Work

Role of Endothelial Dysfunction and Arterial Stiffness in the Development of Diabetic Retinopathy

Year: 2014

Type: article

Abstract: Diabetic retinopathy (DR) remains one of the most important diabetic micro-vascular complications and a leading cause of irreversible blindness, high-lighting the importance of close moni-toring. The atherosclerotic progression in patients with insulin resistance is pre-cipitated by endothelial dysfunction and vascular impairment (1). Therefore, we examined the association of endothelial dysfunction and arterial stiffness with DR and how these measurements can be used for the early identification and monitoring of patients at high risk to develop DR. In this case-control study, we included 100 healthy control (CL) subjects and 200 consecutive subjects with type 2 diabetes recruited from the 1st Department of Ophthalmology of the University of Athens Medical School where they were referred to evaluate for DR. All partici-pants underwent a complete ophthal-mological examination by the same experienced ophthalmologist, which included fundoscopy after pupillary dila-tion, fluorescein angiography, and col-orful fundus photographs. The diabetic patients, according to the Early Treat-ment Diabetic Retinopathy Study (ETDRS) classification, were categorized into three groups: 1) no DR (NDR) (108 subjects), 2) background DR (BDR) (78 subjects), and 3) proliferative DR (PDR) (14 subjects). Endothelial function was evaluated by flow-mediated dilation (FMD) in the brachial artery, and carotid-femoral pulse wave velocity (PWV) and augmen-tation index (AIx) of the radial artery were measured to evaluate arterial stiff-ness and reflected waves, respectively, as previously described (2). Several bio-chemical characteristics including HbA1c were measured in the study population. Subjects with PDR compared with BDR, NDR, and CL were older, had im-paired creatinine clearance, were under insulin treatment more often, had lon-ger duration of diabetes, had earlier on-set of the disease, and had increased levels of HbA1c (P, 0.001 for all). Subjects with PDR compared with BDR, NDR, and CL had impaired FMD (3.38 6 1.23 % vs. 3.58 6 1.24 % vs. 5.71 6 1.92 % vs. 7.54 6 3.06%, respectively,

Source: Diabetes Care

DOI: 10.2337/dc14-1741