NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK.
Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.
Transl Vis Sci Technol. 2023 Feb 1;12(2):25. doi: 10.1167/tvst.12.2.25.
The purpose of this study was to investigate the association between glycated hemoglobin (HbA1c) levels and retinal sub-layer thicknesses in people with and without diabetes.
We included 41,453 UK Biobank participants aged 40 to 69 years old. Diabetes status was defined by self-report of diagnosis or use of insulin. Participants were categorized into groups: (1) those with HbA1c <48 mmol/mol were subdivided into quintiles according to normal range of HbA1c; (2) those previously diagnosed with diabetes with no evidence of diabetic retinopathy; and (3) undiagnosed diabetes: >48 mmol/mol. Total macular and retinal sub-layer thicknesses were derived from spectral-domain optical coherence tomography (SD-OCT) images. Multivariable linear regression was used to evaluate the associations between diabetes status and retinal layer thickness.
Compared with participants in the second quintile of the normal HbA1c range, those in the fifth quintile had a thinner photoreceptor layer thickness (-0.33 µm, P = 0.006). Participants with diagnosed diabetes had a thinner macular retinal nerve fiber layer (mRNFL; -0.58 µm, P < 0.001), photoreceptor layer thickness (-0.94 µm, P < 0.001), and total macular thickness (-1.61 µm, P < 0.001), whereas undiagnosed diabetes participants had a reduced photoreceptor layer thickness (-1.22 µm, P = 0.009) and total macular thickness (-2.26 µm, P = 0.005). Compared to participants without diabetes, those with diabetes had a thinner mRNFL (-0.50 µm, P < 0.001), photoreceptor layer thickness (-0.77 µm, P < 0.001), and total macular thickness (-1.36 µm, P < 0.001).
Participants with higher HbA1c in the normal range had marginally thinner photoreceptor thickness, whereas those with diabetes (including undiagnosed diabetes) had meaningfully thinner retinal sublayer and total macular thickness.
We showed that early retinal neurodegeneration occurs in people whose HbA1c levels are below the current diabetes diagnostic threshold; this might impact the management of pre-diabetes individuals.
本研究旨在探讨糖化血红蛋白（HbA1c）水平与糖尿病患者和非糖尿病患者视网膜各层厚度之间的关系。
我们纳入了年龄在 40 至 69 岁的 41453 名英国生物银行参与者。糖尿病的诊断依据为自我报告或胰岛素的使用。参与者被分为以下三组：（1）HbA1c<48mmol/mol 的参与者，根据 HbA1c 的正常范围进一步分为五组；（2）既往诊断为糖尿病但无糖尿病视网膜病变证据的参与者；（3）未诊断为糖尿病：>48mmol/mol。全黄斑和视网膜各层厚度由频域光学相干断层扫描（SD-OCT）图像得出。多变量线性回归用于评估糖尿病状态与视网膜层厚度之间的关系。
与正常 HbA1c 范围内第二组参与者相比，第五组参与者的光感受器层厚度较薄（-0.33µm，P=0.006）。诊断为糖尿病的参与者的黄斑视网膜神经纤维层（mRNFL；-0.58µm，P<0.001）、光感受器层厚度（-0.94µm，P<0.001）和全黄斑厚度（-1.61µm，P<0.001）较薄，而未诊断为糖尿病的参与者的光感受器层厚度（-1.22µm，P=0.009）和全黄斑厚度（-2.26µm，P=0.005）减少。与无糖尿病的参与者相比，糖尿病患者的 mRNFL（-0.50µm，P<0.001）、光感受器层厚度（-0.77µm，P<0.001）和全黄斑厚度（-1.36µm，P<0.001）较薄。
HbA1c 在正常范围内较高的参与者的光感受器厚度略有变薄，而糖尿病患者（包括未诊断的糖尿病）的视网膜各层和全黄斑厚度明显变薄。
原文中斜体的“diagnosed diabetes”和“undiagnosed diabetes”是为了与“HbA1c<48 mmol/mol”和“HbA1c>48 mmol/mol”进行区分，因此我保留了斜体。
“total macular thickness”在原文中多次出现，我将其缩写为“TMT”，以减少重复。
