Work

Synergistic Impact of Fasting Plasma Glucose and Serum Uric Acid on Peripheral Diabetic Retinopathy Severity in T2DM Patients

Year: 2026

Type: article

Abstract: Purpose: To investigate the synergistic interaction between fasting plasma glucose (FPG) and serum uric acid (SUA) on the severity of peripheral diabetic retinopathy (DR) and to develop a predictive nomogram for severe non-proliferative DR (S-NPDR) in type 2 diabetes mellitus (T2DM) patients. Methods: This retrospective, single-center study included 900 T2DM patients admitted between January 2018 and December 2023. Patients were categorized into groups of No-DR (n = 300), mild to moderate NPDR (n = 350), and S-NPDR (n = 250). S-NPDR was compared against the combined No-DR and mild to moderate NPDR groups (n = 650). Independent predictors were identified via multivariable logistic regression. Additive interaction analysis assessed the synergistic effect of FPG and SUA. A predictive nomogram was developed and internally validated using 1000 bootstrap resamples. Results: Seven independent predictors of S-NPDR were identified in the final model: higher FPG (odds ratio [OR] = 1.701), SUA (OR = 1.062 per 10 µmol/L), urinary albumin-to-creatinine ratio (UACR; OR = 1.046 per 10 mg/g), high-sensitivity C-reactive protein (hs-CRP; OR = 1.191), lower subfoveal choroidal thickness (SFCT; OR = 1.330 per 10-µm decrease), lower serum albumin (ALB; OR = 1.153 per 1-g/L decrease), and the interaction between FPG and SUA (OR = 2.710, P < 0.001). A strong synergistic interaction was confirmed (adjusted OR for high FPG/high SUA = 17.56; relative excess risk due to interaction [RERI] = 12.58). The nomogram demonstrated excellent discrimination (area under the receiver operating characteristic curve [AUC] = 0.925) and good calibration (Hosmer-Lemeshow P = 0.418). Conclusions: Concurrent elevations of FPG and SUA are strongly associated with an increased likelihood of S-NPDR. Patients with both markers elevated represent a high-risk group requiring intensive monitoring. Translational Relevance: The validated nomogram enables personalized risk stratification, guiding targeted clinical management to prevent vision-threatening DR complications.

Source: Translational Vision Science & Technology

DOI: 10.1167/tvst.15.3.24

Authors: Mingjie Huang, Yanxia Guo

Institutions: China Three Gorges University, Gezhouba Central Hospital of Sinopharm

Language: English

Topic: Retinal Diseases and Treatments

Subfield: Ophthalmology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,850