胰岛素对糖尿病患者糖尿病视网膜病变及视网膜血管参数的影响。

The influence of insulin on diabetic retinopathy and retinal vessel parameters in diabetes.

作者信息

Yuan Tianyi, Lin Senlin, Xu Yi, Lu Lina, Cheng Minna, Wang Yuheng, Yang Qinping, Ling Saiguang, Zhou Dengji, Shi Yan, Zou Haidong, Ma Yingyan

机构信息

Shanghai Eye Disease Prevention & Treatment Center, Shanghai Eye Hospital, School of Medicine, Tongji University, National Clinical Research Center for Eye Diseases, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, No. 1440, Hongqiao Road, Shanghai, China.

Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, No. 85/86, Wujin Road, Shanghai, China.

出版信息

Diabetol Metab Syndr. 2024 Sep 30;16(1):237. doi: 10.1186/s13098-024-01476-9.

DOI:10.1186/s13098-024-01476-9

PMID:39343944

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11440757/

Abstract

AIM

To investigate the associations between insulin use and diabetic retinopathy (DR), and retinal vascular parameters in type 2 diabetes (T2DM).

METHODS

A total of 6,374 T2DM patients, consisting of 2,231 patients receiving insulin alone and 4143 patients without any hypoglycemic medication, were included in cross-sectional analyses. Among those without DR at baseline, 791 patients were followed for three years in longitudinal analyses. Fundus photography was taken to diagnose DR and calculate central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), arteriolar-to-venular ratio (AVR), and vascular tortuosity. Inverse probability treatment-weighted analyses were performed.

RESULTS

After adjusting for gender, age, body mass index, blood pressure, blood glucose, T2DM duration, smoking, and alcohol use, insulin users showed a higher risk of DR (odds ratio (OR) = 2.27, 95% confidence interval (95%CI) = 2.08-2.48, P < 0.001), larger CRVE (β = 3.92, 95%CI = 2.46-5.37, P < 0.001), smaller AVR (β=-0.0083, 95%CI=-0.0121- -0.0046, P < 0.001), and larger vascular curvature (β = 0.19, 95%CI = 0.05-0.33, P = 0.008). After 3 years, insulin users had a higher risk of developing DR (OR = 1.94; 95% CI = 1.37-2.73, P = 0.002), and greater change in CRVE (β = 3.92, 95%CI = 0.96-6.88, P = 0.009).

CONCLUSIONS

The impact of insulin on the retinal microvasculature provides support for linking insulin to the increased risk of DR, as well as cardiovascular events in T2DM.

摘要

目的

研究2型糖尿病（T2DM）患者胰岛素使用与糖尿病视网膜病变（DR）以及视网膜血管参数之间的关联。

方法

横断面分析纳入了6374例T2DM患者，其中2231例仅接受胰岛素治疗，4143例未使用任何降糖药物。在基线时无DR的患者中，791例患者进行了为期三年的纵向分析。通过眼底摄影诊断DR，并计算视网膜中央动脉等效直径（CRAE）、视网膜中央静脉等效直径（CRVE）、动静脉比（AVR）和血管迂曲度。进行了逆概率加权分析。

结果

在调整性别、年龄、体重指数、血压、血糖、T2DM病程、吸烟和饮酒因素后，胰岛素使用者发生DR的风险更高（比值比（OR）=2.27，95%置信区间（95%CI）=2.08-2.48，P<0.001），CRVE更大（β=3.92，95%CI=2.46-5.37，P<0.001），AVR更小（β=-0.0083，95%CI=-0.0121--0.0046，P<0.001），血管曲率更大（β=0.19，95%CI=0.05-0.33，P=0.008）。三年后，胰岛素使用者发生DR的风险更高（OR=1.94；95%CI=1.37-2.73，P=0.002），CRVE变化更大（β=3.92，95%CI=0.96-6.88，P=0.009）。