 0.16). The tear turnover was significantly decreased in eyes having a BUT shorter than 10 seconds compared with eyes having a BUT longer than 10 seconds (P < 0.05). The tear turnover values correlated significantly with the HbA1c and Schirmer-test values in patients with (pre-)proliferative retinopathy (r = 0.7 and r = 0.4, respectively; P < 0.02) and with the blood glucose values in patients without retinopathy (r = 0.41, P = 0.04).Since the tear turnover was not significantly decreased in IDDM patients in comparison with healthy controls the corneal disorders which are more frequently seen in these patients than in a healthy population may not be attributed to a decrease in tear production.     

Cataract surgery on diabetic patients. A prospective evaluation of risk factors and complications

PURPOSE: This study presents an evaluation of cataract surgery on diabetic patients. One experienced surgeon carried out phaco emulsification on all subjects and the same surface-coated one-piece PMMA-lens-type was implanted. The lens fluorescence and the blood-aqueous barrier (BAB) were then evaluated as experimental preoperative risk indicators. RESULTS: During follow-up, 10 out of 39 diabetic patients progressed unilaterally in diabetic retinopathy or developed macular oedema, a significant relative risk. Neither lens fluorescence, BAB, HbA1c, level of retinopathy, type/duration of diabetes, diabetes treatment or antihypertensive treatment differed significantly between the group of patients with postoperative progression of retinopathy/macular oedema and those without. Results indicated NIDDM (non-insulin-dependent diabetes mellitus/type 2 diabetes) patients might have increased risk of a postoperative macular oedema. CONCLUSION: When diabetic retinopathy (DR) is not in a proliferative phase it should not be regarded as a contraindication to modern cataract surgery. Neither lens fluorescence nor BAB is valuable as a risk indicator for postoperative progression of DR.     

糖尿病视网膜病变与脂质代谢紊乱的关系

目的探讨非胰岛素依赖型糖尿病（non-insulin-dependent diabetes mellitus，NIDDM）患者的糖尿病视网膜病变（diabetic retinopathy，DR）与脂质代谢紊乱的关系。方法对有DR的NIDDM患者60例，无DR的NIDDM患者75例以及正常对照55例，检测了血浆总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL-C）及其亚类，以及空腹血糖（FPG）、空腹血浆胰岛素（FINS）和糖基化血红蛋白（HbA_1C）。同时按公式计算血浆低密度脂蛋白（LDL）和极低密度脂蛋白（VLDL）。结果DR组的TC、LDL、FPG、HbA_1C及病程高于或长于非DR组。在DR患者中，增殖型DR患者的TC、LDL、FPG、FINS、HbA_1C及病程高于或长于单纯型DR患者。相关分析表明，DR患者的病变严重程度与TC、LDL、HbA_1C和病程呈显著正相关。结论脂质代谢紊乱在NIDDM患者的DR发生、发展中，可能起着一定的作用。(中华眼底病杂志,1998,14:21-23)     

Relationship of corneal endothelial morphology to diabetic retinopathy, duration of diabetes and glycemic control

Using specular microscopy and computer-assisted morphometry, the morphologic features of the corneal endothelium were evaluated in three groups of patients with type II diabetes mellitus: 20 patients without diabetic retinopathy, 24 with background retinopathy, and 26 with proliferative retinopathy. When compared to age-matched nondiabetic controls (30 patients), all diabetic groups had similar endothelial cell densities but demonstrated significant increases in cell size and shape variability (pleomorphism). However, there was no significant difference in the degree of these endothelial changes among the three diabetic groups. Moreover, none of the endothelial morphologic parameters was found to correlate with the duration of diabetes or glycemic control, as estimated from glycosylated hemoglobin (HbA1) concentrations.     

Urinary 8-hydroxydeoxyguanosine levels in diabetic retinopathy patients

PURPOSE: Involvement of oxidative stress in the pathogenesis of diabetic microvascular complications has been proposed. Recently, 8-hydroxy-2'-deoxyguanosine (8-OHdG) has been reported to serve as a new sensitive biomarker of the oxidative DNA damage in vivo. This study was undertaken to investigate whether the urinary levels of 8-OHdG are altered in patients with type 2 diabetes. The authors also attempted to analyze the relationship between 8-OHdG levels and other clinical parameters of patients with diabetes, especially the relationship between oxidative DNA damage and the severity of the retinal lesions in patients with diabetic retinopathy. METHODS: The authors studied 60 patients with type 2 diabetes and compared them with 35 nondiabetic control subjects. Urinary 8-OHdG concentrations were assayed using competitive enzymelinked immunosorbent assay. RESULTS: The patients with type 2 diabetes had significantly higher concentrations of 8-OHdG in their urine than the control subjects (19.6+/-6.7 vs 11.9+/-4.9 ng/mgCr; p<0.05). The authors could not find any correlation between urinary 8-OHdG levels and age, duration of diabetes, or serum lipids. However, HbA1c values were significantly correlated with 8-OHdG values. Among the patients with diabetes, those with proliferative retinopathy had significantly higher 8-OHdG levels than those with nonproliferative retinopathy or without retinopathy. CONCLUSIONS: The authors' findings show that measuring urinary 8-OHdG is a novel convenient method for evaluating oxidative DNA damage in patients with diabetes, and it is also suggested that 8-OHdG could be a sensitive biomarker and may be helpful for the early diagnosis and treatment of patients with diabetic retinopathy.     

Is microalbuminuria a risk factor for diabetic retinopathy?

PURPOSE: To determine the relationship between microalbuminuria and diabetic retinopathy. METHODS: A prospective 10-year study of 104 younger-onset diabetic patients. The diabetic retinopathy diagnosis was made by fundus retinography, and determination of microalbuminuria was made from urine samples. RESULTS: The incidence of diabetic retinopathy in this group of patients was 39 (37.5%). The epidemiological factors implicated were diabetes duration, higher levels of HbA(1c), male sex, and diastolic arterial hypertension. The incidence of microalbuminuria was 21 patients (20.2%), with high levels of HbA(1c) the epidemiological factor implicated. The association between microalbuminuria and diabetic retinopathy grouped the patients as follows: 56 patients without microalbuminuria or retinopathy, 16 patients who developed microalbuminuria and diabetic retinopathy, 23 patients who developed retinopathy but not microalbuminuria, and nine patients who developed only microalbuminuria. The discriminant analysis showed that the high levels of HbA(1c) were associated with microalbuminuria and diabetes duration and high levels of HbA(1c) were associated with diabetic retinopathy. CONCLUSIONS: In the population studied, microalbuminuria was not a good marker for diabetic retinopathy.     

糖尿病视网膜病变患者血清circFTO和miR-141-3p表达情况及其与病变分期的关系

目的:探讨血清circFTO、miR-141-3p水平变化与糖尿病视网膜病变患者不同疾病分期的关系。方法:选取2019-10/2022-11本院收治的198例2型糖尿病患者为研究对象,根据不同分期将患者分为非糖尿病视网膜病变(NDR)组70例、非增殖期糖尿病视网膜病变(NPDR)组66例、增殖期糖尿病视网膜病变(PDR)组62例;同期选取67例本院体检正常的志愿者作为对照组。采用实时荧光定量PCR(qRT-PCR)法检测血清circFTO和miR-141-3p水平;采用Pearson相关性分析检验糖尿病视网膜病变患者血清circFTO、miR-141-3p与各指标间的相关性;采用多因素Logistic回归分析探讨糖尿病视网膜病变的影响因素。结果:PDR组circFTO、收缩压(SBP)、舒张压(DBP)高于对照组、NDR组、NPDR组,miR-141-3p、高密度脂蛋白胆固醇(HDL-C)低于对照组、NDR组、NPDR组(P<0.05)。NDR组、NPDR组、PDR组空腹血糖(FPG)、糖化血红蛋白(HbA1c)高于对照组(均P<0.05)。PDR组病程高于NDR组和NPD...     

Correlation between progression of diabetic retinopathy and blood glucose control.

The relationship between the progression of diabetic retinopathy and consecutive blood glucose control evaluated by glycosylated hemoglobin (HbA1) values was statistically analyzed based on 422 eyes of 211 diabetic subjects who were followed up 2 years or more. The Cox regression model (proportional hazard model) with HbA1, as a time-dependent covariate was applied in the analysis. The cumulative effect and the relative risk of HbA1 affecting the progression of diabetic retinopathy was estimated. The effect of the moving average of HbA1 values for the previous 1-30 months on the progression of retinopathy was assessed to investigate the cumulative effect of HbA1. The cumulative effect of HbA1 on the progression of diabetic retinopathy was significant when the time span of the moving average was 6 months or more than 6 months. The moving average of HbA1 value for 7 months was most relevant to the retinopathy progression. The relative risk corresponding to the increase in the moving average of HbA1 values for 6 months by 1, 2 or 3% was 1.18, 1.39 or 1.63, respectively. When the HbA1 level was adjusted to its average value in the subjects (9.6%), the estimated cumulative retinopathy progression rate for 6, 12, 18 or 24 month follow-up was 3.6, 14.5, 22.5 or 30.5%, respectively. The differences in the cumulative retinopathy progression rate between a well-controlled group with a low moving average of HbA1 value (3% lower than the average) and a poorly-controlled group with a high moving average of HbA1 value (3% higher than the average) were estimated as 3% (6-month follow-up) and 23% (24 months).     

Association of hypomagnesemia with diabetic retinopathy

Serum magnesium was measured in 100 patients of type II diabetes mellitus (40 without retinopathy, 40 with non-proliferative and 20 with proliferative retinopathy) without malnutrition, hepatic or renal disease or albuminuria and in 100 age and sex matched controls. The serum magnesium levels were lower in diabetics than in controls (P less than 0.001), and the levels in diabetics with non-proliferative and proliferative retinopathy were significantly lower than in those without retinopathy (P less than 0.001). These data seem to point towards an association between hypomagnesemia and diabetic retinopathy.     

Differential expression of vitreous proteins in proliferative diabetic retinopathy

PURPOSE: To identify vitreous proteins that were differentially expressed in patients suffering from proliferative diabetic retinopathy with active neovascularization. METHODS: The vitreous samples of 15 active proliferative diabetic retinopathy patients were analyzed by two-dimensional gel electrophoresis and mass spectrometry, and the results were compared with those from age-matched patients with macular hole. RESULTS: Twenty-five protein spots were identified in the two-dimensional gel electrophoresis gels. Eight proteins (pigmented epithelium derived factor, serine protease inhibitor, apolipoprotein A-IV precursor, prostaglandin-H2 D-isomerase, a(1)-antitrypsin precursor, ankyrin repeat domain 15 protein, alpha2-HS-glycoprotein, and beta V spectrin) in the 25 spots were expressed significantly differently between the macular hole and proliferative diabetic retinopathy patients (p value < 0.05). Five proteins were upregulated in the proliferative diabetic retinopathy patients, and three were downregulated (p value < 0.05). CONCLUSIONS: We constructed vitreous protein profiles for proliferative diabetic retinopathy patients and identified eight candidate proteins believed to be involved in the pathogenesis of proliferative diabetic retinopathy.     

Diabetic retinopathy before and after cataract surgery.

AIMS/BACKGROUND: Increased retinopathy progression has been reported after cataract surgery in patients with diabetes mellitus. To assess the influence of cataract surgery on visual acuity and retinopathy progression, all diabetic patients who were subjected to cataract surgery during 1991-3 have been followed up at the Department of Ophthalmology in Helsingborg. The average follow up time was 2 years. METHODS: One eye of each of 70 patients was included in the study, 35 monocularly and 35 binocularly operated on. Sixteen of the 70 patients had proliferative diabetic retinopathy (PDR) at baseline. The Wisconsin scale was used for the grading of retinopathy. The degree of glycaemic control was assessed by measurements of HbA1c. RESULTS: Most patients obtained improved visual acuity; a postoperative visual acuity of 0.5 or better was achieved in 89% of diabetic surgical eyes. Progression of the retinopathy occurred in 30 out of the 70 eyes, and was associated with mean level of HbA1c (p = 0.04), duration of diabetes (p = 0.02), insulin treatment (p = 0.001), and presence of retinopathy at baseline (p = 0.01). Patients who progressed had a significantly higher incidence of macular oedema (p = 0.006) than those who did not progress. No significant differences were found when operated and non-operated eyes were compared in the 35 patients with monocular surgery. Two patients in this group, however, ended up with macular oedema and worse vision in the operated eye than in the eye which was not operated on. Both patients had background retinopathy before surgery. CONCLUSIONS: Patients in this study, also those with PDR, obtained good visual acuity, better than in most previous studies. Poor glycaemic control was a factor of importance for the progression of diabetic retinopathy after cataract surgery.     

HLA antigens and other risk factors in the development of retinopathy in type 1 diabetes.

Factors possibly influencing the development of diabetic retinopathy were studied in 112 randomly selected type 1 diabetics having no or minimal retinopathy (group A) and in 82 type 1 diabetics with known severe diabetic retinopathy. The latter comprised those with severe background retinopathy (group B, n = 17) and those having proliferative retinopathy without (group C, n = 38) and with group D, n = 27) diabetic nephropathy. Nonretinopaths (group A) were of similar sex ratio, body weight, and age at diagnosis of diabetes but had been diabetic longer (p less than 0.001) and were thus older (p less than 0.001) than retinopaths (groups B-D). The distribution of HLA antigens of the A, B, and C loci was similar in nonretinopaths and retinopaths with the exception that HLA B7 showed a reduced (p less than 0.05) prevalence in the retinopaths (6% versus 17%) and was singularly underrepresented in group D, where no patients had this antigen. Mean postprandial plasma glucose and HbA1 concentrations were higher (p less than 0.01 and p less than 0.001) and cigarette smoking was more prevalent (p less than 0.01) in the retinopathy groups B-D than in group A. Systolic and diastolic blood pressures were similar in groups A-C, with higher (p less than 0.001) values only in group D. There was no association between insulin antibody binding in the serum or measurable plasma C-peptide immunoreactivity and retinopathy status. The risk of development of diabetic retinopathy in type 1 diabetes may be related to HLA-associated genetic factors and to cigarette smoking.     

Effect of rapid glycemic control on progression of diabetic retinopathy.

The effect of the start of glycemic control on the progression of retinopathy was investigated by a case-control study. The changes in glycosylated hemoglobin (HbA1) were compared between a case group, diabetic cases showing progression of retinopathy (Group 1), and a control group, diabetic cases showing no progression of retinopathy (Groups 2-A and 2-B). Group 2-A was matched with Group 1 on the basis of the grade of retinopathy at the first examination and other clinical data. Group 2-B was matched with Group 1 in terms of HbA1 value and methods of control, but had no retinopathy or background retinopathy. The retrospective follow-up period for the three groups was 24 months. On the basis of the respective matching factors, Groups 1 and 2-A were divided into 9 blocks of homogeneous subjects, and Groups 1 and 2-B were similarly divided into 6 blocks. The resulting data was evaluated block by block, using the analysis of variance (ANOVA) and a conditional logistic regression analysis. In Group 1, the HbA1 value decreased rapidly 10-6 months before the progression of retinopathy, but the HbA1 value did not change in Groups 2-A and 2-B during the 24-month follow-up. The difference in the estimated mean HbA1 value between 10-9 months and 1-0 month before the progression of retinopathy was 2.46% greater in Group 1 than in Group 2-A, as determined by ANOVA. The relative risks of a 1, 2 and 3% increase in HbA1 value for 7-6 months were estimated as 1.6, 2.4 and 3.8, respectively, by conditional logistic regression analysis. These findings indicate that the decrease in HbA1 value during any 6-month period should be limited to less than 2% in order to prevent the progression of retinopathy. It is also evident that too rapid a decrease at the initiation of glycemic control could cause severe or transient exacerbation of the progression of retinopathy.