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Artificial intelligence (AI) is an emerging science and technology that studies and develops theories, methods, technologies, and application systems for simulating and expanding human intelligence. AI has made great breakthroughs in the field of intelligent medicine, and has shown great potential in the diagnosis and treatment of diabetic retinopathy (DR), retinopathy of prematurity, and other fundus diseases. A number of clinical trials on the application of AI technologies to DR screening have been carried out in the domestic and overseas, which not only have a high accuracy rate, but also save doctors' reading time and reduce the burden of society, medical work and patients. However, due to the lack of evaluation system for DR intelligent diagnosis technology, the accuracy of AI system still lacks of big data verification. Secondly, most of the color fundus photographs are taken in the posterior 45°, which only show the most vulnerable areas, making some lesions undetectable. In addition, the current DR screening system has not yet been applied to the clinic, most of which are in the stage of prospective research and trials. There are still many obstacles from the environment to the hospital or the clinic. Doctors cannot use real patient data to evaluate the AI system, so it is not popular in clinical practice. In the future, DR screening algorithms and diagnostic models can be further improved and established to make DR AI screening more accurate.
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Objective@#To investigate the effect of obstructive sleep apnoea-hypoapnoea syndrome(OSAHS)on diabetic retinopathy(DR)in elderly patients with type 2 diabetes mellitus(T2DM)and analyze risk factors for DR process.@*Methods@#Data of elderly diabetic patients without DR admitted into our hospital from January 2012 to December 2014 were retrospectively analyzed.Based on whether or not to combine OSAHS, patients were divided into the OSAHS group(n=42)and the control group(n=85). After 36 months' follow-up, the incidence and progression of DR were compared, and the effect of different degree of OSAHS on DR was analyzed.Multivariate logistic regression analysis was used to analyze the risk factors for DR.@*Results@#The systolic pressure, diastolic pressure and Epworth sleepiness scores were higher in the OSAHS group than in the control group(P<0.05). At the(34.5±6.7)months of follow-up versus baseline, body mass index, renal function and cardiac function were markedly decreased in both groups(P<0.05). The systolic pressure, diastolic pressure, 2-h postprandial blood glucose and Epworth sleepiness scores were higher in the OSAHS group than in the control group; and the glomerular filtration rate(GFR)and left ventricular ejection fraction were lower in the OSAHS group than in the control group(P<0.05). The incidences of mild, moderate and severe non-proliferative DR were higher in the OSAHS group than in the control group(P<0.05). The results of subgroup analysis showed that the incidence of DR was higher in patients with moderate to severe OSAHS than in controls(OR=4.57, 95%CI: 1.24~13.78, P=0.002), while the incidence of DR in patients with mild OSAHS was similar to that in the controls(OR=2.33, 95%CI: 0.66~12.56, P=0.29). Multivariate logistic regression analysis showed that T2DM duration ≥7 years(OR=3.24, 95%CI: 1.80-9.59, P<0.05), haemoglobin A1c(HbA1c)≥7.5%(OR=2.07, 95%CI: 1.41-8.52, P<0.05), GFR<60 ml/min(OR=4.52, 95%CI: 1.75-14.26, P<0.05)and apnea/hyponea index ≥15/h(OR=2.03, 95%CI: 1.37-11.24, P<0.05)were independent risk factors for DR.@*Conclusions@#OSAHS patients tend to have hypertension and high glucose level, and are more prone to cardiac and renal dysfunction and DR.T2DM duration ≥7 years, HbA1c ≥7.5%, GFR<60 ml/min and AHI ≥15/h are independent risk factors for DR progression.And more studies are needed to confirm the independent risk factors.
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Objective To investigate the effect of obstructive sleep apnoea-hypoapnoea syndrome (OSAHS) on diabetic retinopathy(DR)in elderly patients with type 2 diabetes mellitus (T2DM)and analyze risk factors for DR process.Methods Data of elderly diabetic patients without DR admitted into our hospital from January 2012 to December 2014 were retrospectively analyzed.Based on whether or not to combine OSAHS,patients were divided into the OSAHS group(n=42)and the control group(n =85).After 36 months' follow-up,the incidence and progression of DR were compared,and the effect of different degree of OSAHS on DR was analyzed.Multivariate logistic regression analysis was used to analyze the risk factors for DR.Results The systolic pressure,diastolic pressure and Epworth sleepiness scores were higher in the OSAHS group than in the control group(P ＜0.05).At the(34.5±6.7)months of follow-up versus baseline,body mass index,renal function and cardiac function were markedly decreased in both groups(P ＜0.0 5).The systolic pressure,diastolic pressure,2-h postprandial blood glucose and Epworth sleepiness scores were higher in the OSAHS group than in the control group;and the glomerular filtration rate(GFR)and left ventricular ejection fraction were lower in the OSAHS group than in the control group(P ＜0.05).The incidences of mild,moderate and severe non-proliferative DR were higher in the OSAHS group than in the control group(P ＜0.05).The results of subgroup analysis showed that the incidence of DR was higher in patients with moderate to severe OSAHS than in controls(OR =4.57,95％CI:1.24～ 13.78,P =0.002),while the incidence of DR in patients with mild OSAHS was similar to that in the controls(OR =2.33,95％ CI:0.66 ～ 12.56,P =0.29).Multivariate logistic regression analysis showed that T2DM duration ≥ 7 years(OR =3.24,95 ％ CI:1.80-9.59,P＜0.05),haemoglobin A1c (HbA1c) ≥7.5％ (OR =2.07,95％ CI:1.41-8.52,P＜0.05),GFR＜60 ml/min(OR=4.52,95％CI:1.75-14.26,P＜0.05)and apnea/hyponea index ≥≥15/h(OR=2.03,95％CI:1.37-11.24,P＜0.05)were independent risk factors for DR.Conclusions OSAHS patients tend to have hypertension and high glucose level,and are more prone to cardiac and renal dysfunction and DR.T2DM duration ≥ 7 years,HbA1 c ≥ 7.5 ％,GFR＜ 60 ml/min and AHI ≥15/h are independent risk factors for DR progression.And more studies are needed to confirm the independent risk factors.
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Objective To explore the correlations of dyslipidemia and hypertension with diabetic retinopathy in diabetic patients aged 80 years and over. Methods The 487 diabetic patients admitted to endocrine department of our hospital from January 2013 to June 2017 were recruited and their medical records were retrospectively analyzed. According to the results of examination ,they were divided into three groups :non-diabetic retinopathy group (n = 306 ) ,non-proliferative diabetic retinopathy group (n = 143)and proliferative diabetic retinopathy group (n = 38).The course of diabetes ,levels of blood glucose and lipids ,and the course of hypertension were compared among the three groups. Results Prevalence of diabetic retinopathy was 37.2% (181/487) ,and was increased along with the prolongation of diabetes duration ,and occurrence of coexisted hypertension and dyslipidemia.Statistically significant differences were found among the 3 groups(all P＜0.05)in the levels of glycosylated hemoglobin A1c ,low-density lipoprotein cholesterol ,high-density lipoprotein cholesterol ,triglyceride ,apolipoprotein A ,apolipoprotein B and the ratio of apolipoprotein A over apolipoprotein B.Multivariate analysis showed that the levels of glycosylated hemoglobin A 1c ,low-density lipoprotein cholesterol and the ratio of apolipoprotein A and apolipoprotein B were correlated with the development and progression of diabetic retinopathy ( OR = 3.00 ,0.22 and 2.96 , respectively). Conclusions The incidence of diabetic retinopathy is higher in diabetic patients aged 80 years and over.Dyslipidemia is correlated with development and progression of diabetic retinopathy.
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Objective To explore the correlation between diabetic retinopathy (DR)and glycosylated blood protein(HbA1c) among diabetic patients aged 80 years and over.Methods The medical records of 403 diabetic patients(≥80 years old)admitted to endocrine department of Heji Hospital Affilicated to Changzhi Medical College from January 2013 to March 2017 were retrospectively analyzed.They were divided to three groups of non-DR group (254 cases),non proliferative DR group (122 cases) and proliferative DR group (27 cases).The duration of diabetes,levels of fasting blood glucose and glycosylated hemoglobin were compared among groups.Results One-hundred and forty-nine(37.0％)elderly diabetic patients developed DR.DR was associated with longer history of diabetes and hypertension and with family history of diabetes.There were statistically significant differences in serum levels of fasting blood glucose and glycosylated hemoglobin(both P＜ 0.05)among three groups.Furthermore,multivariate analysis showed that glycosylated hemoglobin was associated with the incidence and development of DR(OR =4.137,P＜0.01).Conclusions More than one third(37.0 ％) elderly diabetic patients(≥80 years old) have diabetic retinopathy,which is associated with the level of glycosylated hemoglobin.
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Objective To explore the correlation between diabetic retinopathy (DR)and glycosylated blood protein(HbA1c) among diabetic patients aged 80 years and over.Methods The medical records of 403 diabetic patients(≥80 years old)admitted to endocrine department of Heji Hospital Affilicated to Changzhi Medical College from January 2013 to March 2017 were retrospectively analyzed.They were divided to three groups of non-DR group (254 cases),non proliferative DR group (122 cases) and proliferative DR group (27 cases).The duration of diabetes,levels of fasting blood glucose and glycosylated hemoglobin were compared among groups.Results One-hundred and forty-nine(37.0％)elderly diabetic patients developed DR.DR was associated with longer history of diabetes and hypertension and with family history of diabetes.There were statistically significant differences in serum levels of fasting blood glucose and glycosylated hemoglobin(both P＜ 0.05)among three groups.Furthermore,multivariate analysis showed that glycosylated hemoglobin was associated with the incidence and development of DR(OR =4.137,P＜0.01).Conclusions More than one third(37.0 ％) elderly diabetic patients(≥80 years old) have diabetic retinopathy,which is associated with the level of glycosylated hemoglobin.
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Objective To investigate the effect of vitamin D supplementation on biochemical imdexes and compliations in patients with type 2 diabetes(T2DM).Methods Two hundred and ten patients with type 2 diabetes of the People's Hospital of Chongli County were selected from January 2001 to January 2002.According to the envelope sampling method they were divided into vitamin D supplementation group of 105 people and not supplemented group of 105 people,and 105 healthy people at the same period as control group.Compared the biochemical baseline indicators differences.After 10 years of follow-up,the biochemical indexes and the complications were detected and compared again.Results After ten years follow-up,82 cases of supplementation group were followed up,78 cases of not supplemented group were followed up.The level of FPG and HbA1c of supplementation group and not supplementation group were higher than that of control group,the differernce was significant(P＜0.05).In supplement group,TG levels,25(OH) D3 concentrations and BMD values were (2.11±0.41) mmol/L,(16.88±5.02) μg/L and-1.15±(-0.25) respectively,and equal to the control group ((2.12 ± 0.38) mmol/L,(44.83 ± 21.25) mmol/L,-0.94 ± (-0.21)),and TG levels were lower than not supplemented group,25 (OH) D3 concentrations and high bone density higher than not supplemented group((24.53±15.61) mmol/L,-3.15±(-0.33),P＜0.05).FPG,Cr,BUN,UA,FIB,and BNP in supplement group were(10.00±2.32) mmol/L,(64.77±9.31) μmol/L,(6.41± 1.24) mmol/L,(339.83±43.74) mmol/L,(2.41±0.46) g/L and (588.92±73.69) ng/L,in not supplemented group were (15.60±2.51) mmol/L,(92.69±11.68).μmol/L,(8.70±2.35) mmol/L,(398.94±49.13) mmol/L,(2.89±0.54) g/L and (761.09±91.52) ng/L,all higher than those in control group ((5.01 ±0.59) mmol/L,(57.81±6.61) μmol/L,(4.52±1.11) mmol/L,(311.83±49.51) mmol/L,(2.00±0.31) g/L,(434.31 ± ±71.03) ng/L),and those indexes in supplement group all higher than in not supplemented group(P＜0.05).The level of HbA1c of supplement group and not supplemented group both higher than control group((11.32 ± ±2.03) ％,(13.22±4.17) ％ and (5.34±1.99) ％,P＜0.05).There were 45 cases in supplement group occurred diabetic nephropathy and cardiovascular complications,and 65 cases of not supplemented group (x2 =15.07,P＜0.05).Conclusion The relationship of Vitamin D and various complications of diabetes mellitus are closely,and supplementing vitamin D can reduce the complications of diabetes.