Early Retinal and Renal Abnormalities in Diabetes (original) (raw)
Related papers
2007
Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of blindness in the working-aged population of most developed countries. The increasing number of persons with diabetes worldwide suggests that DR/DME will continue to be major contributors to vision loss and associated functional impairment for years to come. Early detection of retinopathy in persons with diabetes is critical in preventing visual loss, but current methods of screening fail to identify a sizable number of high-risk patients. The control of diabetes-associated metabolic abnormalities (ie, hyperglycemia, hyperlipidemia, and hypertension) is also important in preserving visual function, as these conditions have been identifi ed as risk factors for both the development and progression of DR/DME. The non-pharmacologic interventions for DR/DME, laser photocoagulation and vitrectomy, only target advanced stages of disease. Several biochemical mechanisms, including increased vascular endothelial g...
Pathophysiological Ramifications of Diabetic Condition: A Review
Asian Journal of Biomedical and Pharmaceutical Sciences
Diabetes is a chronic hyperglycaemic disorder. Due to altered metabolism of insulin and related pathways, consistently raised blood glucose levels leads to manifestation of collateral pathophysiologies or complications. Such long term complications include cardiovascular diseases, nephropathy, neuropathy and retinopathy. Microvascular complications are the major cause of these pathologies. Understanding the etiology of these complications is important to devise effective prevention and treatment strategies. Therefore, the current review was undertaken to enumerate various diabetes related pathologies, the relevant mechanisms, disease progression and available treatment options. The data was collected from major indexing services like-PubMed, Scopus, Google Scholar and some related journals which fall under the scope of the review paper. The major keywords which were used for the collection of data include diabetes, pathophysiology of diabetes, comorbidities of diabetes, diabetes complications, diabetes management, diagnosis of diabetes, diagnosis of comorbidities of diabetes etc. Most of the articles referred are published in last 8 years. However, some relevant articles are also considered which are published before this time frame.
Link between retinopathy and nephropathy caused by complications of diabetes mellitus type 2
International Ophthalmology, 2014
While the correlation and chronology of appearance of diabetic nephropathy and retinopathy is well known in diabetes mellitus (DM) type 1 patients, in DM type 2 this correlation is less clear. A retrospective study including 917 patients with type 2 diabetes. Diabetic retinopathy (DR) was diagnosed based on fundus photographs taken with a non-mydriatic camera. Diabetic nephropathy (DN) was diagnosed based on urinary albumin concentration in a morning urine sample. Statistical analysis was performed with a seemingly unrelated regression (SUR) model. Our SUR model is statistically significant: the test for ''model versus saturated'' is 2.20 and its significance level is 0.8205. The model revealed that creatinine and glomerular filtration rate (GFR) have strong influence on albuminuria, while body mass index (BMI) and
General aspects of diabetes mellitus
Handbook of clinical neurology, 2014
Diabetes mellitus is a heterogeneous group of disorders characterized by hyperglycemia due to an absolute or relative deficit in insulin production or action. The chronic hyperglycemia of diabetes mellitus is associated with end organ damage, dysfunction, and failure, including the retina, kidney, nervous system, heart, and blood vessels. The International Diabetes Federation (IDF) estimated an overall prevalence of diabetes mellitus to be 366 million in 2011, and predicted a rise to 552 million by 2030. The treatment of diabetes mellitus is determined by the etiopathology and is most commonly subdivided in type 1 and type 2 diabetes mellitus. There is a greater propensity towards hyperglycemia in individuals with coexisting genetic predisposition or concomitant drug therapy such as corticosteroids. The screening for diabetes mellitus may either be in the form of a 2hour oral glucose tolerance test, or via HbA1c testing, as recently recommended by the American Diabetes Association (...
Journal of Diabetes and its Complications, 2009
To determine the differences observed between two transversal studies separated 14 years. Methods: The sample was obtained by randomized hazard selection of 1157 Type 2 and 93 Type 1 diabetic patients in the 2006 study, and 741 Type 2 and 76 Type 1 diabetic patients in the 1993 study. We evaluate the prevalence of diabetic retinopathy (DR), microalbuminuria, overt nephropathy, and its risk factors. Results: In Type 2 diabetic patients, we observed a decrease of the prevalence of DR from 39.41% in the 1993 study to 27.48% in the 2006 study, but we did not observe it in Type 1 diabetic patients-35.52% in 1993 to 36.55% in 2006. The diabetic macular edema prevalence is similar in both studies-7.15% in 1993 and 7.86% in 2006 in Type 2 patients, and 11.84-12.90% in Type 1; microalbuminuria decreased in Type 2 but not in Type 1 patients (from 22.13% to 17.02% in Type 2, and 28.33-27.95% in Type 1); overt nephropathy decreased in both types of diabetic patients
Factors associated with diabetic nephropathy in subjects with proliferative retinopathy
International Urology and Nephrology, 2012
Aim The purpose was to compare the phenotype of subjects with type 2 diabetes mellitus having both retinopathy and nephropathy with that of subjects having retinopathy but no nephropathy. Methods We recruited 196 subjects; 85 were normoalbuminuric (controls), whilst cases consisted of patients with micro-(n = 66) or macroalbuminuria (n = 45). Both groups underwent 24-h blood pressure (BP) monitoring and were analysed regarding markers of the metabolic syndrome, inflammation (erythrocyte sedimentation rate [ESR] and high-sensitivity CRP [hsCRP]) and insulin resistance (HOMA-IR). Results Cases had significantly higher white cell count (P = 0.02), ESR (P \ 0.001), platelets (P = 0.02), triglycerides (P = 0.001), uric acid (P \ 0.001), daytime and night-time systolic BP (P = 0.001 & P = 0.001, respectively), diastolic BP (P = 0.007 & P = 0.001), pulse pressure (P = 0.02 & 0.055) and mean arterial pressure (P = 0.001 & P \ 0.001) in univariate analysis. Cases had a lower haemoglobin level (P = 0.01) and estimated glomerular filtration rate (eGFR) (P = 0.002) in comparison with controls. Multivariate analysis showed that night-time diastolic BP (P = 0.002, B = 1.057), platelet count (P = 0.018, B = 1.007) and eGFR (P \ 0.001, B = 0.097) are independent predictors of diabetic nephropathy. Platelet count (P = 0.045, B = 1.006), night-time mean diastolic BP (P = 0.029, B = 1.042) and eGFR (P = 0.001, B = 0.975) were also found to be independent predictors of the occurrence of microalbuminuria. Conclusions By analysing factors associated with diabetic nephropathy rather than microvascular disease in general, this study provides evidence that night-time diastolic BP and a relative increase in platelet count are associated with incipient diabetic nephropathy.
Prilozi - Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki, 2023
Introduction: Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and the leading cause of visual impairment and blindness. The aim of the study was to estimate and compare the prevalence of DR and to determine an association between DR and systemic risk factors in hospitalized type 1 (DMT1) and type 2 (DMT2) diabetic patients. Material and methods: We analyzed 260 patients with diabetes, 43 with DMT1 and 217 with DMT2. The following data were collected: age, gender, type and duration of diabetes, glycemic control, blood pressure, estimated glomerular filtration rate, ophthalmologic examinations and routine biochemical parameters. Results: Out of the total number of 260 patients, 77 (29.6%) had non-proliferative DR (NPDR), 21 (8.1%) had proliferative DR (PDR), 29 (11.1%) had diabetic macular edema (DME), and 69 (23.5%) had diabetic cataracts. Forty-three (16.5%) patients were previously diagnosed with DMT1 and 217 (83.5%) with DMT2. The duration of diabetes was not significantly longer in DMT1 (12.8±11.2 years) in comparison to DMT2 (11.07±8.1 years). The prevalence of NPDR and PDR did not differ statistically in either groups. DME was more prevalent in DMT2 than in DMT1 (P<0.05). Diabetic cataract was found in 26.7% vs. 6.7% of patients with DMT2 and DMT1, respectively (p<0.01). The duration of diabetes significantly correlated with NPDR and PDR in DMT1 (r=o.31, p<0.05; r=0.55, p<0.001, respectively). In DMT2, significant correlations were found between the duration of diabetes and cataract, NPDR, PDR and DME (r=0.31, p<0.001; r=0.43 p<0.01, r=0.16 p<0.05 and r=0.20 p<0.01, respectively). Fasting plasma glucose (FPG) significantly correlated with PDR (r=0.258, p<0.05), while HbA1c with DME (r= 0.15 p<0.05). Conclusion: The duration of diabetes and hyperglycemia were associated with DR in both types of diabetes.
Association of Diabetic Retinopathy, Albuminuria and CKD in Patients with Type 2 Diabetes Mellitus
Journal of Medical Science And clinical Research, 2018
Background: Retinopathy and renal involvement are two of the major microvascular complications of diabetes mellitus. Recent reports challenge the traditional view of renal involvement progressing from increased glomerular filtation to progressively increasing levels of albuminuria that culminate in chronic kidney disease, and have found that retinopathy and albuminuria may not always co-exist. This study was undertaken to understand the relationship between retinopathy, albuminuria and chronic kidney disease in patients with type 2 diabetes mellitus. Methods: One hundred patients with type 2 diabetes mellitus attending the diabetic clinic were evaluated for retinopathy and renal parameters that included a 24 urinary albumin excretion, serum creatinine and evidence of chronic kidney disease based on the estimated glomerular filtration rate. Results: 67 patients were found to have retinopathy, out of which 12 (17.9 %) had no evidence of any abnormal renal parameters, 25 (37.3%) had only abnormal albuminuria (microalbuminuria or macralbuminuria), one (1.5 %) had evidence of CKD, and 29 (43.3 %) had both albuminuria and CKD. 16 patients with CKD did not have any evidence of retinopathy. Conclusion: There was a statistically significant association between the presence and severity of retinopathy, and abnormal urinary excretion of albumin. A similar association between retinopathy and CKD was not seen.
Diabetologia, 2004
Aims/hypothesis. In a previous study conducted over the last decades we found a decreased incidence of nephropathy but unchanged incidence of severe retinopathy among patients with Type 1 diabetes diagnosed in childhood and with 20 years duration of diabetes. The aim of our current study was to investigate the incidence 5 to10 years later in the same population. Methods. We studied all 269 patients in whom Type 1 diabetes was diagnosed in childhood between 1961 and 1985 in a district in southeastern Sweden. Ninetyone percent were monitored for retinopathy until at least 1997 and 95% were monitored for nephropathy. Severe retinopathy was defined as laser-treated retinopathy and nephropathy as persistent proteinuria. Survival analysis was used and the patients divided into five cohorts according to the time of onset of diabetes. Results. The cumulative proportion of severe retinopathy had declined (p=0.006). After 25 years it was 47% (95% CI 34-61), 28% (15-40) and 24% (12-36) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years it was 53% (40-66) and 44% (28-59) in the oldest cohorts. The cumulative proportion of nephropathy after 25 years duration was 30% (18-42), 8% (1-16) and 13% (4-23
Nephrology Dialysis Transplantation, 2012
Introduction and Aims: The level and prognostic value of various cardiovascular biomarkers differ in patients with proteinuria and renal failure. Mean thrombocyte volume (MPV) is an independent cardiovascular disease (CVD) predictor in non-renal patients. The value of this marker in patients with diabetic nephropathy and factors related with this issue has not been investigated yet. The determination of MPV values in patients, which are at different stages of diabetic nephropathy and to compare these values with normal subjects as well as with diabetic subjects not having nephropathy. Also we aimed to find out the associated factors related with MPV Methods: Totally 621 patients consisting of 4 groups were recruited to this study. Group 1 was the control one consisting of 157 non-diabetic subjects. Group 2 with a number of 160 patients involved the subjects with type 2 diabetes mellitus (DM) which have not shown chronic complications yet. Group 3 with 144 subjects were the diabetic people showing clinical proteinuria (>500 mg/day) where as group 4 which had 160 people were composed of chronic kidney disease patients due to diabetes. For all groups; patients under antiaggregant and/or anticoagulant treatment, subjects with hematological and/or symptomatic cardiovascular disease were excluded from the study. MPV value, platelet count, serum creatinine level, lipid profile, fasting plasma glucose level, proteinuria and microalbuminuria in 24 hour collected urine, glomerular filtration rate (GFR), HbA1c, albumin, parathyroid hormone and demographic values were evaluated. Results: MPV level was found to be increased in diabetic subjects as the complication ratio increased (For all group comparisons p value <0.05). Gender status and smoking did not have effect on MPV values within the groups (p>0.05). While MPV values had positive correlation with the age, serum creatinine, HbA1c, waist circumstance, proteinuria and duration of the diabetes, a negative correlation with the GFR was detected (For all parameters p value <0.001, r values; 0.34, 0.39, 0.53, 0.56, 0.42, 0.56 and-0.36 respectively). Conclusions: MPV values were higher in diabetic groups than normal subjects, and tended to increase with the progression of diabetic nephropathy. HbA1c, waist circumstance, proteinuria and duration of the DM were found to be the most powerful determinants of MPV in patients with DM and diabetic nephropathy.