CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229HX, Maastricht, the Netherlands.
Diabetologia. 2020 Jul;63(7):1408-1417. doi: 10.1007/s00125-020-05146-z. Epub 2020 May 8.
AIMS/HYPOTHESIS: Retinal microvascular diameters are biomarkers of cardio-metabolic risk. However, the association of (pre)diabetes with retinal microvascular diameters remains unclear. We aimed to investigate the association of prediabetes (impaired fasting glucose or impaired glucose tolerance) and type 2 diabetes with retinal microvascular diameters in a predominantly white population.
In a population-based cohort study with oversampling of type 2 diabetes (N = 2876; n = 1630 normal glucose metabolism [NGM], n = 433 prediabetes and n = 813 type 2 diabetes, 51.2% men, aged 59.8 ± 8.2 years; 98.6% white), we determined retinal microvascular diameters (measurement unit as measured by retinal health information and notification system [RHINO] software) and glucose metabolism status (using OGTT). Associations were assessed with multivariable regression analyses adjusted for age, sex, waist circumference, smoking, systolic blood pressure, lipid profile and the use of lipid-modifying and/or antihypertensive medication.
Multivariable regression analyses showed a significant association for type 2 diabetes but not for prediabetes with arteriolar width (vs NGM; prediabetes: β = 0.62 [95%CI -1.58, 2.83]; type 2 diabetes: 2.89 [0.69, 5.08]; measurement unit); however, there was a linear trend for the arteriolar width across glucose metabolism status (p for trend = 0.013). The association with wider venules was not statistically significant (prediabetes: 2.40 [-1.03, 5.84]; type 2 diabetes: 2.87 [-0.55, 6.29], p for trend = 0.083; measurement unit). Higher HbA levels were associated with wider retinal arterioles (standardised β = 0.043 [95% CI 0.00002, 0.085]; p = 0.050) but the association with wider venules did not reach statistical significance (0.037 [-0.006, 0.080]; p = 0.092) after adjustment for potential confounders.
CONCLUSIONS/INTERPRETATION: Type 2 diabetes, higher levels of HbA and, possibly, prediabetes, are independently associated with wider retinal arterioles in a predominantly white population. These findings indicate that microvascular dysfunction is an early phenomenon in impaired glucose metabolism.
目的/假设：视网膜微血管直径是心血管代谢风险的生物标志物。然而，（前驱）糖尿病与视网膜微血管直径的关系仍不清楚。我们旨在研究在以白种人为主的人群中，前驱糖尿病（空腹血糖受损或葡萄糖耐量受损）和 2 型糖尿病与视网膜微血管直径的关系。
在一项基于人群的队列研究中，对 2 型糖尿病进行了过采样（N=2876；n=1630 正常葡萄糖代谢[NGM]，n=433 前驱糖尿病，n=813 2 型糖尿病，51.2%为男性，年龄 59.8±8.2 岁；98.6%为白种人），我们用视网膜健康信息和通知系统[RHINO]软件测定了视网膜微血管直径（以测量单位表示）和葡萄糖代谢状态（用 OGTT）。采用多变量回归分析，调整了年龄、性别、腰围、吸烟、收缩压、血脂和使用调脂及/或降压药物等因素，评估了相关性。
多变量回归分析显示，2 型糖尿病与动脉直径有显著相关性，但前驱糖尿病无相关性（与 NGM 相比；前驱糖尿病：β=0.62[95%CI-1.58，2.83]；2 型糖尿病：2.89[0.69，5.08]；测量单位）；然而，在葡萄糖代谢状态之间存在动脉直径的线性趋势（p 趋势=0.013）。与静脉变宽的相关性无统计学意义（前驱糖尿病：2.40[-1.03，5.84]；2 型糖尿病：2.87[-0.55，6.29]，p 趋势=0.083；测量单位）。较高的 HbA 水平与视网膜动脉变宽有关（标准化β=0.043[95%CI0.00002，0.085]；p=0.050），但调整潜在混杂因素后，静脉变宽的相关性无统计学意义（0.037[-0.006，0.080]；p=0.092）。
结论/解释：在以白种人为主的人群中，2 型糖尿病、HbA 水平升高以及可能的前驱糖尿病与视网膜动脉变宽独立相关。这些发现表明，微血管功能障碍是葡萄糖代谢受损的早期现象。
