The effect of type 2 diabetes mellitus on the retina

doi:10.21203/rs.3.rs-2110260/v1

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The effect of type 2 diabetes mellitus on the retina

https://doi.org/10.21203/rs.3.rs-2110260/v1

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Aim

A retrospective study was undertaken at Damascus Hospital to investigate retinopathy and associated disorders in patients with type 2 diabetic mellitus (T2DM).

Methods

Between June and August 2022, Damascus Hospital patients with T2DM were found. In the archive department, patients' files were referred to, as were the results of eye examinations and digital fundus imaging, as well as the lab values requested for them when they visited the hospital. An ophthalmologist identified and classified the existence and severity of DR.

Results

The study included 77 diabetic patients, 33 of whom were males (45%) and 40 of whom were females (55%). The patients' median age was 56.15 years, and the average duration of diabetes was 16.41 years. We discovered non-proliferative diabetic retinopathy in 47 of the sample patients (64%), while proliferative diabetic retinopathy was detected in only 24 (33%). The proportion of diabetic retinopathy patients who did not have regulated glucose readings was 43% (p value 0.0346). The percentage of females who had no proliferative diabetic retinopathy was 75%, whereas males were 52%, resulting in a p value of 0.0370. We did not find any meaningful relationships between the presence of diabetic retinopathy and high total cholesterol values.

Conclusion

Type II diabetes mellitus is a risk factor for retinopathy, and female patients are more affected. Therefore, it is critical to keep blood glucose levels normal or close to normal, with periodic assessment by expert doctors to determine the extent of this condition's development.

Endocrinology & Metabolism

Ophthalmology

Diabetes mellitus

diabetic retinopathy

Damascus Hospital

The prevalence of type 2 diabetes (T2DM) is rising quickly across the globe [1]. One of the most common and harmful microvascular consequences of T2DM is diabetic retinopathy (DR). In mainland China, the incidence of DR varies from 11.9–43.1% [2, 3], and is estimated to be 34.6% [4]. DR is still the predominant cause of blindness among people of working age in both industrialized and developing nations [5]. However, when DR proceeds to late-stage illness, when eyesight is already compromised, there are few therapy choices available. A substantial socioeconomic burden is caused by late-stage DR, which necessitates recurrent treatments (laser photocoagulation or intravitreal injections of anti-vascular endothelial growth factor drugs) with disappointing results [6, 7]. Therefore, it is important to identify the risk factors that may be controlled in order to postpone the onset and progression of DR.

A number of risk factors, including chronic hyperglycemia, hypertension, dyslipidemia, long-term diabetes, obesity, and aging, contribute to DR [8, 9]. Large prospective randomized studies have demonstrated that intensive diabetes control with the aim of reaching near-normoglycemia can stop or postpone the formation and progression of diabetic retinopathy [10, 11]. It has been demonstrated that lowering blood pressure can slow the onset of retinopathy in people with type 2 diabetes, albeit strict objectives (systolic blood pressure of 120 mmHg) are not any more advantageous than aims of 140 mmHg [11, 12].

This contradiction underlines the requirement for more research into the relationship between DR and T2DM. Additionally, there is a dearth of information on the Syrian population, which recently has seen an increase in the number of T2DM patients. Therefore, the main goal of this study was to investigate the connection between DR and T2DM; the secondary goal was to find out how common DR was among patients with T2DM in Damascus hospital.

73 individuals with type 2 diabetes mellitus were included in a retrospective study at the Damascus hospital between June 2022 and August 2022. According to the grading of fundus color photos, all patients received thorough ocular examinations and were divided into DR groups and DR severity categories. Proliferative diabetic retinopathy (PDR) in DR patients was further characterized.

Eye examination:

All patients had standard operating procedure-compliant eye exams from specially qualified ophthalmologists. The eye tests included tonometry, anterior ocular structure, and fundus examinations using a defined technique, as well as assessments of visual acuity. A non-contact tonometer was used to assess the intraocular pressure in both eyes.

Statistical analysis:

The data was assembled using MS Excel, and it was then examined using SPSS 20.0. The mean and standard deviation were used as the descriptive statistics for quantitative variables, and frequencies and percentages were used for qualitative data. In order to create hypotheses, relationships between variables were examined using the correlation or unpaired t-test for quantitative data and the Chi-square test for qualitative variables.

A total of 73 participants—33 men and 40 women—had type 2 diabetes mellitus; their average age was 56.15 years. Patients who smoked were 42 patients (58%), whereas those who did not smoke were 31 patients (42%). 65 patients, or 89% of the total, used anti-diabetic medications, whereas 9 patients, or 12%, used insulin. Diabetic neuropathy and diabetic nephropathy were detected in 35 and 49 individuals, respectively, at 48% and 67%. Patients in the sample had random levels of blood glucose that, on average, were 280.45 mg/dL. (Table 1)

Table 1

Characteristics of the patients.
Age (mean, SD)	56.15 (± 12.57)
Random blood glucose	280.45 (± 91.74)
Gender
Male	33 (45)
Female	40 (55)
Smoking
Yes	42 (58)
No	31 (42)
Use of antidiabetic drugs
Yes	65 (89)
No	8 (11)
Insulin use
Yes	9 (12)
No	64 (88)
Diabetic neuropathy
Yes	35 (48)
No	38 (52)
Diabetic nephropathy
Yes	49 (67)
No	24 (33)

When we looked at diabetic retinopathy in sample patients, we discovered that non-proliferative diabetic retinopathy was present in 47 of them (64%), but proliferative diabetic retinopathy was only present in 24 of them (33%). The right eye suffered greater damage than the left, with 40 patients affected by 55%, 23 patients infecting the left eye by 32%, and 10 patients infecting both eyes by just 14%. The majority of the 71 individuals in the study had visual abilities that were 97% lower than normal. The number of patients categorized as having moderate, severe, or very severe retinopathy was 17, 28, and 28 individuals, at 23%, 38%, and 38%, respectively. (Table 2).

Table 2

Diabetic retinopathy prevalence and severity in patients
Non proliferative diabetic retinopathy	N (%)
Yes	47 (64)
No	26 (36)
Proliferative diabetic retinopathy
Yes	24 (33)
No	49 (67)
Site
Right eye	40 (55)
Left eye	23 (32)
Both of them	10 (14)
Low vision acuity
Yes	71 (97)
No	2 (3)
Degree of diabetic retinopathy
Moderate	17 (23)
Severe	28 (38)
Extremely severe	28 (38)

By examining the relationship between the presence of retinopathy and the patient's sex, we discovered that there was a statistically significant relationship between these variables. Since 75% of females and 52% of male patients had non-proliferative diabetic retinopathy, the p value for this relationship was 0.0370, indicating a relationship between these two variables. The incidence of proliferative diabetic retinopathy was greater in men than in women, with men having a percentage of 45% and women having only 23%; thus, the value of the p value was 0.0377, indicating a significant link between these variables. We could not detect any statistically significant associations between the site of the damage, the degree of diabetic retinopathy, or the limited visual ability, with p values of 0.478, 0.192, 0.445, and 0.465, respectively. (Table 3).

Table 3

The relationship between gender and diabetic retinopathy.
Diabetic retinopathy	Gender		P value
Diabetic retinopathy	Male	Female	P value
Non proliferative diabetic retinopathy			0.0370*
Yes	17 (52)	30 (75)
No	16 (48)	10 (25)
Proliferative diabetic retinopathy			0.0377*
Yes	15 (45)	9 (23)
No	18 (55)	31 (77)
Site			0.478
Right eye	20 (61)	20 (50)
Left eye	8 (24)	15 (38)
Both of them	5 (15)	5 (12)
Low vision acuity			0.192
Yes	33 (100)	38 (95)
No	0 (0.00)	2 (5)
Degree of diabetic retinopathy			0.465
Moderate	6 (18)	11 (28)
Severe	12 (36)	16 (40)
Extremely severe	15 (45)	13 (32)

When examining the association between elevated blood sugar levels and the presence of non-proliferative diabetic retinopathy, we discovered a statistically significant relationship between these increases on average and the condition. The average was higher in patients without this pathology, where it was 323.34 mg/dL, yielding a p value of 0.0031. Patients with proliferative diabetic retinopathy had a higher average, with a random blood sugar value of 325.29 mg/dL on average and a p value of 0.0045.

Additionally, there was a significant relationship between the rise in average random blood sugar and the rise in the severity of diabetic retinopathy, with average random blood sugar values in patients with average cases being 64.13, severe cases being 256.14 mg/dL, and the most severe cases being 334.57 mg/dL, with a p value of 0.0001 indicating a significant correlation between the rise in average random blood sugar and the rise in severity of diabetic retinopathy. (Table 4).

Table 4

The relationship between random blood glucose and diabetic retinopathy.
Diabetic retinopathy	Random blood glucose	p value
Non proliferative diabetic retinopathy		0.0031*
Yes	256.21 (± 84.54)
No	323.34 (± 89.67)
Proliferative diabetic retinopathy		0.0045*
Yes	325.29 (± 92.47)
No	258.04 (± 83.61)
Site		0.254
Right eye	274.65 (± 85.09)
Left eye	303.13 (± 82.16)
Both of them	253.13 (± 130)
Low vision acuity		0.787
Yes	280.61 (± 93.02)
No	275 (± 21.21)
Degree of diabetic retinopathy		< 0.0001*
Moderate	229.94 (± 64.13)
Severe	256.14 (± 95.06)
Extremely severe	334.57 (± 75.88)

An estimated 30 million Americans (or nearly 9% of the U.S. population) are projected to have diabetes, making it a rising global epidemic [13]. One of the most frequent consequences of diabetes, with an estimated 382 million cases worldwide, is diabetic retinopathy [4, 14]. One in six diabetics over the age of 40 in the United States has diabetic retinopathy, which poses a danger to their ability to see [15]. It should be mentioned that the most common cause of blindness in working adults is diabetic retinopathy [16].

Only 17 male patients had non-proliferative diabetic retinopathy, compared to 30 female patients. This was in contrast to a global study done in the United States in 2014 that found that advanced retinopathy in type 1 diabetes is more common in males and that the presence and severity of diabetic retinopathy at the time of diagnosis in patients with type 2 diabetes is more closely associated with male gender [17], the limited sample size in our study, which caused this disparity, can be blamed for the difference.

Our findings, however, supported a study from China that found that while females are more likely than males to have diabetic retinopathy, there is no difference in the severity of this condition between the sexes [9]. Our findings demonstrated that the severity of this condition was similar in both sexes, with a p value of 0.465, indicating that this was the case. There is growing evidence that sex may play a significant role in DR [18, 19]. However, it is still unclear whether gender is more prone to developing diabetic retinopathy. According to several studies, having a female partner increases the likelihood of developing DR, as well as the overall prevalence (PDR) [20].

Our study's average patients age for diabetic retinopathy was 56.15 years, which was in line with findings from other research showing people over 50 posed a significant risk factor for the disease's development. This study might have a big impact because of the growing proportion of senior citizens throughout the world who are more likely to be afflicted by diabetes and its complications and need medical treatment for those conditions [21]. This is essential because as diabetes patients live longer, issues like diabetic retinopathy are more likely to develop (DR) [22].

Retinopathy is a risk factor for type II diabetes mellitus, and female patients are especially susceptible. Therefore, it is essential to maintain normal or almost normal blood glucose levels with frequent evaluation by skilled medical professionals to ascertain the extent of this condition's development.

Acknowledgments:

We are thankful to the management of the Syrian Private University and for their support in the field of medical training and research. We are thankful to everyone who participated in this study.

Funding:

This research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors.

Availability of data and materials:

All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.

Ethics approval and consent to participate:

This study was approved by the Institutional Review Board (IRB) at the Syrian Private University (SPU). All Participants confirmed their written consent by signing the consent form. Participation in the study was voluntary and participants were assured that anyone who was not inclined to participate or decided to withdraw after giving consent would not be victimized. All information collected from this study was kept strictly confidential.

Consent for Publication:

Not applicable.

Competing interests:

The authors declare that they have no competing interests.

Authors’ contributions:

KT was responsible for study design, literature search, and write-up; and responsible for data analysis;; TH participated in the study design and reviewed the final draft. All authors read and approved the final draft.

Cho, N.H., et al., IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract, 2018. 138: p. 271–281.
Hu, Y., et al., Prevalence and risk factors of diabetes and diabetic retinopathy in Liaoning province, China: a population-based cross-sectional study. PLoS One, 2015. 10(3): p. e0121477.
Wang, F.H., et al., Prevalence of diabetic retinopathy in rural China: the Handan Eye Study. Ophthalmology, 2009. 116(3): p. 461–7.
Yau, J.W., et al., Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care, 2012. 35(3): p. 556–64.
Solomon, S.D., et al., Diabetic Retinopathy: A Position Statement by the American Diabetes Association. Diabetes Care, 2017. 40(3): p. 412–418.
Ip, M.S., et al., Long-term effects of therapy with ranibizumab on diabetic retinopathy severity and baseline risk factors for worsening retinopathy. Ophthalmology, 2015. 122(2): p. 367–74.
Pearson, P.A., et al., Fluocinolone acetonide intravitreal implant for diabetic macular edema: a 3-year multicenter, randomized, controlled clinical trial. Ophthalmology, 2011. 118(8): p. 1580–7.
Wat, N., R.L. Wong, and I.Y. Wong, Associations between diabetic retinopathy and systemic risk factors. Hong Kong Med J, 2016. 22(6): p. 589–99.
Nittala, M.G., et al., Risk factors for proliferative diabetic retinopathy in a Latino American population. Retina, 2014. 34(8): p. 1594–9.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet, 1998. 352(9131): p. 837 – 53.
Chew, E.Y., et al., Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med, 2010. 363(3): p. 233–44.
Do, D.V., et al., Blood pressure control for diabetic retinopathy. Cochrane Database Syst Rev, 2015. 1: p. Cd006127.
Ogurtsova, K., et al., IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract, 2017. 128: p. 40–50.
Duh, E.J., J.K. Sun, and A.W. Stitt, Diabetic retinopathy: current understanding, mechanisms, and treatment strategies. JCI Insight, 2017. 2(14).
Zhang, X., et al., Prevalence of diabetic retinopathy in the United States, 2005–2008. Jama, 2010. 304(6): p. 649–56.
Rübsam, A., S. Parikh, and P.E. Fort, Role of Inflammation in Diabetic Retinopathy. Int J Mol Sci, 2018. 19(4).
Ozawa, G.Y., M.A. Bearse, Jr., and A.J. Adams, Male-female differences in diabetic retinopathy? Curr Eye Res, 2015. 40(2): p. 234–46.
Kajiwara, A., et al., Gender differences in the incidence and progression of diabetic retinopathy among Japanese patients with type 2 diabetes mellitus: a clinic-based retrospective longitudinal study. Diabetes Res Clin Pract, 2014. 103(3): p. e7-10.
Awa, W.L., et al., Type 2 diabetes from pediatric to geriatric age: analysis of gender and obesity among 120,183 patients from the German/Austrian DPV database. Eur J Endocrinol, 2012. 167(2): p. 245–54.
Stratton, I.M., et al., UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis. Diabetologia, 2001. 44(2): p. 156 – 63.
Leley, S.P., T.A. Ciulla, and A.D. Bhatwadekar, Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment. Clin Interv Aging, 2021. 16: p. 1367–1378.
Li, M., et al., Females with Type 2 Diabetes Mellitus Are Prone to Diabetic Retinopathy: A Twelve-Province Cross-Sectional Study in China. J Diabetes Res, 2020. 2020: p. 5814296.

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The effect of type 2 diabetes mellitus on the retina

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Abstract

Aim

Methods

Results

Conclusion

Introduction

Methods

Results

Discussion

Conclusion

Declarations

References

Status:

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