Department of Medicine, The Lundquist Institute at Harbor-University of California Los Angeles (UCLA) Medical Center, Torrance, CA, United States.
Front Endocrinol (Lausanne). 2021 Nov 29;12:734360. doi: 10.3389/fendo.2021.734360. eCollection 2021.
Diabetic retinopathy (DR) is a potentially devastating complication of diabetes because it puts patients at risk of blindness. Diabetes is a common cause of blindness in the U.S. and worldwide and is dramatically increasing in global prevalence. Thus new approaches are needed to prevent this dreaded complication. There is extensive data that indicates beta cell secretory failure is a risk factor for DR, independent of its influence on glycemic control. This perspective article will provide evidence for insufficient endogenous insulin secretion as an important factor in the development of DR. The areas of evidence discussed are: (a) Presence of insulin receptors in the retina, (b) Clinical studies that show an association of beta cell insufficiency with DR, (c) Treatment with insulin in type 2 diabetes, a marker for endogenous insulin deficiency, is an independent risk factor for DR, (d) Recent clinical studies that link DR with an insulin deficient form of type 2 diabetes, and (e) Beta cell replacement studies that demonstrate endogenous insulin prevents progression of DR. The cumulative data drive our conclusion that beta cell replacement will have an important role in preventing DR and/or mitigating its severity in both type 1 diabetes and insulinopenic type 2 diabetes.
糖尿病性视网膜病变（DR）是糖尿病一种潜在的破坏性并发症，因为它使患者有失明的风险。糖尿病是美国和全球失明的常见原因，其全球患病率正在显著上升。因此，需要新的方法来预防这种可怕的并发症。有大量数据表明，β细胞分泌功能衰竭是 DR 的一个危险因素，独立于其对血糖控制的影响。本文观点将提供证据表明，内源性胰岛素分泌不足是 DR 发展的一个重要因素。讨论的证据领域包括：（a）视网膜中存在胰岛素受体，（b）临床研究表明β细胞功能不足与 DR 有关，（c）2 型糖尿病中用胰岛素治疗，这是内源性胰岛素缺乏的标志物，是 DR 的一个独立危险因素，（d）最近的临床研究将 DR 与胰岛素缺乏型 2 型糖尿病联系起来，以及（e）β细胞替代研究表明内源性胰岛素可防止 DR 进展。累积数据使我们得出结论，β细胞替代将在预防 DR 方面以及在 1 型糖尿病和胰岛素缺乏型 2 型糖尿病中减轻其严重程度方面发挥重要作用。
