Clinical Characteristics of Diabetic Patients with Diabetic Retinopathy

Authors

  • Arnon Blum Department of Medicine
  • Dorina Socea Ophthalmologic Department, Baruch-Padeh Poria Hospital, Lower Galilee 15208 Israel

DOI:

https://doi.org/10.6000/1929-5634.2013.02.01.6

Keywords:

Endothelial function, diabetic retinopathy, ABI

Abstract

Background: Proliferative diabetic retinopathy is a consequence of retinal ischemia due to capillary occlusion resulting from damage to the retinal endothelium, and is associated with increased risk of cardiovascular morbidity and mortality.

Methods: We randomly assigned seventy three patients with DM type II and grouped them according to their retinal proliferative disease (Group A - 25 patients [12 males], mean age 62.8±10.8 years, no diabetic retinopathy; Group B - 25 patients [19 males], mean age 61.9±9.4 years, non-proliferative retinopathy; and Group C - 23 patients [13 males], mean age 59.2±10.3 years, proliferative retinopathy). Twenty three healthy subjects (14 males; mean age 44.3±11.6 years) served as the control group. We studied their retinal vasculopathy status, height, weight, body mass index (BMI), waist circumference, age, endothelial function (flow mediated diameter [FMD%] percent change) and their peripheral artery disease (ankle brachial index [ABI]).

Results: A significant difference was found between the duration of length of DM type II between patients without retinopathy [group A] (9±6 years) and patients with non-proliferative retinopathy [group B] (17±9 years) (p=0.001). No difference in length of diabetes was observed between patients with non-proliferative retinopathy [group B] and patients with proliferative retinopathy [group C] (19±6 years) (p=0.30). A significant difference was observed in HgA1C% between group A (7.1±2.7%) and group B (8.5±1.5%) (p=0.02). No such difference was noted between group B and group C (8.5±1.6%) (p=0.98). Only 6 patients (out of 23) used insulin treatment in group A compared with 16 group B (out of 25) and 17 in group C (out of 25) (p=0.004). All three groups of diabetic patients were older (62.8±10.8, 61.9±9.4, 59.2±10.3 years, respectively) than volunteers (44.3±11.6 years) (p≤0.001), had a lower stature (1.65±0.09, 1.68±0.07, 1.65±0.09 meters, respectively) compared with controls (1.73±0.08 meters) (p≤0.05), had a larger waist circumference (110.04±14.17, 108.88±13.00, 109.30±13.49 cm, respectively) than controls (93.43±11.66 cm) (p≤0.001), and larger BMIs (30±6, 29±4, 30±5) compared with controls (25±4) (p≤0.001). All diabetic patients had severe endothelial dysfunction measured by FMD% (-1.9±7.4, -3.3±9.2, -3.1±6.6 %, respectively) compared with the control group (16.5±7.5%) (p≤0.001). ABI was within normal range in all patient (0.97±0.18, 1.14±0.24, 1.03±0.28, respectively), and in volunteers (1.06±0.18) (p≥0.05). There was no significant change within the 3 subgroups of diabetic retinopathy patients in age, height, weight, BMI, or FMD%.

Conclusions: All patients with DM type II had severe endothelial dysfunction, higher BMIs, lower statures, larger waist circumferences; however they all had normal ABIs

References

Frank RN. Diabetic Retinopathy. N Engl J Med 2004; 350: 48-58. http://dx.doi.org/10.1056/NEJMra021678 DOI: https://doi.org/10.1056/NEJMra021678

Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984; 102: 520-6. http://dx.doi.org/10.1001/archopht.1984.01040030398010 DOI: https://doi.org/10.1001/archopht.1984.01040030398010

Idem. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984; 102: 527-32. http://dx.doi.org/10.1001/archopht.1984.01040030405011 DOI: https://doi.org/10.1001/archopht.1984.01040030405011

Van Hecke MV, Dekker JM, Stehouwer CDA, Polak BCP, Fuller JH, Sjolie AK, et al. Diabetic retinopathy is associated with mortality and cardiovascular disease incidence. The EURODIAB Prospective Complications Study. Diabetes Care 2005; 28: 1383-9. http://dx.doi.org/10.2337/diacare.28.6.1383

Torffvit O, Lovestam-Adrian M, Agardh E, Agardh CD. Nephropathy, but not retinopathy, is associated with the development of heart disease in type I diabetes: a 12-year observation study of 462 patients. Diabet Med 2005; 22: 723-9. http://dx.doi.org/10.1111/j.1464-5491.2005.01476.x DOI: https://doi.org/10.1111/j.1464-5491.2005.01476.x

Klein BE, Klein R, McBride PE, Cruickshanks KS, Palta M, Knudtson MD, et al. Cardiovascular disease, mortality, and retinal microvascular characteristics in type I diabetes: Wisconsin epidemiology study of diabetic retinopathy. Arch Intern Med 2004; 164: 1917-24. http://dx.doi.org/10.1001/archinte.164.17.1917 DOI: https://doi.org/10.1001/archinte.164.17.1917

Cusick M, Meleth AD, Agron E, Fisher MR, Reed GF, Knatterud GL, et al. Associations of mortality and diabetes complications in patients with type I and type II diabetes: early treatment diabetic retinopathy study report no. 27. Diabetes Care 2005; 28: 617-25. http://dx.doi.org/10.2337/diacare.28.3.617 DOI: https://doi.org/10.2337/diacare.28.3.617

Hanis CL, Chu HH, Lawson K, Hewett-Emmett D, Barton SA, Schull WJ, et al. Mortality of Mexican Americans with NIDDM. Retinopathy and other predictors in Starr Country, Texas. Diabetes Care 1993; 16: 82-9. http://dx.doi.org/10.2337/diacare.16.1.82 DOI: https://doi.org/10.2337/diacare.16.1.82

Miettinen H, Haffner SM, Letho S, Ronnemaa T, Pyorala K, Laakso M. Retinopathy predicts coronary heart disease events in NIDDM patients. Diabetes Care 1996; 19: 1445-8. http://dx.doi.org/10.2337/diacare.19.12.1445 DOI: https://doi.org/10.2337/diacare.19.12.1445

Van Hecke MV, Dekker JM, Nijpels G, Moll AC, Van Leiden HA, Heine RJ, et al. Retinopathy is associated with cardiovascular and all-cause mortality in both diabetic and non-diabetic subjects. The Hoorn study. Diabetes Care 2003; 26: 2958-9. http://dx.doi.org/10.2337/diacare.26.10.2958

Fuller JH, Stevens LK, Wang SL. Risk factors for cardiovascular mortality and morbidity: the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001; 44: S54-S64. http://dx.doi.org/10.1007/PL00002940 DOI: https://doi.org/10.1007/PL00002940

Klein R, Klein BEK, Moss SE, Cruickshanks KJ. Association of ocular disease and mortality in a diabetic population. Arch Ophthalmol 1999; 117: 1487-95. http://dx.doi.org/10.1001/archopht.117.11.1487 DOI: https://doi.org/10.1001/archopht.117.11.1487

Juutilainen A, Letho S, Ronnemaa T, Pyorala K, Laakso M. Retinopathy predicts cardiovascular mortality in type 2 diabetic men and women. Diabetes Care 2007; 30: 292-9. http://dx.doi.org/10.2337/dc06-1747

Targher G, Bertolini L, Zenari L, Lippi G, Pichirit I, Zoppinit G, et al. Diabetic retinopathy is associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetic Med 2008; 25: 45-50. http://dx.doi.org/10.1111/j.1464-5491.2007.02327.x DOI: https://doi.org/10.1111/j.1464-5491.2007.02327.x

Wilkinson CP, Ferris FL, Klein RE, Lee PP, Agardh CD, Davis M, et al. Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 2003; 110: 1677-82. http://dx.doi.org/10.1016/S0161-6420(03)00475-5 DOI: https://doi.org/10.1016/S0161-6420(03)00475-5

Van Hecke MV, Dekker JM, Stehouwer CD, Polak BC, Fuller JH, Sjolie AK, et al. Diabetic retinopathy is associated with mortality and cardiovascular incidence: the EURODIAB prospective complications study. Diabetes Care 2005; 28: 1383-9. http://dx.doi.org/10.2337/diacare.28.6.1383 DOI: https://doi.org/10.2337/diacare.28.6.1383

Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353: 2643-53. http://dx.doi.org/10.1056/NEJMoa052187 DOI: https://doi.org/10.1056/NEJMoa052187

Klein R, Moss SE, Klein BE, DeMets DL. Relation of ocular and systemic factors to survival in diabetes. Arch Intern Med 1989; 149: 266-72. http://dx.doi.org/10.1001/archinte.1989.00390020016004 DOI: https://doi.org/10.1001/archinte.149.2.266

Targher G, Bertolini L, Tessari R, Zenari L, Arcaro G. Retinopathy predicts future cardiovascular events among type 2 diabetic patients: the Valpolicella Heart Diabetes Study (letter). Diabetes Care 2006; 29: 1178. http://dx.doi.org/10.2337/dc06-0233 DOI: https://doi.org/10.2337/dc06-0233

Van Hecke MV, Dekker JM, Nijpels G, Moll AC, Van Leiden HA, Heine RJ, et al. Retinopathy is associated with cardiovascular and all-cause mortality in both diabetic and nondiabetic subjects: the Hoorn Study (letter). Diabetes Care 2003; 26: 2958. http://dx.doi.org/10.2337/diacare.26.10.2958 DOI: https://doi.org/10.2337/diacare.26.10.2958

Juutilainen A, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Retinopathy predicts cardiovascular mortality in type 2 diabetic men and women. Diabetes Care 2007; 30: 292-9. http://dx.doi.org/10.2337/dc06-1747 DOI: https://doi.org/10.2337/dc06-1747

Wang JJ, Liew G, Wong TY, Smith W, Klein R, Leeder S, Mitchell P. Retinal vascular caliber and the risk of coronary heart disease-related death. Heart 2006; 92: 1583-7. http://dx.doi.org/10.1136/hrt.2006.090522 DOI: https://doi.org/10.1136/hrt.2006.090522

Wong TY, Klein R, Couper DJ, Couper LS, SHahar E, Hubbard LD, et al. Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study. Lancet 2001; 358: 1134-40. http://dx.doi.org/10.1016/S0140-6736(01)06253-5 DOI: https://doi.org/10.1016/S0140-6736(01)06253-5

Wong TY, Klein R, Sharrett AR, Duncan BB, Couper DJ, Tielsch JM, et al. Retinal arteriolar narrowing and risk of coronary heart disease in men and women: the Atherosclerosis Risk in Communities Study. JAMA 2002; 287: 1153-9. http://dx.doi.org/10.1001/jama.287.9.1153 DOI: https://doi.org/10.1001/jama.287.9.1153

Wong TY, Rosamond W, Chang PP, Couper DJ, Sharrett AR, Hubbard LD, et al. Retinopathy and risk of congestive heart failure. JAMA 2005; 293: 63-9. http://dx.doi.org/10.1001/jama.293.1.63 DOI: https://doi.org/10.1001/jama.293.1.63

Kajita K, Ishizuka T, Miura A, Kanoh Y, Ishizawa M, Kimura M, et al. Increased platelet aggregation in diabetic patients with microangiopathy despite good glycemic control. Platelets 2001; 12(6): 343-51. http://dx.doi.org/10.1080/09537100120078386 DOI: https://doi.org/10.1080/09537100120078386

Abu el-Asrar AM, Soliman RT, al Amro SA, al-Shammary FJ. Production of superoxide anion by polymorphonuclaer leukocytes from diabetic patients with or without diabetic retinopathy. Doc Ophthalmol 1995-1996; 91(3): 243-54. http://dx.doi.org/10.1007/BF01204175 DOI: https://doi.org/10.1007/BF01204175

De La Cruz JP, Moreno A, Guerrero A, Ortega G, Gonzalez-Correa JA, Sanchez de la Cuesta F. Nitric oxide-cGMP and prostacyclin-cAMP pathways in patients with tpe II diabetes and different types of retinopathy. Pathophysiol Haemost Thromb 2002; 32(1): 25-32. http://dx.doi.org/10.1159/000057285 DOI: https://doi.org/10.1159/000057285

Tan K, Lessieur E, Cutler A, Nerone P, Vasanji A, Asosingh K, et al. Impaired function of circulating CD34+CD45- cells in patients with proliferative diabetic retinopathy. Experimental Eye Res 2010; 91: 229-37. http://dx.doi.org/10.1016/j.exer.2010.05.012 DOI: https://doi.org/10.1016/j.exer.2010.05.012

Maleki MT, Osmenda G, Walus-Miarka M, Skupien J, Cyganek K, Mirkiewicz-Sieradzeka B, et al. Retinopathy in type 2 diabetes mellitus is associated with increased intima-media thickness and endothelial dysfunction. Eur J Clin Invest 2008; 38(12): 925-30. http://dx.doi.org/10.1111/j.1365-2362.2008.02051.x DOI: https://doi.org/10.1111/j.1365-2362.2008.02051.x

Bissinger A, Grycewicz T, Grabowicz W, Lubinski A. Endothelial function and left ventricular remodeling in diabetic and non-diabetic patients after acute coronary syndrome. Med Sci Monit 2011; 17(2): CR73-77. http://dx.doi.org/10.12659/MSM.881390 DOI: https://doi.org/10.12659/MSM.881390

Baykan M, Erdogan T, Erem C, Hacihasanoglu A, Gedikli O, Kucukosmanoglu M, et al. The relationship between flow mediated dilatation and left ventricular function in type 2 diabetic patients with microalbuminuria. Endocrine 2006; 30(2): 197-202. http://dx.doi.org/10.1385/ENDO:30:2:197 DOI: https://doi.org/10.1385/ENDO:30:2:197

Asao K, Kao L, Baptiste-Roberts K, Bandeen-Roche K, Erlinger TP, Brancati FL. Short stature and the risk of adiposity, insulin resistance, and type 2 diabetes in middle age. Diabetes Care 2006; 29: 1632-7. http://dx.doi.org/10.2337/dc05-1997 DOI: https://doi.org/10.2337/dc05-1997

Guerrero-Igea FJ, Lepe-Jimenez JA, Garrido-Serrano A, Palomo-Gil S. Association among hyperinsulinemia, family history of diabetes, and diminutive stature in normoglycemic premenopausal women (letter). Diabetes Care 2001; 24: 602-3. http://dx.doi.org/10.2337/diacare.24.3.602-a DOI: https://doi.org/10.2337/diacare.24.3.602-a

Smith GD, Greenwood R, Gunnell D, Sweetnam P, Yarnell J, Elwood P. Leg length, insulin resistance, and coronary heart disease risk: the Caerphilly Study. J Epidemiol Community Health 2001; 55: 867-72. http://dx.doi.org/10.1136/jech.55.12.867 DOI: https://doi.org/10.1136/jech.55.12.867

Lawlor DA, Ebrahim S, Davey SG. The association between components of adult height and type II diabetes and insulin resistance: British Women’s Heart and Health Study. Diabetologia 2002; 45: 1097-106. http://dx.doi.org/10.1007/s00125-002-0887-5 DOI: https://doi.org/10.1007/s00125-002-0887-5

Njolstad I, Arnesen E, Lund-Larsen PG. Sex differences in risk factors for clinical diabetes mellitus in a general population: a 12 year follow up of the Finnmark Study. Am J Epidemiol 1998; 147: 49-58. http://dx.doi.org/10.1093/oxfordjournals.aje.a009366 DOI: https://doi.org/10.1093/oxfordjournals.aje.a009366

Waden J, Forsblom C, Thorn LM, Saraheimo M, Rosengard-Barlund M, Heikkila O, et al. Adult stature and diabetes complications in patients with type 1 diabetes. Diabetes 2009; 58: 1914-20. http://dx.doi.org/10.2337/db08-1767 DOI: https://doi.org/10.2337/db08-1767

Arenz S, Ruckerl R, Koletzko B, von Kries R. Breast feeding and childhood obesity: a systematic review. Int J Obes Relat Metab Disorde 2004; 28: 1247-56. http://dx.doi.org/10.1038/sj.ijo.0802758 DOI: https://doi.org/10.1038/sj.ijo.0802758

Pettitt DJ, Forman MR, Hanson RL, Knowler WC, Bennett PH. Breastfeeding and incidence of non-insulin dependent diabetes mellitus in Pima Indians. Lancet 1997; 350: 166-8. http://dx.doi.org/10.1016/S0140-6736(96)12103-6 DOI: https://doi.org/10.1016/S0140-6736(96)12103-6

Rosenfeld RG. Insulin like growth factors and the basis of growth. N Engl J Med 2003; 349: 2184-6. http://dx.doi.org/10.1056/NEJMp038156 DOI: https://doi.org/10.1056/NEJMp038156

Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet 1993; 341: 938-41. http://dx.doi.org/10.1016/0140-6736(93)91224-A DOI: https://doi.org/10.1016/0140-6736(93)91224-A

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2013-03-31

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Blum, A., & Socea, D. (2013). Clinical Characteristics of Diabetic Patients with Diabetic Retinopathy. Journal of Nutritional Therapeutics, 2(1), 46–52. https://doi.org/10.6000/1929-5634.2013.02.01.6

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