J.ophthalmol.(Ukraine).2022;6:19-23.
http://doi.org/10.31288/oftalmolzh202261923
Received:11.11.2022; Accepted: 08.12.2022; Published on-line: 21.12.2022
Prognostic risk factors for diabetic retinopathy in patients with type 2 diabetes mellitus
I. S. Alifanov 1, 2, V. M. Sakovych 1
1 Dnipro State Medical University
2 Dnipropetrovsk Regional Clinical Ophthalmic Hospital
Dnipro (Ukraine)
TO CITE THIS ARTICLE: Alifanov IS, Sakovych VM. Prognostic risk factors for diabetic retinopathy in patients with type 2 diabetes mellitus. J.ophthalmol.(Ukraine).2022;6:19-23. http://doi.org/10.31288/oftalmolzh202261923
Purpose: To establish a relationship of diabetic retinopathy with the presence of lesions of other target organs, disease severity and the requirement for insulin therapy in patients with type 2 diabetes mellitus, and to determine the most significant prognostic markers.
Material and Methods: We examined 270 patients (270 eyes) with type 2 diabetes mellitus. They were divided into the diabetic retinopathy group and no-diabetic retinopathy group. The status of diabetic target organs was determined as per endocrinologist’s, cardiologist’s, nephrologist’s, neurologist’s and vascular surgeon’s conclusions. Statistica v6.1 (Statsoft, Tulsa, OK) software was used for statistical analysis. The level of significance р < 0.05 was assumed.
Results: Diabetic retinopathy positively correlated with severe diabetes (r = 0.383, p < 0.001), insulin therapy requirement (r = 0.389, p < 0.001), diabetic nephropathy (r = 0.350, p < 0.001), chronic kidney failure (r = 0.390, p < 0.001), and lower-extremity angiopathy (r = 0.312, p < 0.001). In addition, the risk of diabetic retinopathy was high in patients on insulin therapy (odds ratio (OR) 6.1; 95 % СІ 3.40-10.93), patients with diabetic nephropathy (OR 17.34; 95 % СІ 4.94-60.83), chronic kidney failure (OR 6.88; 95 % СІ 3.66-12.94), lower-extremity angiopathy (OR 19.15; 95 % СІ 4.24-86.45), coronary heart disease (OR 2.4; 95 % СІ 1.21-4.76) and essential hypertension (OR 4.29; 95 % СІ 1.22-15.10). The risk of diabetic retinopathy was higher in patients with severe diabetes (OR 5.79, 95% CI 3.26-10.26) as compared to patients with mild to moderate diabetes.
Conclusion: The positive associations of diabetic retinopathy with chronic kidney failure, diabetic nephropathy and lower-extremity angiopathy were stronger than the positive associations with other diabetic target organs. In addition, there was a moderate positive correlation of diabetic retinopathy with severe diabetes and insulin therapy requirement. The association of diabetic retinopathy with acute coronary and cerebral events was not significant.
Keywords: diabetes mellitus, diabetic retinopathy, target organs, prognostic markers
References
1.International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: 2021. Available at: https://diabetesatlas.org/atlas/tenth-edition/
2.International Council Of Ophthalmology. ICO Guidelines for Diabetic Eye Care (2017). Availble at: https://icoph.org/eye-care-delivery/diabetic-eye-care/
3.Cavan D, Makaroff L, da Rocha Fernandes J, Sylvanowicz M et al. The Diabetic Retinopathy Barometer Study: Global perspectives on access to and experiences of diabetic retinopathy screening and treatment. Diabetes Res Clin Pract. 2017 Jul; Volume 129:16-24.
4.Alifanov IS, Sakovych VN, Alifanova TO. Disability due to ocular complications of diabetes mellitus in Ukraine. J Ophthalmol (Ukraine). 2019;6:34-8.
5.Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-564.
6.Harris Nwanyanwu K, Talwar N, Gardner TW, Wrobel JS, Herman WH, Stein JD. Predicting development of proliferative diabetic retinopathy. Diabetes Care. 2013;36(6):1562-1568.
7.Brownrigg JR, Hughes CO, Burleigh D, et al. Microvascular disease and risk of cardiovascular events among individuals with type 2 diabetes: a population-level cohort study. Lancet Diabetes Endocrinol. 2016;4(7):588-597.
8.Barlovic DP, Harjutsalo V, Gordin D, Kallio M, Forsblom C, King G, Groop P-H; on behalf of the Finn Diane Study Group, The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes: A Longitudinal Follow-up. Diabetes Care. 1 December 2018; 41 (12): 2487–94.
9.Hughes AD, Falaschetti E, Witt N, et al. Association of Retinopathy and Retinal Microvascular Abnormalities With Stroke and Cerebrovascular Disease. Stroke. 2016;47(11):2862-2864.
10.Hanff TC, Sharrett AR, Mosley TH, et al. Retinal microvascular abnormalities predict progression of brain microvascular disease: an atherosclerosis risk in communities magnetic resonance imaging study. Stroke. 2014;45(4):1012-1017.
11.Crosby-Nwaobi RR, Sivaprasad S, Amiel S, Forbes A. The relationship between diabetic retinopathy and cognitive impairment. Diabetes Care. 2013;36(10):3177-3186.
12.Foussard N, Saulnier P-J, Potier L, Ragot S, Schneider F, Gand E, et al.; on behalf of the SURDIAGENE Study Group, Relationship Between Diabetic Retinopathy Stages and Risk of Major Lower-Extremity Arterial Disease in Patients With Type 2 Diabetes. Diabetes Care 1 November 2020; 43 (11): 2751–2759.
13.Mohammedi K, Woodward M, Hirakawa Y, et al. Microvascular and Macrovascular Disease and Risk for Major Peripheral Arterial Disease in Patients With Type 2 Diabetes. Diabetes Care. 2016;39(10):1796-1803.
14.Pearce I, Simó R, Lövestam-Adrian M, Wong DT, Evans M. Association between diabetic eye diseaseand other complications of diabetes: Implications for care. A systematic review. Diabetes Obes Metab. 2019;21:467–78.
Disclosures
Corresponding author: Alifanov I. S., alifanov00@gmail.com
Disclaimer: The authors declare that the opinions expressed in this article are their own and not the official positions of the institution.
Conflict of Interest. The authors declare that they have no actual or potential conflict of interest including any financial, personal, or other relationships with other people or organizations that could inappropriately influence, or be perceived to influence, their work.
Sources of funding: none.