Retinal Arteriolar Dilation Predicts Retinopathy in Adolescents With Type 1 Diabetes

Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
Diabetes care (Impact Factor: 8.42). 09/2008; 31(9):1842-6. DOI: 10.2337/dc08-0189
Source: PubMed


Alterations in retinal vascular caliber may reflect early subclinical microvascular dysfunction. In this study, we examined the association of retinal vascular caliber to incident retinopathy in young patients with type 1 diabetes.
This was a prospective cohort study of 645 initially retinopathy-free type 1 diabetic patients, aged 12-20 years. Participants had seven-field stereoscopic retinal photographs taken of both eyes at baseline and follow-up. Retinal vascular caliber was measured from baseline photographs using a computer-based program following a standardized protocol. Incident retinopathy was graded according to the modified Airlie House classification from follow-up photographs.
Over a median follow-up of 2.5 years, 274 participants developed retinopathy (14.8 per 100 person-years). After adjustments for age, sex, diabetes duration, glycemia, mean arterial blood pressure, BMI, and cholesterol levels, larger retinal arteriolar caliber (fourth versus first quartile) was associated with a more than threefold higher risk of retinopathy (hazard rate ratio 3.44 [95% CI 2.08-5.66]). Each SD increase in retinal arteriolar caliber was associated with a 46% increase in retinopathy risk (1.46 [1.22-1.74]). This association was stronger in female than in male participants. After similar adjustments, retinal venular caliber was not consistently associated with incident retinopathy.
Retinal arteriolar dilatation predicts retinopathy development in young patients with type 1 diabetes. Our data suggest that arteriolar dysfunction may play a critical role in the pathogenesis of early diabetic retinopathy and that computer-based retinal vascular caliber measurements may provide additional prognostic information regarding risk of diabetes microvascular complications.

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    • "One of the most specific chronic diabetic complications is diabetic microangiopathy [3] [4] [5] [6]. Clinically, microangiopathy manifests as retinopathy, nephropathy, and diabetic neuropathy— somatic as well as autonomic [4] [5] [6]. Many trials have also shown that the main determinants of the vessel damage in the course of diabetes are hyperglycemia and diabetes duration [7] [8] [9]. "
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    ABSTRACT: The aim of this study was to evaluate the relationship between serum transforming growth factor β 1 (TGF- β 1) concentrations and the duration of type 1 diabetes mellitus (T1DM) in children and adolescents. One hundred and sixteen patients with T1DM and 19 healthy controls were examined. Serum TGF- β 1 concentrations were measured using the cytometric bead array (CBA). A positive association between the time of diabetes duration and higher serum TGF- β 1 concentrations was observed. Similarly, the prevalence of microvascular complications, such as retinopathy and nephropathy, increased with the duration of diabetes. Logistic regression analysis showed that serum TGF- β 1 concentrations and the duration of the disease are independent risk factors of microangiopathy development. Higher serum TGF- β 1 concentrations were associated with a significant risk of microangiopathy development after 10 years of T1DM duration. In the successive years of the disease, the effect was even stronger. The results of our study indicate that serum TGF- β 1 concentrations are one of the factors that may have an impact on the progression of vascular complications in children and adolescents with T1DM.
    Mediators of Inflammation 10/2013; 2013(1):849457. DOI:10.1155/2013/849457 · 3.24 Impact Factor
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    • "Our study confirmed literature reports that hypertension is associated with increased retinal venule diameter [33]. We found that larger arteriolar diameter i associated with longer diabetes duration; other studies have found arteriolar diameter to be associated with a risk retinopathy development [11] although not diabetes duration. It is thought that arteriolar dilation is a direct indicator of retinal microvascular dysfunction in diabetes; the physiological basis of this has been widely explored in other studies [11,34]. "
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    ABSTRACT: The detection of microvascular damage in type 1 diabetes is difficult and traditional investigations do not detect changes until they are well established. The purpose of this study was to investigate the combined ability of nailfold capillaroscopy, laser Doppler flowmetry, retinal vessel analysis and 24-hr ambulatory blood pressure monitoring to detect early microvascular changes in a paediatric and adolescent population with type 1 diabetes. Patients aged between 8 – 18 years with type I diabetes and no other autoimmune conditions were studied. The participants underwent the above cardiac and vascular investigations in a single three-hour session. Standard parameters including HbA1c were also investigated. Associations between all parameters were described by correlation analysis. Fisher’s exact and t-tests determined the association with clinical findings. 26 participants were recruited. The mean HbA1c was 8.1% (SD ± 1.1) with a mean duration of type 1 diabetes of 7.9 years (SD ± 3.4). Three participants had microalbuminuria and one had early signs of retinopathy. Participants with microvascular complications had more avascular areas on nailfold capillaroscopy (p = 0.03). Recent HbA1c was positively associated with the number of nailfold microhaemorrhages (p = 0.03) Decreased baseline perfusion by laser Doppler flowmetry was associated with increased capillary density (p = 0.001) and an increased number of microaneurysms (p = 0.04) on nailfold capillaroscopy. This pilot study has shown that in children and adolescents with established type 1 diabetes, abnormal microvasculature can be detected by these investigations. These markers were also positively associated with evidence of suboptimal diabetes control as assessed by HbA1c. Further research will be necessary to determine the practical role of these investigations in the management and progress of the complications of type 1 diabetes. Trial registration Clinical Trial number NCT01279928,
    BMC Endocrine Disorders 10/2013; 13(1):41. DOI:10.1186/1472-6823-13-41 · 1.71 Impact Factor
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    • "In the Wisconsin Epidemiology Study of Diabetic Retinopathy (WESDR), an increase in retinal venular caliber of 10 í µí¼‡m was associated with higher 6-year incidence of DR, progression of DR, and incidence of proliferative DR [6]. Longitudinal studies from our group have demonstrated that larger retinal arteriolar caliber [7] [8] and changes in length-diameter ratio and tortuosity [9] predict the development of DR. In cross-sectional studies, increased vessel tortuosity [10] and increase fractal dimension [11] have also been associated with increased risk of DR independent of known risk factors of microvascular complications. "
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    ABSTRACT: Changes in retinal geometric parameters predict risk and progression of diabetic retinopathy (DR). We have shown that vitamin D deficiency (VDD) is associated with DR. We hypothesized that VDD mediates changes in retinal geometric parameters. Retinal vascular geometric parameters were assessed using a semiautomated computer program in photographs from young people with type 1 diabetes (T1D) (n = 481) and summarized as central retinal arteriolar and venular equivalents (CRAE, CRVE), fractal dimension, length-diameter ratio, branching angle and curvature tortuosity. Parameters were compared between those with and without DR and VDD (25-hydroxyvitamin D concentration ≤ 50 nmol/L). Retinal vascular geometric parameters were also compared across quartiles of vitamin D levels. Median CRVE was higher in patients with DR compared with those without (median (IQR) CRVE 247.3 μ m (31.3) versus 238.8 μ m (23.5), P = 0.01). Fractal dimension was marginally greater in patients without VDD (1.49 (0.06) versus 1.47 (0.07) P = 0.03). There was no difference in CRAE, CRVE, length-diameter ratio, branching angle, and curvature tortuosity between those with and without VDD and across quartiles of 25OHD. In conclusion, DR is associated with higher CRVE in young people with T1D; however, VDD is not associated with changes in retinal vascular geometric measures, suggesting an earlier role in the time course of DR pathogenesis.
    Journal of Diabetes Research 07/2013; 2013(3):280691. DOI:10.1155/2013/280691 · 2.16 Impact Factor
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