Assessment of trace element imbalances in diabetes mellitus patients with and without diabetic retinopathy: a case-control study in Iraq.

Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus (DM). Evidence suggests that trace element imbalances may contribute to the development and progression of DR. This study aimed to evaluate the levels of selected trace elements in Iraqi patients with DM, with and without retinopathy, to identify potential biomarkers associated with disease progression. A total of 120 participants were involved and divided into three groups: healthy controls (n = 60), DM patients (n = 30), and DR patients (n = 30). Blood samples were analyzed for the concentrations of Cu, Zn, Mg, Pb, Cd, Ni, Cr, Co, Mn, and Al using flame and flameless atomic absorption spectrophotometry. DR patients showed elevated levels of Cu, Pb, Cd, Ni, and Al, and decreased levels of Zn, Mg, Cr, Co, and Mn compared to both DM and control groups (p < 0.05 or p < 0.01). Correlation analyses revealed distinct element interactions within DM and DR groups, particularly antagonistic relationships such as Cu-Zn and Zn-Co in DR patients. The study demonstrates a strong association between trace element dysregulation and diabetic retinopathy, suggesting that specific elements such as Cu, Zn, Mg and Co may serve as valuable indicators for monitoring disease progression. These findings strongly support further investigation into trace elements for the prevention and management of DR.