King's College London, London, UK.
King's College Hospital NHS Foundation Trust, London, UK.
Diabet Med. 2023 Mar;40(3):e14952. doi: 10.1111/dme.14952. Epub 2022 Sep 12.
To explore if novel non-invasive diagnostic technologies identify early small nerve fibre and retinal neurovascular pathology in prediabetes.
Participants with normoglycaemia, prediabetes or type 2 diabetes underwent an exploratory cross-sectional analysis with optical coherence tomography angiography (OCT-A), handheld electroretinography (ERG), corneal confocal microscopy (CCM) and evaluation of electrochemical skin conductance (ESC).
Seventy-five participants with normoglycaemia (n = 20), prediabetes (n = 29) and type 2 diabetes (n = 26) were studied. Compared with normoglycaemia, mean peak ERG amplitudes of retinal responses at low (16-Td·s: 4.05 μV, 95% confidence interval [95% CI] 0.96-7.13) and high (32-Td·s: 5·20 μV, 95% CI 1.54-8.86) retinal illuminance were lower in prediabetes, as were OCT-A parafoveal vessel densities in superficial (0.051 pixels/mm , 95% CI 0.005-0.095) and deep (0.048 pixels/mm , 95% CI 0.003-0.093) retinal layers. There were no differences in CCM or ESC measurements between these two groups. Correlations between HbA and peak ERG amplitude at 32-Td·s (r = -0.256, p = 0.028), implicit time at 32-Td·s (r = 0.422, p < 0.001) and 16-Td·s (r = 0.327, p = 0.005), OCT parafoveal vessel density in the superficial (r = -0.238, p = 0.049) and deep (r = -0.3, p = 0.017) retinal layers, corneal nerve fibre length (CNFL) (r = -0.293, p = 0.017), and ESC-hands (r = -0.244, p = 0.035) were observed. HOMA-IR was a predictor of CNFD (β = -0.94, 95% CI -1.66 to -0.21, p = 0.012) and CNBD (β = -5.02, 95% CI -10.01 to -0.05, p = 0.048).
The glucose threshold for the diagnosis of diabetes is based on emergent retinopathy on fundus examination. We show that both abnormal retinal neurovascular structure (OCT-A) and function (ERG) may precede retinopathy in prediabetes, which require confirmation in larger, adequately powered studies.
探索新型无创诊断技术是否能在糖尿病前期识别早期小神经纤维和视网膜神经血管病变。
对血糖正常、糖尿病前期和 2 型糖尿病患者进行横断面分析，采用光学相干断层扫描血管造影（OCT-A）、手持式视网膜电图（ERG）、角膜共聚焦显微镜（CCM）和电化学皮肤电导（ESC）评估。
研究共纳入 75 名血糖正常（n=20）、糖尿病前期（n=29）和 2 型糖尿病（n=26）患者。与血糖正常组相比，糖尿病前期患者的视网膜低亮度（16-Td·s：4.05μV，95%置信区间 [95%CI] 0.96-7.13）和高亮度（32-Td·s：5.20μV，95%CI 1.54-8.86）时视网膜反应的峰值 ERG 幅度较低，OCT-A 浅层（0.051 像素/mm，95%CI 0.005-0.095）和深层（0.048 像素/mm，95%CI 0.003-0.093）视网膜层的血管密度也较低。两组间 CCM 和 ESC 测量值无差异。HbA 与 32-Td·s 时的峰值 ERG 幅度（r=-0.256，p=0.028）、32-Td·s 时的隐时（r=0.422，p<0.001）和 16-Td·s 时的隐时（r=0.327，p=0.005）、浅层（r=-0.238，p=0.049）和深层（r=-0.3，p=0.017）视网膜层的 OCT 浅层血管密度、角膜神经纤维长度（CNFL）（r=-0.293，p=0.017）和 ESC-hands（r=-0.244，p=0.035）呈负相关。HOMA-IR 是 CNFD（β=-0.94，95%CI-1.66 至-0.21，p=0.012）和 CNBD（β=-5.02，95%CI-10.01 至-0.05，p=0.048）的预测因子。
糖尿病的诊断血糖阈值基于眼底检查出现的进行性视网膜病变。我们表明，糖尿病前期可能会出现视网膜神经血管结构（OCT-A）和功能（ERG）异常，这需要在更大的、充分的、有影响力的研究中进一步证实。
