Pancreatic B-cell function in relation to diabetic retinopathy in Asian Indian NIDDM patients

Summary Pancreatic B-cell function in relation to diabetic retinopathy was studied in 195 NIDDM patients with long-standing diabetes. Background diabetic retinopathy (BDR) was present in 95 (48.7%) and proliferative retinopathy (PDR) in 17 (8.7%) of the subjects. There was no significant difference between the BDR, PDR, and non-retinopathy groups with respect to age, age at diagnosis of diabetes and HbA₁ values. Mean duration of diabetes was higher in the PDR group (p<0.05). Serum C-peptide values showed no correlation with the presence of retinopathy or with the duration of diabetes. The C-peptide values were widely scattered in patients with BDR and PDR showing no association between pancreatic B-cell reserve and occurrence or severity of retinopathy in NIDDM patients. Thus, decreased pancreatic B-cell reserve does not appear to be a risk factor for diabetic retinopathy in NIDDM patients.     

颈动脉粥样硬化与糖尿病视网膜病变的关系

目的探讨颈动脉粥样硬化与糖尿病视网膜病变（DR）的关系。方法将92例DM患者的眼底病变分为无糖尿病视网膜病变期（NDR）、背景期（BDR）、增生前期（PPDR）及增生期（PDR）4期,彩色多普勒显像检测20例正常对照（NC）和92例DM患者双侧颈总动脉、颈内动脉、眼动脉、视网膜中央动脉、视网膜中央静脉的血流动力学变化及颈动脉粥样斑块情况,依据颈动脉有无斑块分为有斑块组和无斑块组。结果颈动脉粥样硬化检出率NDR、BDR组与NC组相比无统计学差异;PPDR、PDR组与NC组相比有统计学差异。有斑块组颈总动脉、颈内动脉、眼动脉、视网膜中央动脉、视网膜中央静脉的血流速度均比无斑块组降低,且有统计学差异。结论随着DR程度的加重,颈动脉粥样硬化的检出率呈明显升高趋势;颈动脉粥样斑块导致同侧眼血流速度下降。     

Incidence and risk factors of severe non‐proliferative/proliferative diabetic retinopathy: More than a decade follow up in the Tehran Lipids and Glucose Study

Aims/IntroductionTo examine the incidence rate of severe non‐proliferative and proliferative diabetic retinopathy (severe‐NPDR/PDR) and determine its potential risk factors.Materials and MethodsThe study consisted of 1,169 participants (675 women) with type 2 diabetes mellitus, aged ≥20 years. A trained interviewer collected information about the history of pan‐retinal photocoagulation as a result of diabetic retinopathy. Multivariable Cox proportional hazards regression models were applied.ResultsWe found 187 cases (126 women) of severe‐NPDR/PDR during a median follow‐up period of 12.7 years; the corresponding incidence rate was 13.6 per 1,000 person‐years. Being overweight (hazard ratio [HR], 95% confidence interval [CI] 0.60, 0.39–0.92) and obese (HR 0.48, 95% CI 0.27–0.83) were associated with lower risk, whereas being smoker (HR 1.75, 95% CI 1.12–2.74), having fasting plasma glucose levels 7.22–10.0 mmol/L (HR 2.81, 95% CI 1.70–4.62), fasting plasma glucose ≥10 mmol/L (HR 5.87, 95% CI 3.67–9.41), taking glucose‐lowering medications (HR 2.58, 95% CI 1.87–3.56), prehypertension status (HR 1.65, 95% CI 1.05–2.58) and newly diagnosed hypertension (HR 1.96, 95% CI 1.06–3.65) increased the risk of severe‐NPDR/PDR. Among newly diagnosed diabetes patients, being male was associated with a 59% lower risk of severe‐NPDR/PDR (HR 0.41, 95% CI 0.21–0.79). Furthermore, patients who had an intermediate level of education (6–12 years) had a higher risk of developing PDR (HR 1.86, 95% CI 1.05–3.30) compared with those who had <6 years of education.ConclusionsAmong Iranians with type 2 diabetes mellitus, 1.36% developed severe‐NPDR/PDR annually. Normal bodyweight, being a smoker, out of target fasting plasma glucose level, prehypertension and newly diagnosed hypertension status were independent risk factors of severe‐NPDR/PDR. Regarding the sight‐threatening entity of advanced diabetic retinopathy, the multicomponent strategy to control diabetes, abstinence of smoking and tight control of blood pressure should be considered.     

2型糖尿病视网膜病变的危险因素分析

目的 探讨导致2型糖尿病患者发生糖尿病视网膜病变的危险因素,并对其进行分析.方法 选取202例2型糖尿病患者,眼底镜观察视网膜变化,并检测HbAlc,24小时尿白蛋白定量,甘油三脂、总胆固醇,测量收缩压,舒张压.结果 202例患者中有84例合并糖尿病视网膜病变(DR),患病率为41.6%.在DR组中,尿白蛋白总量＞30 mg/24 h的2型糖尿病病例有42例,占DR组总数的67.86%;非DR组中,尿白蛋白总量＞30 mg/24 h的2型糖尿病病例有20例,占非DR组总数的16.95%.通过对两组数据的数值进行独立样本t检验,.DR组和非DR组中,收缩压,'病程,糖化血红蛋白等危险因素有统计学意义(P＜0.05),并对两组的24小时尿白蛋白定量进行非参数检验,结果显示两组的24小时尿白蛋白有显著统计学意义(P＜0.01).将上述可疑危险因素纳入Spearman相关分析,其中收缩压,病程,糖化血红蛋白及24小时尿白蛋白量与糖尿病视网膜病变有明显的相关性(P＜0.05).结论 糖尿病视网膜病变发生及其严重程度与病程、糖化血红蛋白和血压有关,其中病程长短对糖尿病视网膜病变的发生影响最大,是决定糖尿病视网膜病变发生发展的关键因素,24小时尿白蛋白总量与糖尿病视网膜病变的严重程度具有平行关系.     

2型糖尿病患者糖尿病视网膜病变患病率及其相关危险因素

2002年3月至2003年1月本院1254例2型糖尿病人中糖尿病视网膜病变(DR)患病率为23.6%,其中男性为19.9%,女性为26.4%,新诊断的2型糖尿病患者中DR患病率为11.3%。年龄、病程、收缩压、舒张压、总胆固醇及低密度脂蛋白胆固醇是DR发病的危险因素。     

糖尿病视网膜病变在不同糖代谢状态的检出率及其危险因素分析

目的:研究不同糖代谢状态人群糖尿病视网膜病变(DR)的检出率,并探讨其相关危险因素。方法:选取2011年8月至12月在大连市中心医院内分泌科接受糖尿病社区普查并完成免散瞳眼底照相的居民,按登记序列号顺序抽取糖耐量正常者499例、糖耐量异常者490例、糖尿病病程0.05);糖尿病病程<10年组DR检出率为7.21%,病程≥10年组为26.65%(P<0.05),其中糖尿病病程及HbA1c与DR呈显著正相关。结论:糖尿病病程≥10年的患者视网膜病变检出率最高。病程及HbA1c是DR的独立危险因素。     

糖尿病视网膜病变的相关危险因素分析

目的探讨影响糖尿病视网膜病变发生发展的相关危险因素。方法选取2008年8月至2011年12月于天津医科大学代谢病医院住院治疗的2型糖尿病患者708例为研究对象,根据眼底检查结果分为无糖尿病视网膜病变组（NDR,498例）、糖尿病视网膜病变组（DR,210例）。分别比较2组间年龄、性别、病程、血压、血糖、血脂、24h尿白蛋白排泄率等生化指标以及糖尿病慢性并发症及胰岛素应用情况等,两两比较用t检验,计数资料组间比较用×2检验。采用logistic回归法分析其与视网膜病变的相关性,运用spearman相关分析法分析DR与糖尿病肾病（DN）之间的相关性。结果DR组患者的腰围、病程、收缩压、舒张压、血尿酸、尿酸排泄率、纤维蛋白原、24h尿白蛋白排泄率、尿素氮、肌酐、血黏度均明显高于NDR组[分别为（95±11）、（93±10）cm,（12-±7）、（7±7）年,（144±23）、（135±19）mmHg（1mmHg=0．133kPa）,（83-±12）、（81±10）himHg,（316±87）、（300±86）μmol／L,（26±15）％、（23±11）％,（3．5±1．1）、（3．1±0．8）g／L,（125±122）、（51±45）mg／24h,（8±5）、（6±3）mmo]／L,（110±101）、（71±48）μmol／L,39／115／44、57／303／109,t值分另0为-2．069、-8．285、-4．807、-2．612、-2．104、-2．883、-4．186、-7．949、-5．132、-4．561、6．513,均P〈0．05],而血红蛋白,直接胆红素、总胆红素、丙氨酸转氨酶、内生肌酐清除率明显低于NDR组,差异均有统计学意义[分别为（8．9-±2．2）、（8．1±2．1）g／L,（4．5±2．3）、（4．0±2．1）μmol／L,（13±6）、（12±6）μmol／L,（27±22）、（21±16）U／L,（117±43）、（88±50）ml／min,t值分别为-0．067、2．719、2．396、3．22、6．548,均P〈0．05]。logistic逐步回归分析显示,病程、24h尿白蛋白排泄率及内生肌酐清除率与糖尿病视网膜病变的发生相关（P〈0．05）。spearman相关分析显示DN的严重程度与DR的发生发展呈显著正相关（r=0．513,P〈0．05）。结论糖尿病病程〉5年、24h尿白蛋白排泄率增高及内生肌酐清除率降低与糖尿病视网膜病变发生发展独立相关。     

Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

The aim of this systematic review was to examine the associations between diabetic retinopathy (DR) and the common micro- and macrovascular complications of diabetes mellitus, and how these could potentially affect clinical practice. A structured search of the PubMed database identified studies of patients with diabetes that assessed the presence or development of DR in conjunction with other vascular complications of diabetes. From 70 included studies, we found that DR is consistently associated with other complications of diabetes, with the severity of DR linked to a higher risk of the presence of, or of developing, other micro- and macrovascular complications. In particular, DR increases the likelihood of having or developing nephropathy and is also a strong predictor of stroke and cardiovascular disease, and progression of DR significantly increases this risk. Proliferative DR is a strong risk factor for peripheral arterial disease, which carries a risk of lower extremity ulceration and amputation. Additionally, our findings suggest that a patient with DR has an overall worse prognosis than a patient without DR. In conclusion, this analysis highlights the need for a coordinated and collaborative approach to patient management. Given the widespread use of DR screening programmes that can be performed outside of an ophthalmology office, and the overall cost-effectiveness of DR screening, the presence and severity of DR can be a means of identifying patients at increased risk for micro- and macrovascular complications, enabling earlier detection, referral and intervention with the aim of reducing morbidity and mortality among patients with diabetes. Healthcare professionals involved in the management of diabetes should encourage regular DR screening.     

血清基质金属蛋白酶9及其抑制物1与糖尿病视网膜病变的关系

目的探讨血清基质金属蛋白酶-9（MMP-9）及其抑制物-1（TIMP-1）与糖尿病视网膜病变（DR）的关系。方法采用酶联免疫吸附法对2型糖尿病患者（DM组）及正常对照组（NC组）血清MMP-9、TIMP-1、Ⅳ型胶原（CIV）水平进行检测,并按眼底结果分为三组：未合并视网膜病变（NDR）组25例,单纯型视网膜病变（SDR）组32例,增殖型视网膜病变（PDR）组18例进行组间比较。结果DM血清TIMP-1、CIV的水平是升高的且随着DR病情程度进展及病程的延长愈加明显,而MMP-9及其MMP-9／TIMP-1比值呈相应递减趋势,MMP-9水平与UAER、FBG显著负相关,TIMP-1水平与UAER、血压呈正相关。结论MMP-9及TIMP-1参与DR发生发展,检测其血清水平可反映DR严重程度。     

The association between taking a course or class in self-managing diabetes with diabetic ocular complications including diabetic retinopathy: A cross-sectional study

AimsDiabetes currently affects 30.3 million people in the United States. The objective of this study was to investigate the association between taking a course in self-managing diabetes and diabetic ocular complications including diabetic retinopathy diagnosis (OC-RD).MethodsThe sample was from the 2017 CDC’s BRFSS participants. We included adults who self-reported they had diabetes. The exposure included those who took a course in how to self-manage diabetes. The outcome was those told they had OC-RD by a doctor. Unadjusted and adjusted logistic regression analysis were used to calculate the odds ratios (OR) and 95% confidence intervals (CI).ResultsThe odds of OC-RD decreased by 30% for those who did not attend a course compared to those who did (OR 0.70; 95% CI 0.60?0.80). Patients who saw a doctor showed a 50% increase in the odds of OC-RD than those who did not (OR 1.50; 95% CI 1.20–1.90). Those earning above $15,000 had a 10% decreased likelihood of OC-RD every time income level increased.ConclusionsTaking a class on self-managing diabetes was associated with an increased risk of OC-RD in the diabetic population. Future studies may analyze how education will affect diabetic complications.     

‘Microalbuminuria’ in type I (insulin-dependent) diabetic patients with and without retinopathy

Summary We investigated the frequency of microalbuminuria (albumin excretion rate, AER>15 μg/min) (‘overnight’ urine collection and radioimmunological evaluation) and its relation to retinopathy (assessed by fluorangiography) in 113 type I (insulin-dependent) diabetic subjects (aged 31±13 years; diabetes duration 11±7 years), all Albustix-negative. Sixty eight patients (60.2%) were free of retinal lesions, 31 (27.4%) had background retinopathy and 14 (12.4%) had proliferative retinopathy. Microalbuminuria was found in 25 patients (22%). Fifteen patients (13%) showed both retinopathy and microalbuminuria. Fifteen % (10/68) of the patients with no retinopathy and sixteen % (5/31) of those with background retinal lesions had microalbuminuria, while 29% (4/14) of the patients with proliferative retinopathy were normoalbuminuric. Among the 29 patients with diabetes for less than five years, 1 had retinopathy and 4 had microalbuminuria. Out of 15 patients with both retinopathy and microalbuminuria, 13 (87%) had had diabetes for more than 10 years. Diabetic retinopathy is more frequent than microalbuminuria (40vs 22%). Although the linkage between retinopathy and microalbuminuria is weak, after ten years of diabetes the two complications may frequently coincide. This work was performed within the context of theRicerca Finalizzata della Regione Toscana. In addition, it was supported in part by grant n ^o 84.02442.56 from the National Research Council and by a grant from theMinistero della Pubblica Istruzione (Ricerca Scientifica 1986).     

Severe hypoglycaemia is a major predictor of incident diabetic retinopathy in Japanese patients with type 2 diabetes

AimHypoglycaemia is a common complication in diabetes patients. However, its relationship with retinopathy has not been well documented in patients with type 2 diabetes (T2D). This study aimed to investigate the associations between hypoglycaemia and the incidence and progression of diabetic retinopathy (DR).MethodsIn this longitudinal cohort study, which was part of the Japan Diabetes Complications Study (JDCS), adult patients with T2D were recruited at 59 diabetes clinics across Japan. Their history of hypoglycaemia was assessed by standardized self-reported questionnaires. Severe hypoglycaemia was defined as having at least one episode with coma requiring an outpatients visit or hospitalization. Adjusted hazard ratios (HRs) for incidence and progression of DR over 8 years of follow-up were determined.ResultsOf 1221 patients without DR, 127 (10.4%) had experienced non-severe hypoglycaemia within the previous year, whereas 10 (0.8%) reported severe hypoglycaemia episodes. During the 8-year follow-up involving 8492 person-years, 329 patients developed DR. In 410 patients with prevalent DR, the adjusted HRs for incident DR were 4.35 (95% CI: 1.98–9.56; P < 0.01) and, for progression of DR, 2.29 (95% CI: 0.45–11.78; P = 0.32) with severe hypoglycaemia.ConclusionHaving a history of severe hypoglycaemia was one of the strongest predictors of incident DR in patients with T2D, with a fourfold increased risk. Identifying patients with greater risks of DR based on their history of hypoglycaemia may help to personalize risk evaluation in patients with diabetes.     

2型糖尿病尿微量白蛋白与心血管病危险因素的研究

目的探讨2型糖尿病（T2DM）患者尿微量白蛋白与心血管病危险因素（血糖、血脂、血压、尿酸等）的关系。方法选择192例确诊为T2DM住院患者,分为微量白蛋白尿（MAU）组（n=60）和正常微量白蛋白尿（NAU）组（n=132）,检测患者体质指数（BMI）、血脂、血压、尿酸等相关危险因素,并进行对比分析;同时以尿微量白蛋白为因变量,各相关危险因素为自变量进行了多元线性回归分析,以明确影响2型糖尿病患者尿微量白蛋白增加的因素。结果 MAU组糖化血红蛋白水平（HbA1c）、入院时收缩压（SBP）、舒张压（DBP）水平、血肌酐（Cr）、尿酸（UA）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平及TC、LDL-C、UA、SBP和DBP的异常率明显高于NAU组,而高密度脂蛋白胆固醇（HDL-C）水平明显低于NAU组（P〈0.05～0.01）,多元线性回归分析发现MAU与BMI、SBP、DBP、TC、TG、LDL-C、HbA1c、UA和Cr呈正相关,而与HDL-C呈负相关（P〈0.05～0.01）。结论血脂、血压等多种危险因素的异常影响T2DM患者尿微量白蛋白水平。     

Relationship between diabetic retinopathy and vascular endothelial function in elderly type 2 diabetic Japanese patients without cardiovascular disease

Background:   Many recent studies point to the importance, in diabetic patients, of vascular endothelial function as an early marker of not only macrovascular complications but also of microangiopathy. The aim of this study is to investigate the relationship between diabetic retinopathy and endothelial function in elderly diabetic patients by using brachial artery flow-mediated dilation (FMD).
Methods:   We studied 71 type 2 diabetic patients aged 65 years or older without cardiovascular diseases. The subjects were categorized as three groups: (i) without diabetic retinopathy ( n  = 49); (ii) with non-proliferative diabetic retinopathy group ( n  = 15); and (iii) those with preproliferative or proliferative diabetic retinopathy ( n  = 7). Brachial artery FMD measurement was performed by high-resolution ultrasonography. The Kruskal–Wallis test, the χ² test and multivariate logistic regression analysis were used to identify associations between both retinopathy and clinical characteristics and FMD.
Results:   There were no differences in clinical characteristics between the three groups. FMD of the three groups were significantly decreased correlating with the severity of retinopathy (8.03% vs 5.40% vs 2.30%; P  = 0.003). Multivariate logistic regression analysis showed that there was a significant correlation between diabetic retinopathy and FMD (odds ratio 0.801; P  = 0.009).
Conclusion:   Our study suggests that FMD has a relation to microangiopathy in elderly diabetic subjects. Prospective studies will be required to determine whether this test has any clinical use for identifying elderly diabetic patients who are likely to develop diabetic retinopathy.     

糖尿病视网膜病变与血管紧张素转换酶基因缺失多态性的系统评价

采用meta分析系统评价中国汉族人血管紧张素转换酶(ACE)基因缺失(DD)多态性与2型糖尿病视网膜病变的关系.共纳入16篇符合条件的文献,共计2型糖尿病视网膜病变组1 014例,对照组1 135例.结果 显示OR为1.69(95%CI1.19～2.40),合并统计值Z=2.91(P=0.004).汉族人群ACE基因该多态性与糖尿病视网膜病变有关联,糖尿病视网膜病变组DD基因型增多.     

E-选择素与糖尿病视网膜病变相关性的研究

糖尿病患者伴视网膜病变组 (DR)血浆中可溶性E 选择素水平高于不伴DR组 ,且与DR严重程度相关 ,提示E 选择素在DR的发生发展中起一定的作用。     

糖尿病视网膜病变与勃起功能障碍的关系

目的探讨糖尿病视网膜病变（DR）与勃起功能障碍（ED）的关系。方法对2型糖尿病（T2DM）合并视网膜病变组（DR组）22例、T2DM无视网膜病变组（非DR组）92例用国际勃起功能指数（IIEF）评分,比较两组间的评分情况。结果DR组的评分明显低于非DR组（P〈0．05）,DR组的ED发生率明显高于非DR组（P〈0．05）。结论糖尿病视网膜病变与ED的发生密切相关。     

初发2型糖尿病患者视网膜病变与动脉内膜中层厚度的相关性

目的 探讨初发2型糖尿病患者视网膜病变(DR)与颈、股动脉内膜中层厚度(IMT)的关系.方法 选择确诊2型糖尿病且病程在1年以内的患者1236例,其中老年组218例,非老年组1018例.采用GATEwAY2Dfx型彩色多普勒超声仪测定颈、股动脉IMT,并行眼底检查.结果 共检出DR 179例,其中老年DR组36例,非老年DR组143例.老年DR组颈、股动脉IMT为(0.83±0.11)mm和(0.80±0.11)mm,老年对照组为(0.78±0.12)mm和(0.75±0.13)mm,两组比较差异有统计学意义(P＜0.05);非老年DR组颈、股动脉IMT为(0.78±0.13)mm和(0.77±0.13)mm,非老年对照组为(0.72±0.14)mm和(0.71±0.13)mm,两组比较差异有统计学意义(P＜0.01).老年组颈、股动脉IMT≥0.8 mm组DR患病率为21.3%和23.0%,与IMT＜0.8 mm组的8.3%和8.5%比较,差异有统计学意义(P＜0.01);非老年组分别为21.3%、23.0%和8.3%、8.5%,差异有统计学意义(P＜0.01和P＜0.05).以DR为因变量,以年龄、血压、空腹血糖、高密度脂蛋白(HDL-C)、空腹胰岛素(FINS)、颈、股动脉IMT为自变量进行Logistic回归分析,在校正年龄、血脂、胰岛素等因素后,颈、股动脉IMT仍与DR相关(P＜0.01).结论 初发2型糖尿病患者DR与颈、股动脉IMT具有明显的相关性,早期DR改变即与IMT相关.     

糖尿病视网膜病变合并糖尿病肾病的危险因素及其预测价值

目的探讨糖尿病视网膜病变(DR)合并糖尿病肾病(DN)的危险因素及预测价值。方法回顾性分析2017年5月至2018年5月南京医科大学附属无锡市人民医院内分泌科收治的2型糖尿病(T2DM)患者1 969例,其中糖尿病视网膜病变(DR)合并糖尿病肾病(DN)患者609例,单纯DR患者746例,未并发DN和DR患者614例,比较3组患者的血糖、血压、肝功能和肾功能指标水平,分析DR合并DN的危险因素及预测价值。采用SPSS 18.0统计软件对数据进行分析。组间比较采用单因素方差分析或χ~2检验。多因素logistic回归分析DR合并DN的危险因素。受试者工作特征(ROC)曲线分析因素预测DR合并DN的价值。结果除高密度脂蛋白胆固醇(HDL-C)水平和左侧颈动脉内膜中层厚度(IMT)外,3组患者其余指标差异均具有统计学意义(P0.05)。多因素logistic回归分析结果显示年龄(OR=0.966,95%CI 0.932～1.000; P=0.049)、白蛋白(ALB)(OR=0.872,95%CI 0.837～0.908; P0.001)、服用他汀类药物(OR=0.400,95%CI 0.265～0.606; P0.001)是DR合并DN的保护因素,高血压病程(OR=1.021,95%CI 1.005～1.037; P=0.011)、收缩压(OR=1.018,95%CI 1.007～1.029; P=0.002)、空腹血糖(OR=1.054,95%CI 1.002～1.108; P=0.040)、甘油三酯(OR=1.133,95%CI 1.021～1.256;P=0.019)、低密度脂蛋白胆固醇(OR=1.355,95%CI 1.017～1.805; P=0.038)、血尿酸(OR=1.124,95%CI 1.016～1.244;P=0.023)、胱抑素C(OR=2.466,95%CI 1.495～4.068; P0.001)、眼底评分(OR=1.275,95%CI 1.088～1.494; P=0.003)、左室后壁厚度(OR=1.306,95%CI 1.051～1.622; P=0.016)和颈动脉粥样斑块形成(OR=1.578,95%CI 1.051～2.370;P=0.028)为危险因素。ROC曲线分析结果表明胱抑素C预测DR合并DN价值最高,AUC为0.677。结论 T2DM患者DR合并DN的患病率较高,其发生与多种因素相关,其中,胱抑素C预测DR合并DN价值最高。