Related Risk Factors between Subclinical Carotid Atherosclerosis and Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetes Mellitus in China

Abstract

Purpose To analyze the clinical features and related risk factors in diabetic retinopathy (DR) and subclinical atherosclerosis, the micro- and macro-vascular diseases in newly diagnosed type 2 diabetes mellitus (T2DM).

Methods A retrospective study of 435 cases of inpatients with newly diagnosed T2DM from 2013–2017, and compare the 2 types of T2DM related vascular complications.

Results The macro- and microvascular complications are not rare at this stage. Subclinical atherosclerosis was found in 251 subjects (57.7%), which was higher than that of DR (13.1%). In addition, some cases of subclinical atherosclerosis co-existed with DR, suggesting that DR was related with subclinical atherosclerosis (r=0.098, P=0.041). Older age showed a significant association with both subclinical atherosclerosis and DR. Single factor analysis indicated that dyslipidemia was the common risk factor in DR and subclinical atherosclerosis.

Conclusions It should be paid attention to the screening of both DR and subclinical atherosclerosis in each age group of newly diagnosed T2DM. Except for the control of blood glucose, the control of the dyslipidemia is important in the prevention and treatment of the micro- and macro-vascular diseases.

Key words

diabetic retinopathy - atherosclerosis - type 2 diabetes mellitus

• References

• 1 Yang W, Lu J, Weng J. et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362: 1090-1101
• 2 Whiting DR, Guariguata L, Weil C. et al. IDF diabetes atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011; 94: 311-321
• 3 Birrer M. [Macroangiopathy in diabetes mellitus]. Vasa 2001; 30: 168-174
• 4 O'Leary DH, Polak JF, Kronmal RA. et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999; 340: 14-22
• 5 Hendrick AM, Gibson MV, Kulshreshtha A. Diabetic retinopathy. Prim Care 2015; 42: 451-464
• 6 Haffner SM, Stern MP, Hazuda HP. et al. Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes?. Jama 1990; 263: 2893-2898
• 7 Stratton IM, Adler AI, Neil HA. et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study. Bmj 2000; 321: 405-412
• 8 Handa N, Matsumoto M, Maeda H. et al. Ultrasonic evaluation of early carotid atherosclerosis. Stroke 1990; 21: 1567-1572
• 9 Liu Y, Teng X, Zhang W. et al. Association between diabetic retinopathy and subclinical atherosclerosis in China: Results from a community-based study. Diab Vasc Dis Res 2015; 12: 366-372
• 10 Xie J, Ikram MK, Cotch MF. et al. association of diabetic macular edema and proliferative diabetic retinopathy with cardiovascular disease: A systematic review and meta-analysis. JAMA Ophthalmol 2017; 135: 586-593
• 11 Stern MP. Diabetes and cardiovascular disease. The “common soil” hypothesis. Diabetes 1995; 44: 369-374
• 12 Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15: 539-553
• 13 Diagnosis and classification of diabetes mellitus. Diabetes Care 2008; 31 (Suppl 1): S55-S60
• 14 Wilkinson CP, Ferris 3rd FL, Klein RE. et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 2003; 110: 1677-1682
• 15 Mansia G, De Backer G, Dominiczak A. et al. 2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Press 2007; 16: 135-232
• 16 Ponto KA, Koenig J, Peto T. et al. Prevalence of diabetic retinopathy in screening-detected diabetes mellitus: Results from the Gutenberg Health Study (GHS). Diabetologia 2016; 59: 1913-1919
• 17 Jammal H, Khader Y, Alkhatib S. et al. Diabetic retinopathy in patients with newly diagnosed type 2 diabetes mellitus in Jordan: Prevalence and associated factors. J Diabetes 2013; 5: 172-179
• 18 Spijkerman AM, Dekker JM, Nijpels G. et al. Microvascular complications at time of diagnosis of type 2 diabetes are similar among diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the hoorn screening study. Diabetes Care 2003; 26: 2604-2608
• 19 Lim S, Chellumuthi C, Crook N. et al. Low prevalence of retinopathy, but high prevalence of nephropathy among Maori with newly diagnosed diabetes-Te Wai o Rona: Diabetes Prevention Strategy. Diabetes Res Clin Pract 2008; 80: 271-274
• 20 de Fine Olivarius N, Nielsen NV, Andreasen AH. Diabetic retinopathy in newly diagnosed middle-aged and elderly diabetic patients. Prevalence and interrelationship with microalbuminuria and triglycerides. Graefes Arch Clin Exp Ophthalmol 2001; 239: 664-672
• 21 Chatziralli I, Sergentanis TN, Crosby-Nwaobi R et al. model for risk-based screening of diabetic retinopathy in people with newlydiagnosed type 2 diabetes mellitus. Invest Ophthalmol Vis Sci 2017; 58: Bio99-bio105
• 22 Voigt M, Schmidt S, Lehmann T. et al. prevalence and progression rate of diabetic retinopathy in type 2 diabetes patients in correlation with the duration of diabetes. Exp Clin Endocrinol Diabetes 2018; 126: 570-576
• 23 Catalan M, Herreras Z, Pinyol M. et al. Prevalence by sex of preclinical carotid atherosclerosis in newly diagnosed type 2 diabetes. Nutr Metab Cardiovasc Dis 2015; 25: 742-748
• 24 Son JW, Jang EH, Kim MK. et al. Diabetic retinopathy is associated with subclinical atherosclerosis in newly diagnosed type 2 diabetes mellitus. Diabetes Res Clin Pract 2011; 91: 253-259
• 25 Harris MI, Klein R, Welborn TA. et al. Onset of NIDDM occurs at least 4–7 yr before clinical diagnosis. Diabetes Care 1992; 15: 815-819
• 26 Soriguer F, Goday A, Bosch-Comas A. et al. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: The [e-mail] Study. Diabetologia 2012; 55: 88-93
• 27 Pinilla I, Sanchez-Cano A, Ferreras A. et al. retinal sensitivity in patients with type i diabetes without retinopathy or with minor retinal changes. Exp Clin Endocrinol Diabetes 2016; 124: 613-617
• 28 Kim KJ, Lee BW, Kim HM. et al. Associations between cardio-ankle vascular index and microvascular complications in type 2 diabetes mellitus patients. J Atheroscler Thromb 2011; 18: 328-336
• 29 Malecki MT, Osmenda G, Walus-Miarka M. et al. Retinopathy in type 2 diabetes mellitus is associated with increased intima-media thickness and endothelial dysfunction. Eur J Clin Invest 2008; 38: 925-930
• 30 Hammes HP, Lemmen KD, Bertram B. Diabetic retinopathy and maculopathy. Exp Clin Endocrinol Diabetes 2014; 122: 387-390
• 31 Minuz P, Patrignani P, Gaino S. et al. Increased oxidative stress and platelet activation in patients with hypertension and renovascular disease. Circulation 2002; 106: 2800-2805
• 32 Bernal-Lopez MR, Pena D, Gomez-Martin P. et al. Cilostazol does not improve peripheral arterial disease-linked oxidative stress. Cardiovasc Ther 2015; 33: 15-19
• 33 Giordano CR, Roberts R, Krentz KA. et al. Catalase therapy corrects oxidative stress-induced pathophysiology in incipient diabetic retinopathy. Invest Ophthalmol Vis Sci 2015; 56: 3095-3102
• 34 Fort-Gallifa I, Hernandez-Aguilera A, Garcia-Heredia A et al. galectin-3 in peripheral artery disease. relationships with markers of oxidative stress and inflammation. Int J Mol Sci 2017; 18:
• 35 Kowluru RA, Kowluru A, Mishra M. et al. Oxidative stress and epigenetic modifications in the pathogenesis of diabetic retinopathy. Prog Retin Eye Res 2015; 48: 40-61