Department of Endocrinology, Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, People's Republic of China.
The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
Acta Diabetol. 2023 Sep;60(9):1267-1277. doi: 10.1007/s00592-023-02120-0. Epub 2023 Jun 6.
Retinal vascular parameters are biomarkers of diabetic microangiopathy. We aimed to investigate the relationship between time in range (TIR) assessed by continuous glucose monitoring (CGM) and retinal vascular parameters in patients with type 2 diabetes in China.
The TIR assessed by CGM and retinal photographs were obtained at the same time from adults with type 2 diabetes who were recruited. Retinal vascular parameters were extracted from retinal photographs by a validated fully automated computer program, and TIR was defined as between 3.9-7.8 mmol/L over a 24-h period. The association between TIR and caliber of retinal vessels distributed in different zones were analyzed using multivariable linear regression analyses.
For retinal vascular parameters measurements, the peripheral arteriovenous and middle venular calibers widen with decreasing TIR quartiles (P < 0.05). Lower TIR was associated with wider peripheral venule after adjusting for potential confounders. Even after further correction for GV, there was still a significant correlation between TIR and peripheral vascular calibers (CV: β = - 0.015 [- 0.027, - 0.003], P = 0.013; MAGE: β = - 0.013 [- 0.025, - 0.001], P = 0.038) and SD: β = - 0.013 [- 0.026, - 0.001], P = 0.004). Similar findings were not found for the middle and central venular calibers or arterial calibers located in different zones.
The TIR was associated with adverse changes to peripheral retinal venules but not central and middle vessels in patients with type 2 diabetes, suggesting that peripheral retinal vascular calibers may be affected by glycemic fluctuations earlier.
视网膜血管参数是糖尿病微血管病变的生物标志物。本研究旨在探讨中国 2 型糖尿病患者通过连续血糖监测（CGM）评估的时间在目标范围内（TIR）与视网膜血管参数之间的关系。
从招募的成年 2 型糖尿病患者中同时获得 CGM 评估的 TIR 和视网膜照片。通过经过验证的全自动计算机程序从视网膜照片中提取视网膜血管参数，并将 TIR 定义为 24 小时内 3.9-7.8mmol/L。使用多变量线性回归分析来分析 TIR 与分布在不同区域的视网膜血管口径之间的关系。
对于视网膜血管参数测量，随着 TIR 四分位数的降低，周边动静脉和中间静脉口径变宽（P<0.05）。在调整潜在混杂因素后，较低的 TIR 与较宽的外周小静脉相关。即使进一步校正 GV，TIR 与外周血管口径之间仍存在显著相关性（CV：β=−0.015 [−0.027，−0.003]，P=0.013；MAGE：β=−0.013 [−0.025，−0.001]，P=0.038）和 SD：β=−0.013 [−0.026，−0.001]，P=0.004）。在不同区域的中间和中央静脉口径或动脉口径中未发现类似的发现。
TIR 与 2 型糖尿病患者外周视网膜小静脉的不良变化相关，但与中央和中间血管无关，提示血糖波动可能更早影响外周视网膜血管口径。
