Trott Mike, Driscoll Robin, Iraldo Enrico, Pardhan Shahina
Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge, CB1 2LZ UK.
Centre for Public Health, Queen's University Belfast, Belfast, UK.
J Diabetes Metab Disord. 2022 May 26;21(1):1177-1184. doi: 10.1007/s40200-022-01059-3. eCollection 2022 Jun.
Vitamin D levels have been shown to be associated with diabetic retinopathy, however to date, no review has examined the relationship between vitamin D and sight threatening diabetic retinopathy (STDR) and non-sight threatening diabetic retinopathy (NSTDR). The aim of this review, therefore, was to pool associations between vitamin D deficiency (25(OH)D < 20 ng/mL) and STDR/NSTDR. A further aim was to examine associations between circulating 25(OH)D levels and STDR/NSTDR.
A systematic review of major databases was undertaken for studies published from inception to 22/04/2022, using a pre-published protocol. Studies reporting prevalence of STDR or NSTDR versus a control group with diabetes and no DR or DME and either (a) vitamin D deficiency prevalence, or (b) circulating 25(OH)D levels, were included. A random effects meta-analysis was undertaken.
Following screening, 12 studies ( = 9057) were included in the meta-analysis. STDR was significantly associated with vitamin D deficiency (OR = 1.80 95%CI 1.40-2.30; = <0.001), whereas NSTDR was not (OR = 1.07 95%CI 0.90-1.27; = 0.48). Both conclusions were graded as low credibility of evidence. Furthermore, circulating 25(OH)D levels were significantly associated with both NSTDR (SMD = -0.27 95%CI -0.50; -0.04; = 0.02) and STDR (SMD = -0.49 95%CI -0.90; -0.07; = 0.02), although these were graded as low credibility of evidence.
Vitamin D deficiency is significantly associated with STDR (including DME), but not with NSTDR. Given the well-reported associations between vitamin D deficiency and other unfavourable outcomes, it is important that vitamin D deficiency is managed appropriately and in a timely manner to reduce the risk of blindness in people with diabetes.
The online version contains supplementary material available at 10.1007/s40200-022-01059-3.
维生素D水平已被证明与糖尿病视网膜病变有关，然而迄今为止，尚无综述研究维生素D与威胁视力的糖尿病视网膜病变（STDR）和非威胁视力的糖尿病视网膜病变（NSTDR）之间的关系。因此，本综述的目的是汇总维生素D缺乏（25(OH)D＜20 ng/mL）与STDR/NSTDR之间的关联。另一个目的是研究循环25(OH)D水平与STDR/NSTDR之间的关联。
使用预先发表的方案，对主要数据库进行系统综述，纳入从数据库建立至2022年4月22日发表的研究。纳入报告STDR或NSTDR患病率与糖尿病对照组（无糖尿病视网膜病变或糖尿病性黄斑水肿）以及（a）维生素D缺乏患病率或（b）循环25(OH)D水平的研究。进行随机效应荟萃分析。
经过筛选，12项研究（n = 9057）纳入荟萃分析。STDR与维生素D缺乏显著相关（OR = 1.80，95%CI 1.40 - 2.30；P = ＜0.001），而NSTDR则不然（OR = 1.07，95%CI 0.90 - 1.27；P = 0.48）。这两个结论的证据可信度均为低等级。此外，循环25(OH)D水平与NSTDR（SMD = -0.27，95%CI -0.50；-0.04；P = 0.02）和STDR（SMD = -0.49，95%CI -0.90；-0.07；P = 0.02）均显著相关，尽管这些证据的可信度也为低等级。
维生素D缺乏与STDR（包括糖尿病性黄斑水肿）显著相关，但与NSTDR无关。鉴于维生素D缺乏与其他不良结局之间有充分报道的关联，及时且适当地处理维生素D缺乏对于降低糖尿病患者失明风险很重要。
在线版本包含可在10.1007/s40200 - 022 - 01059 - 3获取的补充材料。
