Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Ophthalmic Res. 2023;66(1):968-977. doi: 10.1159/000530904. Epub 2023 Jun 2.
The aim of this study was to quantitatively assess retinal neurodegenerative changes with optical coherence tomography (Cirrus HD-OCT) in type 2 diabetes mellitus (T2DM) patients without diabetic retinopathy (DR) and evaluate their relationships with insulin resistance (IR) and associated systemic indicators.
102 T2DM patients without DR and 48 healthy controls were included in this observational cross-sectional study. The OCT parameters of macular retinal thickness (MRT) and ganglion cell-inner plexiform layer (GCIPL) thicknesses were evaluated between diabetic and normal eyes. The receiver operating characteristics (ROC) curve was generated to evaluate the discrimination power of early diabetes. Correlation and multiple regression analysis were performed between ophthalmological parameters and T2DM-related demographic and anthropometric variables, and serum biomarkers and homeostasis model assessment of insulin resistance (HOMA-IR) scores.
MRT and GCIPL thicknesses showed significant thinning in patients, especially in inferotemporal area. High body mass index (BMI) correlated with decreased GCIPL thicknesses and elevated intraocular pressure (IOP). A negative correlation between waist-to-hip circumference ratio (WHR) and GCIPL thicknesses was also found. High-density lipoprotein (HDL) and fasting C-peptide (CP0) were associated with GCIPL thickness but only in inferotemporal region (r = 0.20, p = 0.04; r = -0.20, p = 0.05, respectively). Multiple regression analysis showed that increased HOMA-IR scores independently predicted both average (β = -0.30, p = 0.05) and inferotemporal (β = -0.34, p = 0.03) GCIPL thinning.
Retinal thinning in early T2DM was associated with obesity-related metabolic disorders. IR as an independent risk factor for retinal neurodegeneration may increase the risk of developing glaucoma.
本研究旨在通过光学相干断层扫描（Cirrus HD-OCT）定量评估无糖尿病视网膜病变（DR）的 2 型糖尿病（T2DM）患者的视网膜神经退行性变化，并评估其与胰岛素抵抗（IR）和相关全身指标的关系。
本观察性横断面研究纳入了 102 例无 DR 的 T2DM 患者和 48 例健康对照者。评估了糖尿病眼和正常眼的黄斑视网膜厚度（MRT）和神经节细胞-内丛状层（GCIPL）厚度的 OCT 参数。绘制受试者工作特征（ROC）曲线以评估早期糖尿病的鉴别能力。对眼科参数与 T2DM 相关的人口统计学和人体测量学变量、血清生物标志物和稳态模型评估的胰岛素抵抗（HOMA-IR）评分之间进行相关性和多元回归分析。
MRT 和 GCIPL 厚度在患者中明显变薄，尤其是在颞下区。高体重指数（BMI）与 GCIPL 厚度降低和眼内压（IOP）升高相关。还发现腰围-臀围比（WHR）与 GCIPL 厚度呈负相关。高密度脂蛋白（HDL）和空腹 C 肽（CP0）与 GCIPL 厚度相关，但仅在颞下区（r = 0.20，p = 0.04；r = -0.20，p = 0.05）。多元回归分析显示，升高的 HOMA-IR 评分独立预测平均（β = -0.30，p = 0.05）和颞下（β = -0.34，p = 0.03）GCIPL 变薄。
早期 T2DM 的视网膜变薄与肥胖相关的代谢紊乱有关。IR 作为视网膜神经退行性变的独立危险因素，可能会增加发生青光眼的风险。
