scholarly journals Development and Progression of Diabetic Retinopathy in Adolescents and Young Adults With Type 2 Diabetes: Results From the TODAY Study

2021 ◽  
Author(s):  
Rose Gubitosi-Klug ◽  
Ingrid Libman ◽  
Kimberly L. Drews ◽  
Diane Uschner ◽  
Barbara A. Blodi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Treatment Options ◽  
Diabetes Duration ◽  
Fundus Photography ◽  
Dominant Factor ◽  
Fundus Photographs ◽  
Design And Methods

<p><b>Objective</b>: The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) trial reported a 13.9% prevalence of diabetic retinopathy (DR) in youth with an average 4.9 ± 1.5 years of type 2 diabetes duration. After seven years of additional follow up, we report the risk factors for progression of DR in the TODAY cohort. </p> <p><b>Research Design and Methods</b>: Retinal photographs (n = 517) were obtained in 2010-2011 and again in 2017-18 (n = 420) with seven standard stereoscopic field digital fundus photography. Photographs were graded centrally using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Three hundred sixty-seven patients with gradable fundus photographs in at least one eye at both assessments were included in analyses of progression of diabetic retinopathy, defined as an increase of three or more steps on the ETDRS scale.</p> <p><b>Results</b>: With mean age of 25.4 ± 2.5 years and diabetes duration of 12.0 ± 1.5 years, participants had a 49% prevalence of any diabetic retinopathy. Prevalence by DR stage included: 39% very mild or mild non-proliferative diabetic retinopathy (NPDR); 6% moderate to severe NPDR; and 3.8% proliferative diabetic retinopathy. Compared with non-progressors, participants who progressed three or more steps had significantly lower BMI, higher HbA1c, higher blood pressure, increased triglycerides, decreased C-peptide, and higher prevalence of other comorbidities. Multivariate analysis demonstrated that HbA1c was the dominant factor impacting DR progression.</p> <p><b>Conclusions</b>: Poor glycemic control of youth-onset type 2 diabetes imparts a high risk for progression of DR, including advanced, sight-threatening disease by young adulthood. <b><u></u></b></p>

scholarly journals Development and Progression of Diabetic Retinopathy in Adolescents and Young Adults With Type 2 Diabetes: Results From the TODAY Study

2021 ◽  
Author(s):  
Rose Gubitosi-Klug ◽  
Ingrid Libman ◽  
Kimberly L. Drews ◽  
Diane Uschner ◽  
Barbara A. Blodi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Treatment Options ◽  
Diabetes Duration ◽  
Fundus Photography ◽  
Dominant Factor ◽  
Fundus Photographs ◽  
Design And Methods

<p><b>Objective</b>: The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) trial reported a 13.9% prevalence of diabetic retinopathy (DR) in youth with an average 4.9 ± 1.5 years of type 2 diabetes duration. After seven years of additional follow up, we report the risk factors for progression of DR in the TODAY cohort. </p> <p><b>Research Design and Methods</b>: Retinal photographs (n = 517) were obtained in 2010-2011 and again in 2017-18 (n = 420) with seven standard stereoscopic field digital fundus photography. Photographs were graded centrally using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Three hundred sixty-seven patients with gradable fundus photographs in at least one eye at both assessments were included in analyses of progression of diabetic retinopathy, defined as an increase of three or more steps on the ETDRS scale.</p> <p><b>Results</b>: With mean age of 25.4 ± 2.5 years and diabetes duration of 12.0 ± 1.5 years, participants had a 49% prevalence of any diabetic retinopathy. Prevalence by DR stage included: 39% very mild or mild non-proliferative diabetic retinopathy (NPDR); 6% moderate to severe NPDR; and 3.8% proliferative diabetic retinopathy. Compared with non-progressors, participants who progressed three or more steps had significantly lower BMI, higher HbA1c, higher blood pressure, increased triglycerides, decreased C-peptide, and higher prevalence of other comorbidities. Multivariate analysis demonstrated that HbA1c was the dominant factor impacting DR progression.</p> <p><b>Conclusions</b>: Poor glycemic control of youth-onset type 2 diabetes imparts a high risk for progression of DR, including advanced, sight-threatening disease by young adulthood. <b><u></u></b></p>

scholarly journals Risk Factors For Diabetic Retinopathy Progression

2015 ◽  
Vol 22 (2) ◽  
pp. 159-165
Author(s):  
Mónika Deák ◽  
Monica Lasca ◽  
Ioan Andrei Vereşiu
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Smoking Status ◽  
Diabetes Duration ◽  
Diabetes Diagnosis ◽  
Number Of Patients

AbstractBackground and Aims. There is no unanimous opinion regarding the risk factors associated with progression of diabetic retinopathy (DR). We have done a retrospective analysis of risk factors and clinical features associated with DR progression.Material and Methods. This analysis included consecutive patients with moderate non-proliferative or severe retinopathy between December 1, 2013 and May 31, 2014 who had at least two eye examinations before that period. We have collected demographic, clinical and lab data.Results. 51.28% of patients were diagnosed with moderate non-proliferative diabetic retinopathy (NPDR), 24.68% with severe NPDR and 21.05% with proliferative diabetic retinopathy. In 82.16% of cases, DR had progressed. The risk factor correlated with DR progression in the whole group was anemia; hypertension, anemia and diabetes duration were risk factors in type 1 and smoking status at diabetes diagnosis in type 2 diabetes. Total cholesterol, triglycerides, diabetes control and presence of diabetic renal disease were positively but not statistically significant correlated with DR progression.Conclusions. In our study the risk factors correlated with DR progression were hypertension, anemia and diabetes duration in type 1, respectively smoking at diabetes diagnosis in type 2 diabetes. Glycemic goals were achieved in a small number of patients.

scholarly journals Different retinopathy phenotypes in type 2 diabetes predict retinopathy progression

2020 ◽  
Author(s):  
Inês P. Marques ◽  
Maria H. Madeira ◽  
Ana L. Messias ◽  
António C.-V. Martinho ◽  
Torcato Santos ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Retinal Thickness ◽  
Formation Rate ◽  
Fundus Photography ◽  
Phenotype Classification ◽  
Design And Methods ◽  
Higher Sensitivity

Abstract Purpose To characterize the progression in retinopathy severity of different phenotypes of mild nonproliferative diabetic retinopathy (NPDR) in patients with type 2 diabetes. Design and methods Patients with type 2 diabetes and mild NPDR (ETDRS 20 or 35) were followed in a 5-year longitudinal study. Examinations, including color fundus photography (CFP) and optical coherence tomography (OCT and OCTA), were performed at baseline, 6 months and then annually. Phenotype classification was performed based on microaneurysm turnover (MAT, on CFP) and central retinal thickness (CRT, on OCT). Phenotype A is characterized by low MAT (< 6) and normal CRT; Phenotype B by low MAT (< 6) and increased CRT; and Phenotype C by higher MAT (≥ 6) with or without increased CRT. ETDRS grading of seven fields CFP was performed at the initial and last visits. Results Analysis of ETDRS grade step changes showed significant differences in diabetic retinopathy (DR) progression between the different phenotypes (p < 0.001). Of the 66 participants with phenotype A only 2 eyes (3%) presented 2-or-more-step worsening. None of the 50 participants characterized as phenotype B developed 2-step worsening, whereas 13 eyes (23.2%) characterized as phenotype C had 2-or-more-steps worsening. Phenotype C presents the higher risk for 2-or-more step worsening (OR: 15.94 95% CI: 3.45–73.71; p < 0.001) and higher sensitivity, correctly identifying 86.7% of cases at risk (AUC: 0.84 95% CI: 0.72–0.96; p < 0.001). Diabetic retinopathy severity progression was associated with HbA1c (p = 0.019), LDL levels (p = 0.043), and ocular factors as MAT (p = 0.010), MA formation rate (p = 0.014) and MA disappearance rate (p = 0.005). Capillary closure at 5-year follow-up, identified by lower vessel density (VD) on OCTA, was also associated with diabetic DR severity progression (p = 0.035). Conclusions Different DR phenotypes in type 2 diabetes show different risks of retinopathy progression. Phenotype C is associated with increased HbA1c values and presents a higher risk of a 2-or-more-step worsening of the ETDRS severity score.

A hemochromatosis-causing mutation C282Y is a risk factor for proliferative diabetic retinopathy in Caucasians with type 2 diabetes

2004 ◽  
Vol 137 (6) ◽  
pp. 1171-1172
Author(s):  
B. Peterlin ◽  
M. Globočnik Petrovič ◽  
J. Makuc ◽  
M. Hawlina ◽  
D. Petrovič
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Risk Factor ◽  
Proliferative Diabetic Retinopathy

scholarly journals Serum levels of mac-2 binding protein are associated with diabetic microangiopathy and macroangiopathy in people with type 2 diabetes

2020 ◽  
Vol 8 (1) ◽  
pp. e001189
Author(s):  
Yoshitaka Hashimoto ◽  
Masahide Hamaguchi ◽  
Ayumi Kaji ◽  
Ryosuke Sakai ◽  
Noriyuki Kitagawa ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Liver Fibrosis ◽  
Proliferative Diabetic Retinopathy ◽  
Binding Protein ◽  
Protein Glycosylation ◽  
Diabetic Microangiopathy ◽  
Alcoholic Fatty Liver ◽  
Increased Risk

IntroductionNon-alcoholic fatty liver disease is reportedly associated with type 2 diabetes and progressive liver fibrosis, as evaluated by transient elastography, and has been linked with micro- and macroangiopathy in people with type 2 diabetes. The purpose of this cross-sectional study was to investigate the association between serum mac-2 binding protein glycosylation isomer (M2BPGi) levels and diabetic complications in people with type 2 diabetes.Research design and methodsSerum M2BPGi levels were measured in terms of cut-off index (C.O.I.) units. Urinary albumin excretion (UAE) was calculated and nephropathy was graded as normoalbuminuria, microalbuminuria, or macroalbuminuria. Retinopathy was divided into three groups: no-diabetic retinopathy (NoDR), non-proliferative-diabetic retinopathy (NPDR), or proliferative-diabetic retinopathy (PDR) .ResultsThe mean age for the 363 studied subjects (212 males) was 66.4±10.6 years, the median serum M2BPGi level was 0.77 (0.57–1.04) C.O.I., and the median UAE was 22 (9–82.1) mg/g creatinine. M2BPGi levels in microalbuminuria (0.83 (0.61 to 1.18) C.O.I.) and macroalbuminuria (0.88 (0.67 to 1.22) C.O.I.) cases were higher than those in normoalbuminuria cases (0.71 (0.54 to 0.92) C.O.I.). M2BPGi levels in NPDR (0.93 (0.68 to 1.28) C.O.I.) and PDR (0.95 (0.71 to 1.31) C.O.I.) cases were higher than in cases with NoDR (0.73 (0.56 to 0.99) C.O.I.). Furthermore, M2BPGi levels in subjects with a history of cardiovascular diseases were higher than in those with no such history (0.82 (0.65 to 1.22) vs 0.76 (0.55 to 1.03) C.O.I., p=0.019). The logarithm of (M2BPGi+1) was associated with the logarithm of UAE values after adjusting for covariates (standardized β=0.107, p=0.031).ConclusionsThis study reveals a close association between serum M2BPGi levels and diabetic microangiopathy and macroangiopathy in people with type 2 diabetes. The results also show that liver fibrosis, evaluated by M2BPGi, is independently associated with an increased risk of albuminuria.

Glucagon-like Peptide 1 Receptor Agonists, Diabetic Retinopathy and Angiogenesis: The AngioSafe Type 2 Diabetes Study

2019 ◽  
Vol 105 (4) ◽  
pp. e1549-e1560 ◽  
Author(s):  
Bénédicte Gaborit ◽  
Jean-Baptiste Julla ◽  
Samaher Besbes ◽  
Matthieu Proust ◽  
Clara Vincentelli ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Fundus Photography ◽  
Endothelial Cell Proliferation ◽  
Receptor Agonists ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Abstract Aims Recent trials provide conflicting results on the association between glucagon-like peptide 1 receptor agonists (GLP-1RA) and diabetic retinopathy (DR). The aim of the AngioSafe type 2 diabetes (T2D) study was to determine the role of GLP-1RA in angiogenesis using clinical and preclinical models. Methods We performed two studies in humans. In study 1, we investigated the effect of GLP-1RA exposure from T2D diagnosis on the severity of DR, as diagnosed with retinal imaging (fundus photography). In study 2, a randomized 4-week trial, we assessed the effect of liraglutide on circulating hematopoietic progenitor cells (HPCs), and angio-miRNAs. We then studied the experimental effect of Exendin-4, on key steps of angiogenesis: in vitro on human endothelial cell proliferation, survival and three-dimensional vascular morphogenesis; and in vivo on ischemia-induced neovascularization of the retina in mice. Results In the cohort of 3154 T2D patients, 10% displayed severe DR. In multivariate analysis, sex, disease duration, glycated hemoglobin (HbA1c), micro- and macroangiopathy, insulin therapy and hypertension remained strongly associated with severe DR, while no association was found with GLP-1RA exposure (o 1.139 [0.800–1.622], P = .47). We further showed no effect of liraglutide on HPCs, and angio-miRNAs. In vitro, we demonstrated that exendin-4 had no effect on proliferation and survival of human endothelial cells, no effect on total length and number of capillaries. Finally, in vivo, we showed that exendin-4 did not exert any negative effect on retinal neovascularization. Conclusions The AngioSafe T2D studies provide experimental and clinical data confirming no effect of GLP-1RA on angiogenesis and no association between GLP-1 exposure and severe DR.

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