Application of non-mydriatic fundus examination and artificial intelligence to promote the screening of diabetic retinopathy in the endocrine clinic: an observational study of T2DM patients in Tianjin, China

Background: We aimed to determine the role of non-mydriatic fundus examination and artificial intelligence (AI) in screening diabetic retinopathy (DR) in patients with diabetes in the Metabolic Disease Management Center (MMC) in Tianjin, China. Methods: Adult patients with type 2 diabetes mellitus who were first treated by MMC in Tianjin First Central Hospital and Tianjin 4th Center Hospital were divided into two groups according to the time that MMC was equipped with the non-mydriatic ophthalmoscope and AI system and could complete fundus examination independently (the former was the control group, the latter was the observation group). The observation indices were as follows: the incidence of DR, the fundus screening rate of the two groups, and fundus screening of diabetic patients with different course of disease. Results: A total of 5039 patients were enrolled in this study. The incidence rate of DR was 18.6%, 29.8%, and 49.6% in patients with diabetes duration of ⩽1 year, 1–5 years, and >5 years, respectively. The screening rate of fundus in the observation group was significantly higher compared with the control group (81.3% versus 28.4%, χ2 = 1430.918, p < 0.001). The DR screening rate of the observation group was also significantly higher compared with the control group in patients with diabetes duration of ⩽1 year (77.3% versus 20.6%; χ2 = 797.534, p < 0.001), 1–5 years (82.5% versus 31.0%; χ2 = 197.124, p < 0.001) and ⩾5 years (86.9% versus 37.1%; χ2 = 475.609, p < 0.001). Conclusions: In the case of limited medical resources, MMC can carry out one-stop examination, treatment, and management of DR through non-mydratic fundus examination and AI assistance, thus incorporating the DR screening process into the endocrine clinic, so as to facilitate early diagnosis.

Download Full-text

Volume rendered 3D OCTA assessment of macular ischemia in patients with type 1 diabetes and without diabetic retinopathy

Scientific Reports ◽

10.1038/s41598-021-99297-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Enrico Borrelli ◽

Domenico Grosso ◽

Mariacristina Parravano ◽

Eliana Costanzo ◽

Maria Brambati ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Retinopathy ◽

Healthy Subjects ◽

Diabetic Group ◽

Control Group ◽

Diabetic Patients ◽

Vascular Volume ◽

Patients With Diabetes ◽

Perfusion Density

AbstractThe aim of this study was to measure macular perfusion in patients with type 1 diabetes and no signs of diabetic retinopathy (DR) using volume rendered three-dimensional (3D) optical coherence tomography angiography (OCTA). We collected data from 35 patients with diabetes and no DR who had OCTA obtained. An additional control group of 35 eyes from 35 healthy subjects was included for comparison. OCTA volume data were processed with a previously presented algorithm in order to obtain the 3D vascular volume and 3D perfusion density. In order to weigh the contribution of different plexuses’ impairment to volume rendered vascular perfusion, OCTA en face images were binarized in order to obtain two-dimensional (2D) perfusion density metrics. Mean ± SD age was 27.2 ± 10.2 years [range 19–64 years] in the diabetic group and 31.0 ± 11.4 years [range 19–61 years] in the control group (p = 0.145). The 3D vascular volume was 0.27 ± 0.05 mm3 in the diabetic group and 0.29 ± 0.04 mm3 in the control group (p = 0.020). The 3D perfusion density was 9.3 ± 1.6% and 10.3 ± 1.6% in diabetic patients and controls, respectively (p = 0.005). Using a 2D visualization, the perfusion density was lower in diabetic patients, but only at the deep vascular complex (DVC) level (38.9 ± 3.7% in diabetes and 41.0 ± 3.1% in controls, p = 0.001), while no differences were detected at the superficial capillary plexus (SCP) level (34.4 ± 3.1% and 34.3 ± 3.8% in the diabetic and healthy subjects, respectively, p = 0.899). In conclusion, eyes without signs of DR of patients with diabetes have a reduced volume rendered macular perfusion compared to control healthy eyes.

Download Full-text

Diabetes duration may modify the association between genetic variation in the glycoprotein Ia subunit of the platelet collagen receptor and risk of severe diabetic retinopathy: a working hypothesis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613553 ◽

2003 ◽

Vol 89 (01) ◽

pp. 142-148 ◽

Cited By ~ 4

Author(s):

Elisabeth Agardh ◽

Gayle Teramura ◽

Prashart Gaur ◽

Lakshmi Gaur ◽

Carl-David Agardh ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Genetic Variation ◽

Confidence Interval ◽

Odds Ratio ◽

Diabetes Duration ◽

Diabetic Patients ◽

Integrin Subunit ◽

Patients With Diabetes ◽

Collagen Receptor ◽

Risk Of Retinopathy

SummaryGenetic factors appear to contribute to the severity and progression of diabetic retinopathy. We assessed the associations of the C807T and Glu505Lys variants of the glycoprotein Ia ( 2 integrin) subunit of the platelet/endothelial collagen receptor and risk of retinopathy in a population-based survey of 288 diabetic patients in one Swedish community. Neither variant was associated with retinopathy risk overall. However, the 807T variant was associated with increased risk of severe retinopathy, and the association was modified by diabetes duration. Among patients with diabetes of longer duration ( 25 years), the 807T variant was strongly associated with risk of severe retinopathy (odds ratio 7.49, 95% confidence interval 1.75 to 32.1). There was no association between the 807T variant and risk of severe retinopathy among patients with diabetes duration <25 years. The Lys505 variant of glycoprotein Ia was associated with an odds ratio for severe retinopathy of 1.88 (95% confidence interval 0.83 to 4.24). Overall, there was a significant interaction between glycoprotein Ia genotype and duration of diabetes on the risk of retinopathy (P-value for interaction = 0.019).These results suggest the hypothesis that genetic variation of platelet glycoprotein Ia may play a particularly important role during the advanced stages of diabetic retinopathy.

Download Full-text

Systemic Erythropoietin Concentration and its Correlation with Stage of Diabetic Retinopathy

10.21203/rs.2.12950/v1 ◽

2019 ◽

Author(s):

Sofija Davidović ◽

Babić Nikola ◽

Jovanović Sandra ◽

Barišić Sava ◽

Grković Desanka ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Serum Concentration ◽

Proliferative Diabetic Retinopathy ◽

Elevated Serum ◽

Average Concentration ◽

Control Group ◽

Diabetic Patients ◽

Study Results ◽

Patients With Diabetes

Abstract Summary: Background: Erythropoietin (Epo) is one of systemic angiogenic factors, and its role in ocular angiogenesis and in diabetic retinopathy (DR) is not yet fully understood. Latest research data reveal possible correlation of higher EPO concentrations of erythropoietin in blood and in the eye, with more severe of stages of DR. The main aim of this work was to examine the possible influence of serum concentrations of erythropoietin on the development and stages of diabetic retinopathy in patients with diabetes mellitus type 2. Methods: The research involved 90 patients examined at University Eye Clinic in Clinical Center of Vojvodina in Novi Sad, Serbia. First group comprised of 60 patients with diabetes mellitus lasting 10 years or more, with diabetic retinopathy. Second, control group, consisted of 30 healthy individuals. In the first group of 60 diabetic patients, 30 of them had non-proliferative diabetic retinopathy (NPDR), and 30 had proliferative diabetic retinopathy (PDR). Laboratory EPO serum levels were determined, and they were correlated to the stage of DR. Concentration of EPO was assessed by ELISA method at the end of the study. Results: The highest average concentration of EPO in serum (9.95 mIU/ml) was determined in group of diabetics with PDR. The lowest average concentration of EPO in serum (6.90 mIU/ml) was found in control group. The average concentration of Epo in serum in group of diabetics with NPDR was 7.00 mIU/ml. EPO concentration in serum was elevated in group of PDR, and it was directly proportional to the level of clinical stadium of PDR, being significantly higher in moderate and severe subgroup of PDR comparing to control healthy subjects, NPDR and mild PDR (h=9.858, p=0.007). Conclusions: Significantly elevated serum concentration of EPO in advanced stages of DR, and positive correlation between EPO serum concentration and clinical stadium of PDR, suggest that erythropoietin presents one of the important growth factors from blood, which plays role in retinal ischemia and angiogenesis in diabetic retinopathy, especially in the proliferative stage of this disease. Keywords: diabetic retinopathy; erythropoietin; glycated hemoglobin; non-proliferative diabetic retinopathy; proliferative diabetic retinopathy.

Download Full-text

Serum Erythropoietin Concentration And Its Correlation With Stage Of Diabetic Retinopathy

10.21203/rs.2.12950/v2 ◽

2019 ◽

Author(s):

Sofija Davidović ◽

Babić Nikola ◽

Jovanović Sandra ◽

Barišić Sava ◽

Grković Desanka ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Serum Concentration ◽

Proliferative Diabetic Retinopathy ◽

Elevated Serum ◽

Average Concentration ◽

Control Group ◽

Diabetic Patients ◽

Study Results ◽

Patients With Diabetes

Download Full-text

A Single-center, Retrospective Study to Evaluate the Clinical Performance of Artificial Intelligence Medical Assisted Diagnostic Software (VeriSee DR) for Screening of Diabetic Retinopathy in Patients With Diabetes Mellitus

Case Medical Research ◽

10.31525/ct1-nct04160988 ◽

2019 ◽

Author(s):

Keyword(s):

Artificial Intelligence ◽

Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Retrospective Study ◽

Clinical Performance ◽

Single Center ◽

Patients With Diabetes ◽

Diagnostic Software

Download Full-text

Proteomic Analysis of the Vitreous Body in Proliferative and Non-Proliferative Diabetic Retinopathy

Current Proteomics ◽

10.2174/1570164617666200302101442 ◽

2020 ◽

Vol 17 ◽

Cited By ~ 1

Author(s):

Van-An Duong ◽

Jeeyun Ahn ◽

Na-Young Han ◽

Jong-Moon Park ◽

Jeong-Hun Mok ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Microvascular Complications ◽

Treatment Options ◽

Vitreous Body ◽

Control Group ◽

Diabetic Patients ◽

Protein Protein Interaction ◽

Alpha Beta ◽

New Treatment

Background: Diabetic Retinopathy (DR), one of the major microvascular complications commonly occurring in diabetic patients, can be classified into Proliferative Diabetic Retinopathy (PDR) and Non-Proliferative Diabetic Retinopathy (NPDR). Currently available therapies are only targeted for later stages of the disease in which some pathologic changes may be irreversible. Thus, there is a need to develop new treatment options for earlier stages of DR through revealing pathological mechanisms of PDR and NPDR. Objective: The purpose of this study was to characterize proteomes of diabetic through quantitative analysis of PDR and NPDR. Methods: Vitreous body was collected from three groups: control (non-diabetes mellitus), NPDR, and PDR. Vitreous proteins were digested to peptide mixtures and analyzed using LC-MS/MS. MaxQuant was used to search against the database and statistical analyses were performed using Perseus. Gene ontology analysis, related-disease identification, and protein-protein interaction were performed using the differential expressed proteins. Results: Twenty proteins were identified as critical in PDR and NPDR. The NPDR group showed different expressions of kininogen-1, serotransferrin, ribonuclease pancreatic, osteopontin, keratin type II cytoskeletal 2 epidermal, and transthyretin. Also, prothrombin, signal transducer and activator of transcription 4, hemoglobin subunit alpha, beta, and delta were particularly up-regulated proteins for PDR group. The up-regulated proteins related to complement and coagulation cascades. Statherin was down-regulated in PDR and NPDR compared with the control group. Transthyretin was the unique protein that increased its abundance in NPDR compared with the PDR and control group. Conclusion: This study confirmed the different expressions of some proteins in PDR and NPDR. Additionally, we revealed uniquely expressed proteins of PDR and NPDR, which would be differential biomarkers: prothrombin, alpha-2-HS-glycoprotein, hemoglobin subunit alpha, beta, and transthyretin.

Download Full-text

Dynamic Expression of HDAC3 in db/db Mouse RGCs and Its Relationship with Apoptosis and Autophagy

Journal of Diabetes Research ◽

10.1155/2020/6086780 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Yuhong Fu ◽

Ying Wang ◽

Xinyuan Gao ◽

Huiyao Li ◽

Yue Yuan

Keyword(s):

Diabetic Retinopathy ◽

Ganglion Cell ◽

Retinal Ganglion Cells ◽

Retinal Ganglion Cell ◽

Ganglion Cells ◽

Control Group ◽

Diabetic Patients ◽

Retinal Ganglion ◽

Glucose Levels ◽

Dynamic Expression

Background. Diabetic retinopathy (DR) is a severe complication of diabetes mellitus. DR is considered as a neurovascular disease. Retinal ganglion cell (RGC) loss plays an important role in the vision function disorder of diabetic patients. Histone deacetylase3 (HDAC3) is closely related to injury repair and nerve regeneration. The correlation between HDAC3 and retinal ganglion cells in diabetic retinopathy is still unclear yet. Methods. To investigate the chronological sequence of the abnormalities of retinal ganglion cells in diabetic retinopathy, we choose 15 male db/db mice (aged 8 weeks, 12 weeks, 16 weeks, 18 weeks, and 25 weeks; each group had 3 mice) as diabetic groups and 3 male db/m mice (aged 8 weeks) as the control group. In this study, we examined the morphological and immunohistochemical changes of HDAC3, Caspase3, and LC3B in a sequential manner by characterizing the process of retinal ganglion cell variation. Results. Blood glucose levels and body weights of db/db mice were significantly higher than that of the control group, P<0.01. Compared with the control group, the number of retinal ganglion cells decreased with the duration of disease increasing. HDAC3 expression gradually increased in RGCs of db/db mice. Caspase3 expression gradually accelerated in RGCs of db/db mice. LC3B expression dynamically changed in RGCs of db/db mice. HDAC3 was positively correlated with Caspase3 expression (r=0.7424), P<0.01. HDAC3 was positively correlated with LC3B expression (r=0.7336), P<0.01. Discussion. We clarified the dynamic expression changes of HDAC3, Caspase3, and LC3B in retinal ganglion cells of db/db mice. Our results suggest the HDAC3 expression has a positive correlation with apoptosis and autophagy.

Download Full-text

Clinical efficacy of oxidative stress correction by actovegin in diabetic polyneuropathy at type 2 diabetic patients with arterial hypertension

Diabetes Mellitus ◽

10.14341/2072-0351-5680 ◽

2010 ◽

Vol 13 (2) ◽

pp. 84-89

Author(s):

Ivan Petrovich Gorshkov ◽

Vladimir Ivanovich Zoloedov ◽

Anna Petrovna Volynkina

Keyword(s):

Oxidative Stress ◽

Arterial Hypertension ◽

Diabetic Polyneuropathy ◽

Oxidative Capacity ◽

Control Group ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Patients With Diabetes ◽

Total Antioxidant

Aim. To study Actovegin efficacy in oxidative stress (OS) correction at diabetic polyneuropathy (DPN) in patients with diabetes mellitus type 2 (DM2)and arterial hypertension (AH).Materials and Methods. 51 patients (24 women and 27 men) aged 53.4?0.7 with the average duration of DM2 5.6?0.2 years, DPN - 4.9?0.2years and AH - 6.0?0.2 years were examined. Daily albuminuria, glomerular filtration rate (GRF) were evaluated, standard methods for diagnosisof DPN were used. 26 patients took Actovegin therapy during 6-8 weeks, the rest 25 patients were in the control group. Parameters of the OS werestudied. Results. The increase of total oxidative capacity, the decrease of total antioxidant capacity and the rise of levels of antibodies to oxidated LDL wererevealed in patients with DM2, DPN and AH. Antioxidant and anti-hypoxic effects of 400 mg/day of Actovegin were established in this group of patients.Conclusions. Actovegin impacts oxidative stress parameters and improves the clinical manifestation of diabetic polyneuropathy.

Download Full-text

Insulin Glargine and Acarbose in the treatment of elderly patients with diabetes

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.3.86 ◽

2019 ◽

Vol 35 (3) ◽

Author(s):

Jing Li ◽

Jinzhi Ji ◽

Fuyan Liu ◽

Lingling Wang

Keyword(s):

Quality Of Life ◽

Blood Glucose ◽

Elderly Patients ◽

Insulin Glargine ◽

Adverse Reactions ◽

Postprandial Blood Glucose ◽

Control Group ◽

Observation Group ◽

Patients With Diabetes

Objective: To investigate the clinical efficacy of insulin glargine combined with acarbose in the treatment of elderly patients with diabetes. Methods: One hundred and forty-four elderly patients with diabetes who received treatment between December 2016 and December 2017 in Binzhou People’s Hospital, China, were selected and divided into a control group and an observation group, 72 each, using random number table. The control group was treated with insulin glargine, while the observation group was treated with insulin glargine combined with acarbose. The therapeutic effect, improvement of quality of life and adverse reactions were compared between the two groups. Results: After treatment, fasting blood glucose (FBG), 2h postprandial blood glucose (PBG) and glycosylated hemoglobin (Hb Alc) of the two groups were lower than those before treatment, and the decrease degree of the observation group was significantly larger than that of the control group (P<0.05). The time needed for blood glucose reaching the standard level and daily insulin dosage of the observation group were significantly lower than that of the control group, and the differences were statistically significant (P<0.05). SF-36 scale score of the observation group was significantly better than the control group, and the difference was statistically significant (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: The combination of insulin Glargine and Acarbose can significantly control the blood glucose level of elderly patients with diabetes, improve the biochemical indicators, and enhance the quality of life. It is worth promotion in clinical practice. doi: https://doi.org/10.12669/pjms.35.3.86 How to cite this:Li J, Ji J, Liu F, Wang L. Insulin Glargine and Acarbose in the treatment of elderly patients with diabetes. Pak J Med Sci. 2019;35(3):---------. doi: https://doi.org/10.12669/pjms.35.3.86 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

Artificial intelligence-enabled screening for diabetic retinopathy: a real-world, multicenter and prospective study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001596 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001596

Author(s):

Yifei Zhang ◽

Juan Shi ◽

Ying Peng ◽

Zhiyun Zhao ◽

Qidong Zheng ◽

...

Keyword(s):

Artificial Intelligence ◽

Diabetic Retinopathy ◽

Interobserver Variability ◽

Classification Performance ◽

Early Screening ◽

Algorithm Validation ◽

Patients With Diabetes ◽

Registration Number ◽

Classification Images ◽

Design And Methods

IntroductionEarly screening for diabetic retinopathy (DR) with an efficient and scalable method is highly needed to reduce blindness, due to the growing epidemic of diabetes. The aim of the study was to validate an artificial intelligence-enabled DR screening and to investigate the prevalence of DR in adult patients with diabetes in China.Research design and methodsThe study was prospectively conducted at 155 diabetes centers in China. A non-mydriatic, macula-centered fundus photograph per eye was collected and graded through a deep learning (DL)-based, five-stage DR classification. Images from a randomly selected one-third of participants were used for the DL algorithm validation.ResultsIn total, 47 269 patients (mean (SD) age, 54.29 (11.60) years) were enrolled. 15 805 randomly selected participants were reviewed by a panel of specialists for DL algorithm validation. The DR grading algorithms had a 83.3% (95% CI: 81.9% to 84.6%) sensitivity and a 92.5% (95% CI: 92.1% to 92.9%) specificity to detect referable DR. The five-stage DR classification performance (concordance: 83.0%) is comparable to the interobserver variability of specialists (concordance: 84.3%). The estimated prevalence in patients with diabetes detected by DL algorithm for any DR, referable DR and vision-threatening DR were 28.8% (95% CI: 28.4% to 29.3%), 24.4% (95% CI: 24.0% to 24.8%) and 10.8% (95% CI: 10.5% to 11.1%), respectively. The prevalence was higher in female, elderly, longer diabetes duration and higher glycated hemoglobin groups.ConclusionThis study performed, a nationwide, multicenter, DL-based DR screening and the results indicated the importance and feasibility of DR screening in clinical practice with this system deployed at diabetes centers.Trial registration numberNCT04240652.

Download Full-text