Objective To investigate the relationship between glomerular filtration rate (GFR) and diabetic retinopathy (DR) and macular thickness in patients with type 2 diabetes mellitus (T2DM). Methods A total of 161 T2DM inpatients were enrolled in this study. There were 95 males (95 eyes) and 66 females (66 eyes), with an average age of (62.2±11.0) years. The average duration of diabetes was (14.8±7.9) years. The patients were grouped according to the degree of DR. Among them, 91 patients were no DR, 24 patients were mild non-proliferative DR (NPDR), 24 patients were moderate NPDR, 13 patients were severe NPDR and 9 eyes were proliferative DR (PDR). Severe NPDR and PDR were combine into severe DR group for statistical analysis. All patients underwent direct ophthalmoscope, fundus colorized photography, spectral domain optical coherence tomography (SD-OCT), fasting blood-glucose, glycated hemoglobin and renal function examinations. GFR was evaluated by99 mTcDTPA. DR degree was evaluated by direct ophthalmoscope and fundus colorized photography. Central subfield (CSF), central macular volume and mean retinal thickness (MRT) were measure by SD-OCT. The correlation between GFR and DR staging and macular retinal thickness were analyzed by Spearman correlation analysis and Pearson correlation analysis. Logistic regression analysis was used to analyze the correlation between GFR and presence of DR. Results GFR was gradually decreased in patients with no DR, mild NPDR, moderate NPDR and severe DR (F=12.32,P＜0.001). Pearson correlation analysis demonstrated that GFR was negatively correlated to CSF (r=−0.202,P=0.010); but no correlation with MRT (r=−0.087,P=0.272). Spearman correlation analysis demonstrated that GFR was negatively correlated to DR staging (r=−0.325,P＜0.001). The difference of DR prevalence rate in normal, slight abnormal renal function and renal insufficiency patients was significant (χ2=12.32,P=0.002). Logistic regression analysis demonstrated that lower levels of GFR was significantly associated with presence of DR (95% confidence interval=1.71–4.32, odds ratio=2.72,P＜0.001). Conclusion In T2DM patients, GFR is negatively correlated to DR staging and CSF. Lower GFR is independent risk factors for DR.
Objective To determine the clinical efficacy of probucol in patients with diabetic macular edema (DME) and elevated serum lipids after focal/grid laser photocoagulation. Methods A prospective randomized controlled study included 48 type 2 diabetic patients with DME and dyslipidemia which were randomly divided into three groups. For patients with bilateral disease only the more severe eye was included. All patients were subjected to strict metabolic and blood pressure control during enrollment. All cases received macular laser photocoagulation. Besides, sixteen patients in group A were treated with probucol, 16 members in group B with atorvastatin and 16 members in group C were not treated with any lipid-lowering therapy for about three months. The outcome measurements were status of macular edema and hard exudates, visual acuity, foveal thickness, serum lipids and urine 8-hydroxydeoxyguanosine (8-OHdG) during the three months. Results The study included 20 men and 28 women with noninsulin dependent diabetes mellitus who could achieve good metabolic and blood pressure control within three months of inclusion in the study. Thirteen of 16 patients in group A, twelve of 16 patients in group B and five of 16 patients in group C showed reduction in hard exudates. Regression of macular edema was seen in twelve patients in group A, 11 in group B and eight in group C (χ2=2.368,P＞0.05). The difference of foveal thickness in group A, B and C was statistically significant (t=4.929, 4.669; P=0.000). Nine patients in group A, eight in group B and six in group C showed improving of visual acuity (χ2=1.169,P＞0.05). Three months after treatment, triglycerides (TG) (t=7.954, 6.832; P＜0.05), total cholesterol (TC) (t=6.643, 5.368; P＜0.05) and low-density lipoprotein cholesterol (LDLC) (t=3.279, 3.835; P＜0.05) decreased in group A and group B but not in group C, and high-density lipoprotein cholesterol showed no significant difference in the three groups. 8-OHdG decreased gradually during the first and third month in group A and group B but not in group C. In the first month post treatment, 8-OHdG showed no difference between group A and group B. In the third month, the 8-OHdG was lower in group A than group B, and the difference was statistically significant (t=2.947,P＜0.05). ConclusionsIn type 2 diabetes patients with DME and dyslipidemia, oral probucol can reduce the severity of hard exudates and macular edema, improve the visual acuity, and inhibit the levels of TG, TC, LDLC and 5-OHdG. The effect of probucol was similar to atorvastatin. Probucol could be an adjunct treatment of those patients.
ObjectiveTo observe and analyze the correlation between time within target glucose range (TIR) and hemoglobin A1c (HbA1c) and the risk of diabetic retinopathy (DR). MethodsA retrospective clinical study. From March 2020 to August 2021, 91 patients with type 2 diabetes mellitus (T2DM) who were hospitalized in Department of Endocrinology and Metabolic Diseases, Affiliated Hospital of Weifang Medical University, were included in the study. All patients underwent Oburg's no-dilatation ultra-wide-angle laser scan ophthalmoscopy, HbA1c and continuous glucose monitoring (CGM) examinations. According to the examination results and combined with the clinical diagnostic criteria of DR, the patients were divided into non-DR (NDR) group and DR group, with 50 and 41 cases respectively. The retrospective CGM system was used to monitor the subcutaneous interstitial fluid glucose for 7 to 14 consecutive days, and the TIR was calculated. Binary logistic regression was used to analyze the correlation between TIR, HbAlc and DR in patients with T2DM0. At the same time, a new indicator was generated, the predicted probability value (PRE_1), which was generated to represent the combined indicator of TIR and HbA1c in predicting the occurrence of DR. The receiver operating characteristic curve (ROC curve) was used to analyze the value of TIR, HbAlc and PRE_1 in predicting the occurrence of DR. ResultsThe TIR of patients in the NDR group and DR group were (81.58±15.51)% and (67.27±22.09)%, respectively, and HbA1c were (8.03±2.16)% and (9.01±2.01)%, respectively. The differences in TIR and HbA1c between the two groups of patients were statistically significant (t=3.501,－2.208; P=0.001, 0.030). The results of binary logistic regression analysis showed that TIR, HbA1c and DR were significantly correlated (odds ratio=0.960, 1.254; P=0.002, 0.036). ROC curve analysis results showed that the area under the ROC curve (AUC) of TIR, HbA1c and PRE_1 predicting the risk of DR were 0.704, 0.668, and 0.707, respectively [95% confidence interval (CI) 0.597-0.812, P=0.001; 95%CI 0.558-0.778, P=0.006; 95%CI 0.602-0.798, P=0.001]. There was no statistically significant difference between TIR, HbA1c and PRE_1 predicting the AUC of DR risk (P>0.05). The linear equation between HbAlc and TIR was HbAlc (%) = 11.37－0.04×TIR (%). ConclusionsTIR and HbA1c are both related to DR and can predict the risk of DR. The combined use of the two does not improve the predictive value of DR. There is a linear correlation between TIR and HbAlc.
Objective To investigate the relationship between subclinical hypothyroidism (SCH) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). Methods A total of 792 patients of T2DM were enrolled in the study. There were 448 males and 344 females, with an average age of (54.13±13.06) years. The average duration of diabetes was (8.03±6.70) years. The patients were grouped according to the degree of DR and thyroid function. Among them, 483 patients (61.0%) were no DR, 240 patients (30.3%) were mild DR, 69 patients (8.7%) were severe DR. 725 patients (91.5%) were normal thyroid function, 67 patients (8.5%) were SCH. The prevalence of SCH among no DR group, mild DR group and severe DR group was compared. And the prevalence of DR between normal thyroid function group and SCH group was compared. Logistic regression analysis was used to estimate the association between SCH and DR. Results No significant differences among the three groups (no DR group, mild DR group, severe DR group) were found in the prevalence of SCH (χ2=1.823,P=0.402). There were no significant differences in the incidences of DR between normal thyroid function group and SCH group (χ2=1.618,P=0.239). Logistic regression analysis demonstrated that SCH was not significant associated with DR [mild DR: odds ratio (OR)=1.361, 95% confidence interval (CI)=0.773−2.399,P=0.286; severe DR:OR=1.326, 95%CI=0.520−3.384,P=0.555; DR:OR=1.353, 95%CI=0.798−2.294,P=0.261). Conclusion SCH is not significant associated with DR in patients with T2DM.
ObjectiveTo observe the serum vascular endothelial growth factor (VEGF), apelin and heme oxygenase-1 (HO-1) levels in patients with type 2 diabetes mellitus (T2DM) and to explore their their relationship with diabetic retinopathy (DR).MethodsA total of 208 patients with T2DM and 50 healthy subjects (control group) from the Central Hospital of Western Hainan during January 2014 and December 2017 were selected in this study. Vision, slit lamp microscope, indirect ophthalmoscope and FFA examinations were performed on all the subjects. According to the results of the examinations combined with the DR clinical staging criteria, the patients were divided into non-DR (NDR) group, non-proliferative DR (NPDR) group, and proliferative DR (PDR) group, with 72, 76 and 60 patients in each, respectively. The clinical data of each group were recorded, and the levels of fasting blood glucose (FPG), HbA1c, total cholesterol (TC), three acylglycerol (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), VEGF, apelin and HO-1 were detected in each group. The receiver operating characteristic curve (ROC) were used to analyze the value of VEGF, apelin and HO-1 in predicting the occurrence of PDR. Correlation analysis of serum VEGF, Apelin and HO-1 with clinical parameters in PDR patients by Pearson correlation analysis.ResultsThe level of VEGF (56.82±10.16 vs 91.74±22.83, 140.15±36.40, 195.28±42.26 pg/ml) and apelin (2.95±0.53 vs 4.68±0.74, 7.25±1.13, 10.16±1.35 ng/ml) in PDR group were significantly higher than those in NPDR, NDR and control groups (F=17.306, 21.814; P＜0.05). The level of HO-1 (50.37±10.14 vs 43.58±8.16, 30.25±6.28, 22.60±4.72 mmol/L) in PDR group was significantly lower than those in NPDR, NDR and control groups (F=15.827, P＜0.05). The ROC curve analysis showed that the best cut-off values of serum VEGF, apelin and HO-1 were 162.50 pg/ml, 8.30 ng/ml, 27.13 mmol/L, and the three combined to predict PDR of AUC (95%CI) was 0.906 (0.849−0.962), and their sensitivity (90.3%) and specificity (83%) were better. The correlation analysis showed that the VEGF, apelin and HO-1 of PDR patients were correlated with the course of diabetes (r=0.382, 0.416, −0.36; P＜0.05), FPG (r=0.438, 0.460, −0.397; P＜0.05) and HbAlc (r=0.375, 0.478, −0.405; P＜0.05), and the serum VEGF were correlated with apelin and HO-1 (r=0.793, −0.594; P＜0.01).ConclusionElevated serum VEGF and apelin levels and reduced HO-1 levels are associated with the progression of DR, and the three combination helps predict the occurrence of PDR.
ObjectiveTo assess the association of hemoglobin (Hb) levels with the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).MethodsA cross-sectional study. From January 2017 to December 2018, 707 patients with T2DM who were hospitalized in the Department of Internal Medicine of Chu Hsien-I Memorial Hospital & Tianjin Medical University, were included in the study. All patients underwent color photography of the fundus of both eyes with dilated pupils. According to DR diagnostic criteria, patients were divided into DR group and non-DR (NDR) group, with 210 and 497 cases, respectively; DR group was further divided into non-proliferative DR group (NPDR) group and proliferative DR (PDR) group, about 186, 24 cases, respectively. Hb level was detected, single factor analysis of its correlation with DR; logistic regression analysis was used to evaluate the relationship between Hb level and DR risk.ResultsThe Hb levels of the patients in the NDR group and the DR group were 140.58±17.26 and 132.35±23.48 g/dl; compared with the NDR group, the Hb level of the DR group was significantly lower, and the difference was statistically significant (t=5.107, P=0.000). In the NDR group, NPDR group, and PDR group, Hb levels of male patients were 149.3±1.01, 142.6±2.35, 132.9±8.44 g/dl, respectively; Hb levels of female patients were 131.7±0.90, 124.0±2.09, 116.8±5.23 g/dl. With the progress of DR, Hb levels of different sexes decreased significantly, and the difference was statistically significant (P＜0.000 1). The results of correlation analysis showed that Hb reduction was an independent risk factor for DR (odds ratio=4.437, 95% confidence interval 2.590-7.603, P＜0.000 1).ConclusionThe reduction of Hb in T2DM patients is positively correlated with the severity of DR.
ObjectiveTo investigate the risk factors for retinopathy in type 2 diabetes patients. MethodsA total of 112 patients with type 2 diabetes treated between December 2009 and December 2012 were divided into two groups. Fifty-two patients had no diabetic retinopathy (NDR group) and 60 had diabetic retinopathy (DR group). Blood pressure, blood lipids, and blood glucose were detected to analyze the correlation of retinopathy with disease course, blood pressure, blood lipid, and blood sugar. ResultsDisease course was longer and blood glucose level was higher in DR group than in NDR group (P<0.05). Logistic regression analysis results showed that the incidence of retinopathy was correlated with blood glucose[OR=1.490, 95% CI (1.123, 1.976), P=0.006] and disease course[OR=2.207, 95% CI (1.579, 3.085), P=0.000]. ConclusionBlood glucose and disease course may be the risk factors for DR. Active control of the blood glucose can be benefit for the prevention and treatment of DR.
Objective To observe the serum betatrophin levels in patients with type 2 diabetes mellitus (T2DM) and to explore the role of betatrophin in the pathogenesis of diabetic retinopathy (DR). Methods A total of 59 patients with T2DM (DM group) and 14 healthy controls (NC group) were enrolled in the study. Vision, slit lamp microscope, indirect ophthalmoscope, fluorescein fundus angiography were performed on all the subjects. According to the results of the examination combined with the international DR clinical staging criteria, the patients were divided into no DR (Non-DR) group, non-proliferative DR (NPDR) group, and proliferative DR (PDR) group, with 30, 20 and 9 patients in each, respectively. The fasting blood glucose (FPG), insulin (FIN), C-peptide, glycated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipid Protein (LDL-C) levels were detected. The level of betatrophin in serum was determined by enzyme-linked immunosorbent assay. The correlation between betatrophin and other indicators was analyzed by Spearman correlation. The influencing factors of PDR were analyzed by logistic regression. Results Compared with subjects in the NC group, the level of FPG (F=-4.316, P＜0.001), FIN (F=2.142, P=0.001), HbA1c (F=-5.726, P＜0.001), TC (t=3.609, P=0.010), LDL-C (t=0.000, P=0.003), and betatrophin (F=-2.263, P=0.024) were significantly increased and HDL-C level (F=-3.924, P＜0.001) was decreases in the DM group. The difference of TG level between two groups was not statistically significant (F= -1.422, P=0.155). Compared with the Non-DR group and the NPDR group, the serum C-peptide (F=7.818, P=0.020) and betatrophin levels (F=12.141, P=0.002) were significantly increased in the PDR group. Spearman correlation analysis showed that the levels of betatrophin in the DM group was positively correlated to TC (r=0.304, P=0.019). The serum levels of betatrophin was positively correlated to body mass index in the Non-DR group (r=0.513, P=0.004). Furthermore, in the PDR group, a significant positive correlation was observed between the serum betatrophin levels and diastolic blood pressure (r=0.685, P=0.042). Logistic regression analysis showed that the duration of diabetes, serum C-peptide and betatrophin levels were risk factors for PDR. After controlling for the duration and serum C-peptide, the PDR risk for betatrophin levels great than or equal to 1.0 ng/ml was 12 times as much as betatrophin levels less than 1.0 ng/ml in T2DM patients. Conclusions The serum betatrophin content of patients with T2DM is abnormal. Betatrophin may be involved in the occurrence and development of PDR.
Objectives To assess the efficacy and safety of metformin plus rosiglitazone in treating type 2 diabetes mellitus. Methods Based on the principles and methods of Cochrane systematic reviews, we searched the CochraneLibrary (2008, 4 issue), PubMed (1966 to October 19, 2008), Embase (1974 to October 19, 2008), China BiomedicalLiterature Database (1978 to October 12, 2008), China Journal Fulltext Database (1994 to October 12, 2008), ChineseScientific Journals Full text Database (1989 to October 12, 2008). Randomized controlled trials (RCTs) of Metforminplus roziglitazone versus metformin for type 2 diabetes were included. We assessed the quality of the included RCTsaccording to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results Twelve RCTs totaling 3020 patients were included. Metaanalysis showed that Glycosylated hemoglobin levels [WMD= – 0.48%, 95%CI (– 0.74, – 0.22), P=0.000 3], fasting plasma glucose levels [WMD= – 1.03mmol/L, 95%CI (– 1.85, – 0.75), Plt;0.000 01], insulin sensitivity, and β-cell function improved significantly with metformin plus rosiglitazone therapy. Compared with the metformin monotherapy group, patients treated with metformin plus rosiglitazone had more edema events [RR= 3.27, 95%CI (1.80, 5.91), Plt;0.000 1] and lower gastro-intestinal events [RR= 0.82, 95%CI (0.71, 0.94), P=0.004]. We found no statistically significant effect on body weight, the percentage of patients with at least one adverse event, and hypoglycemia events. Conclusions Current evidence demonstrates that combination treatment with metformin plus rosiglitazone improves glycemic control, insulin sensitivity, and cells function more effectively than with metformin monotherapy. Side effects of two types of therapy have differences in performance.
Objective To observe the amount of endothelial progenitor cells (EPCs) at different stages of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (DM). Methods Sixty patients with type 2 DM were divided into no DR (NDR) group, non-proliferative DR (NPDR)group and proliferative DR (PDR)group according to the examination of fundus and fundus fluorescein angiography, 20 patients in each group. Twenty healthy people were collected as the control group. 6 ml blood samples were taken from all the subjects, and then the EPCs contents in peripheral blood were detected by flow cytometry. Results The EPCs contents in peripheral blood of the control, NDR, NPDR and PDR group were (0.0179plusmn;0.0047)%, (0.0151plusmn;0.0086)%, (0.0123plusmn;0.1137)%, (0.0316plusmn;0.0 294)%. The EPCs contents in peripheral blood of the PDR group was significantly higher than those in others (chi;2=43.780, P＜0.05); the EPCs contents in peripheral blood of the NDR and NPDR group were slightly lower than that in the control group (chi;2=5.244, P=0.73); the EPCs contents in peripheral blood of the NPDR group was lower than that in the NDR group (chi;2=6.016, P=0.12). Conclusion The EPCs contents in peripheral blood decreases in NDR, NPDR patients, while significantly increases in PDR patients.