Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins Biostatistics Center, Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA.
Eye (Lond). 2024 Nov;38(16):3093-3100. doi: 10.1038/s41433-024-03227-6. Epub 2024 Jul 13.
BACKGROUND/OBJECTIVES: To investigate the relative contribution of systemic risk factors to retinopathy in prediabetes using a nationally representative cohort in the US.
SUBJECTS/METHODS: A group of 2098 participants aged ≥40 years with available HbA1c and gradable retinal images from the National Health and Nutrition Examination Survey 2005-2008 were included in this retrospective cross-sectional analysis. Participants were stratified into control, prediabetes, and diabetes groups based on HbA1c and anti-hyperglycaemic medication use. Logistic regression was used to assess the contribution of potential systemic risk factors to retinopathy prevalence.
The prevalence of retinopathy in the prediabetes group was 7.69%. Multivariable logistic regression revealed an inverse association of female sex (OR, 0.25; 95% CI, 0.08-0.74; p = 0.02), eGFR (OR, 0.98; 95% CI, 0.96-1.00; p = 0.04), and fasting glucose levels (OR, 0.92; 95% CI 0.87-0.98; p = 0.02) with retinopathy in individuals with prediabetes and a positive association with a Race/Ethnicity classification of "Other" (OR, 6.05; 95% CI, 1.65-22.1; p = 0.01). Comparison of ORs between groups indicated differential associations of "Other" race, fasting glucose, and C-reactive protein (CRP) with retinopathy in prediabetes compared with diabetes.
The prevalence of retinopathy among individuals with prediabetes in the NHANES database is similar to other studies. Our findings suggest that nonglycemic metabolic risk factors may be especially relevant to the risk of retinopathy in prediabetes and extend the previously suggested protective effect of female sex on retinopathy in diabetes to prediabetes. The increased odds of retinopathy in underrepresented racial/ethnic groups in the setting of prediabetes also have implications for risk assessment in this population.
背景/目的：使用美国具有代表性的全国队列研究，调查系统危险因素对糖尿病前期患者视网膜病变的相对贡献。
受试者/方法：本回顾性横断面分析纳入了美国国家健康和营养检查调查 2005-2008 年中年龄≥40 岁且可获取糖化血红蛋白和可分级视网膜图像的 2098 名参与者。根据糖化血红蛋白和抗高血糖药物的使用情况，将参与者分为对照组、糖尿病前期组和糖尿病组。使用逻辑回归评估潜在系统危险因素对视网膜病变患病率的贡献。
糖尿病前期组的视网膜病变患病率为 7.69%。多变量逻辑回归显示，女性（比值比，0.25；95%置信区间，0.08-0.74；p=0.02）、肾小球滤过率（比值比，0.98；95%置信区间，0.96-1.00；p=0.04）和空腹血糖水平（比值比，0.92；95%置信区间，0.87-0.98；p=0.02）与糖尿病前期患者的视网膜病变呈负相关，而“其他”种族分类（比值比，6.05；95%置信区间，1.65-22.1；p=0.01）与视网膜病变呈正相关。组间比值比的比较表明，与糖尿病相比，“其他”种族、空腹血糖和 C 反应蛋白（CRP）与糖尿病前期患者的视网膜病变有不同的相关性。
NHANES 数据库中糖尿病前期患者的视网膜病变患病率与其他研究相似。我们的研究结果表明，非血糖代谢危险因素可能与糖尿病前期患者视网膜病变的风险尤其相关，并将女性对糖尿病视网膜病变的保护作用扩展到糖尿病前期。在糖尿病前期的代表性不足的种族/族裔群体中，视网膜病变的几率增加，这对该人群的风险评估也具有重要意义。
