Lower Hemoglobin Concentration Is Associated with Retinal Ischemia and the Severity of Diabetic Retinopathy in Type 2 Diabetes

Aims. To assess the association of blood oxygen-transport capacity variables with the prevalence of diabetic retinopathy (DR), retinal ischemia, and macular oedema in patients with type 2 diabetes mellitus (T2DM).Methods. Cross-sectional, case-control study (N=312) with T2DM: 153 individuals with DR and 159 individuals with no DR. Participants were classified according to the severity of DR and the presence of retinal ischemia or macular oedema. Hematological variables were collected by standardized methods. Three logistic models were adjusted to ascertain the association between hematologic variables with the severity of DR and the presence of retinal ischemia or macular oedema.Results.Individuals with severe DR showed significantly lower hemoglobin, hematocrit, and erythrocyte levels compared with those with mild disease and in individuals with retinal ischemia and macular oedema compared with those without these disorders. Hemoglobin was the only factor that showed a significant inverse association with the severity of DR [beta-coefficient = −0.52,P value = 0.003] and retinal ischemia [beta-coefficient = −0.49,P value = 0.001]. Lower erythrocyte level showed a marginally significant association with macular oedema [beta-coefficient = −0.86,P value = 0.055].Conclusions.In patients with DR, low blood oxygen-transport capacity was associated with more severe DR and the presence of retinal ischemia. Low hemoglobin levels may have a key role in the development and progression of DR.

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Tofacitinib Ameliorates Retinal Vascular Leakage in a Murine Model of Diabetic Retinopathy with Type 2 Diabetes

International Journal of Molecular Sciences ◽

10.3390/ijms222111876 ◽

2021 ◽

Vol 22 (21) ◽

pp. 11876

Author(s):

Eimear M. Byrne ◽

María Llorián-Salvador ◽

Timothy J. Lyons ◽

Mei Chen ◽

Heping Xu

Keyword(s):

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

High Glucose ◽

Macular Oedema ◽

Diabetic Macular Oedema ◽

Janus Kinase ◽

Blood Retinal Barrier ◽

Albumin Leakage

We have previously reported that inhibition of the Janus kinase 1 (JAK1) signaling ameliorates IL-17A-mediated blood-retinal barrier (BRB) dysfunction. Higher levels of IL-17A have been observed in the blood and intraocular fluids in patients with diabetic retinopathy (DR), in particular those with diabetic macular oedema. This study aimed to understand whether JAK1 inhibition could prevent BRB dysfunction in db/db mice, a model of type 2 diabetes (T2D). An in vitro study showed that high glucose treatment disrupted the junctional distribution of claudin-5 in bEnd3 cells and ZO-1 in ARPE19 cells and that tofacitinib citrate treatment prevented high glucose-mediated tight junction disruption. Albumin leakage, accompanied by increased levels of the phosphorylated form of JAK1 (pJAK1), was observed in three-month-old db/db mice. Treatment of two-and-a-half-month-old db/db mice with tofacitinib citrate for two weeks significantly reduced retinal albumin leakage and reduced pJAK1 expression. pJAK1 expression was also detected in human DR retina. Our results suggest that JAK1 inhibition can ameliorate BRB dysfunction in T2D, and JAK1 inhibitors such as tofacitinib citrate may be re-purposed for the management of diabetic macular oedema.

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COMPARATIVE EFFICACY OF LASER PHOTOCOAGULATION MONOTHERAPY, INTRAVITREAL BEVACIZUMAB MONOTHERAPY AND COMBINED LASER PHOTOCOAGULATION AND INTRAVITREAL BEVACIZUMAB THERAPY IN THE MANAGEMENT OF MACULAR OEDEMA ≥ 350 µm IN NONISCHAEMIC, NON-PROLIFERATIVE DIABETIC RETINOPATHY IN TYPE 2 DIABETES MELLITUS

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2017/155 ◽

2017 ◽

Vol 6 (09) ◽

pp. 721-726

Author(s):

Meenu Kashyap ◽

Krishnapada Baidya ◽

Tamal Roy

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Macular Oedema ◽

Laser Photocoagulation ◽

Intravitreal Bevacizumab ◽

Comparative Efficacy

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Prevalence and associated risk factors of diabetic retinopathy and macular oedema in patients recently diagnosed with type 2 diabetes

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2019-000304 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000304

Author(s):

Enrique O Graue-Hernandez ◽

David Rivera-De-La-Parra ◽

Sergio Hernandez-Jimenez ◽

Carlos A Aguilar-Salinas ◽

David Kershenobich-Stalnikowitz ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Plasma Glucose ◽

Macular Oedema ◽

Diabetic Macular Oedema ◽

Diabetes Duration ◽

Haemoglobin A1c ◽

Associated Risk Factors

ObjectiveTo determine the prevalence of diabetic retinopathy (DR) and diabetic macular oedema (DME) and their associated risk factors in patients recently diagnosed with type 2 diabetes.Methods and analysisWe carried out a cross-sectional study from April 2014 to August 2017. We included patients aged ≥18 years. Diabetes was defined as fasting plasma glucose of >7.8 mmol/L or 2-hour postload plasma glucose of >11.1 mmol/L. Non-mydriatic fundus examination with a digital-fundus camera was performed. Three images centred in the macula, optic disc and temporal to the macula were obtained and graded according to the Scottish Scale Classification of Diabetic Retinopathy.Results1232 patients (mean age 51.5 years) with a diabetes duration of 0–5 years were examined. Age-adjusted and sex-adjusted prevalence of DR and DME was 17.4% (95% CI 15.3% to 19.6%) and 6.6% (95% CI 5.4% to 8.2%), respectively. DR was associated with diabetes duration (OR per year=1.20, p<0.001), haemoglobin A1c (HbA1c) from 7.0 to 8.9 (OR=2.19, p<0.001), HbA1c≥9 (OR=2.98, p<0.001) and systolic blood pressure (SBP) (OR=1.16 per 5 mm Hg, p<0.001). DME was associated with diabetes duration (OR per year=1.26, p<0.01), HbA1c from 7.0 to 8.9 (OR=2.26, p<0.05), HbA1c≥9 (OR=2.38, p<0.01), SBP (OR per mm Hg=1.15, p<0.001) and albuminuria (OR=2.45, p<0.01).ConclusionOur study contributes to the evidence of progressive increase in DR and DME risk in early stages of diabetes, supporting the urgent need for early screening.

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