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Diabetic retinopathy（DR） and coronary heart disease（CHD） are both major chronic vascular complications that seriously jeopardize the health of the population and often occur together in clinical practice， it is of great clinical value to actively explore the association between the two in the process of disease development and methods of prevention and treatment of modern medicine and traditional Chinese medicine（TCM）. According to TCM， the heart and eyes physiologically communicate with each other by taking Qi， blood and veins as bridges， blood stasis obstructing collaterals is the common TCM etiology of DR and CHD， whose mechanism involves inflammation， oxidative stress and endothelial dysfunction. Promoting blood circulation and removing blood stasis plays an important role in the same treatment for different diseases and prevention and treatment of comorbidities， possibly by inhibiting the expression of interleukin-1β（IL-1β）， endothelin-1（ET-1） and hypoxia inducible factor-1α/vascular endothelial growth factor（HIF-1α/VEGF）， regulating phosphatidylinositol 3-kinases/protein kinase B/mammalian target of rapamycin（PI3K/Akt/mTOR） pathway， initiating adenosine monophosphate（AMP）-activated protein kinase/silent information regulator 1（AMPK/SIRT1） and nuclear transcription factor erythroid 2-related factor 2/heme oxygenase-1（Nrf2/HO-1） signaling pathways， inhibiting Hippo/Yes-associated protein（Hippo/YAP） signaling pathway， inhibiting mitochondrial permeability transition pore and anti-platelet agglutination for treating DR and CHD， which provides a multi-component， multi-pathway and multi-target selection strategies and ideas for the prevention and treatment of DR and CHD by TCM from a biological perspective. Based on this， subsequent studies should focus on constructing clinically relevant comorbidity models， conducting multicenter prospective studies， and fully utilizing artificial intelligence technology to gain a deeper understanding of the relationship between the two diseases， so as to elucidate the mechanism of promoting blood circulation and removing blood stasis in preventing and treating panvascular diseases.
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Background: Diabetes Mellitus refers to a group of common metabolic disorders that share the phenotype of Hyperglycemia. It is the leading cause of morbidity and mortality throughout the world with an estimated worldwide prevalence of 439 million by 2030 and 19% of world抯 DM patients are Indians. Magnesium is an important co-factor for various enzymes involved in Insulin secretion and is involved in sodium-potassium ATPase pump. 25%-38% of Type 2 DM patients had Hypomagnesemia, which has also contributed in developing microvascular complications such as Diabetic Retinopathy (DR) and Diabetic Nephropathy (DN). Various studies have suggested that Magnesium supplementation in Type 2 DM patients with Hypomagnesemia have shown beneficial effects on insulin sensitivity and glucose metabolism. Aim and objectives: To study the prevalence of Hypomagnesemia in Type 2 DM patients and to study the association of Hypomagnesemia with microvascular complications such as DR and DN. Materials and methods: It is a hospital based Observational study carried out in 2022 for a period of 1 year including 60 patients fulfilling the ADA criteria for diagnosing T2DM and patients with Diabetic Retinopathy and Diabetic Nephropathy, and excluding patients with Malabsorption, Chronic diarrhoea, Renal Failure on diuretic therapy, Sepsis, Pancreatitis. Serum Magnesium levels of 1.6 mg/dl � 2.6 mg/dl is considered as normal range. Serum Magnesium were measured using Xylidyl blue colorimetric method. Results: The Mean age of the patients in our study was 55.89 years. Among 60 patients diagnosed with Diabetes Mellitus, 42 patients had Hypomagnesemia, 18 patients had Normomagnesemia (p- value: <0.0001). Patients with an HbA1c levels > 7% had Hypomagnesemia when to compared to patients with HbA1c <7% with a significant p value of 0.009. Hypomagnesemia was also associated with Diabetic Retinopathy and Diabetic Nephropathy with a significant p-value of 0.013 and 0.009 respectively. Conclusion: In our study, it has shown that patients with uncontrolled T2DM had Hypomagnesemia, which is also associated with micro-vascular complications of T2DM such as DR and DN.
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Purpose: The present study aims to determine the macular and choroidal optical coherence tomography angiography (OCTA) biomarkers in the assessment and monitoring of diabetic macular edema (DME) and diabetic macular ischemia (DMI) in patients with non?proliferative diabetic retinopathy (NPDR). Methods: In this cohort study, a total of 176 eyes of 110 patients with NPDR were investigated at our institute over a period of 10 months. Eyes were divided into four groups based on the severity of NPDR. Each eye was subjected to OCTA (Topcon 3D OCT?1 Maestro2) macula 6 × 6 mm2 en face. It features IMAGEnet 6 software for dynamic viewing of OCTA and imaging data. Four OCTA biomarkers for the macula were identified: foveal avascular zone area (FAZ area), foveal avascular zone contour irregularity (FAZ?CI), capillary dropout areas (CDA), and perifoveal intercapillary areas (PICA). The choroidal OCTA biomarker was the number of choroidal circulation flow voids (CCFV). For all analyses, P < 0.05 was considered statistically significant. Results: Increase in FAZ area and number of CDA were statistically significant (p < 0.0001) with an increase in central foveal thickness, suggesting a correlation of ischemic changes with an increase in DME. FAZ?CI, enlarged PICA, and CCFV were significantly associated with more severe NPDR patients. Conclusion: A correlation between DME and DMI in a patient of NPDR and its progression can be evaluated in a single visit. A unique feature of our study is it revealed novel diagnostic biomarkers of OCTA for DMI and DME.
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In order to evaluate the efficacy and safety of Hexue Mingmu tablets in the treatment of diabetic retinopathy（DR） and retinal vein obstruction（RVO）， and to provide a basis for the clinical treatment of ophthalmic diseases， this paper obtained randomized controlled trials（RCTs） of Hexue Mingmu tablets in the treatment of DR and RVO by searching Chinese and English electronic databases and trial registration platforms（up to September 13， 2022）. The risk of bias in the included studies was assessed using RoB2.0， and Meta-analysis was performed using RevMan5.4. A total of 35 RCTs involving a total sample size of 3 261 patients were included. Meta-analysis results showed that compared with conventional western medical treatment alone， the combination of Hexue Mingmu tablets with conventional western medical treatment improved patients' macular thickness｛mean difference（MD） =-39.83， 95% confidence interval（CI） ［-51.60， -28.06］， P<0.000 01｝， improved corrected visual acuity｛risk ratio（RR）dichotomous=1.09， 95% CI ［1.00， 1.18］， P=0.04； MDcontinuous variable=0.15， 95% CI ［0.13， 0.17］， P<0.000 01｝， increased effective rate of fundus symptom improvement（RR=1.26， 95% CI ［1.22， 1.30］， P<0.000 01）， improved hemorheology index｛standard mean difference（SMD）=-1.53， 95% CI ［-2.04， -1.01］， P<0.000 01｝， shortened improvement time of fundus symptoms（MD=-5.53， 95% CI ［-5.96， -5.09］， P<0.000 01）， and there was no significant difference on adverse events between the two groups. The results show that treatment of DR and RVO with Hexue Mingmu tablets may improve the macular thickness and hemorheology index of patients， which can significantly enhance the effect of corrected visual acuity and clinical efficiency， and shorten the time to symptom improvement. However， the original literature is of low quality and the pooled results have some limitations. Subsequent studies should try to use uniform standard assessment criteria and testing methods， focus on the rigor of study design and implementation， and pay attention to the key outcomes of this disease and the clinical safety of medication， so as to provide more reliable evidence to support this kind of clinical problems.
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Diabetic retinopathy (DR) is a major microvascular complication of diabetes. It is the most common cause of blindness in the working-age population in developed countries. We wanted to analyse the correlation between risk factors of blindness like duration of diabetes, dyslipidaemia, hypertension, HbA1c with severity of diabetic retinopathy in order to design appropriate strategies for prevention and treatment of diabetic retinopathy.METHODSThis was a retrospective study of all diabetic patients with diabetic retinopathy who presented to the eye OPD at KS Hegde Medical Academy from April 1st 2018 to March 31st 2019 that fulfilled the inclusion criteria. A dilated fundus examination was done to note the grade of diabetic retinopathy. The demographic data along with the duration of diabetes, HbA1c values, Cholesterol levels and Blood pressure were documented and correlated with the severity of diabetic retinopathy.RESULTSThe study included 92 patients, of which 63 were males and 29 were females with a mean age of 54.5±2.8 years. We found that there was statistically significant association between the duration of diabetes and HbA1c levels with severity of diabetic retinopathy (p= 0.022 and 0.034 association), whereas there was no statistically significant correlation between blood pressure and cholesterol levels with severity of diabetic retinopathy (p= 0.52 and 0.456 respectively)CONCLUSIONSDiabetic retinopathy showed a male preponderance, with risk factors like duration of diabetes and HbA1c levels having a significant association with the severity of diabetic retinopathy. Therefore, it is essential to have a good systemic control of diabetes with diet and suitable medications. Diabetic retinopathy is a preventable cause of blindness when diagnosed early and screening of diabetic retinopathy must be done in all diabetics to prevent the progression of the disease.
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Objective • To evaluate the accuracy and efficiency of the automated supervised machine-learning algorithm for microaneurysm lesion detection in seven-field color fundus photography. Methods • A total of 616 seven-field color fundus photographs were obtained from 44 patients with diabetic retinopathy (DR) from Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from 2014 to 2016. Using the microaneurysm detection algorithm developed in this study, the automated identification and labeling of microaneurysm lesions in the standard seven-field color photography of DR were performed. The results were compared with manual labeling by ophthalmologists to evaluate the sensitivity and efficiency of the automated algorithm. Results • In the standard seven-field fundus color photographic image library, the automated algorithm achieved sensitivity of 94.15% in total and 93.09% in the optic disc field (F1), 94.84% in the macula field (F2), 95.16% in the temporal to macula field (F3), 94.99% in the superior temporal field (F4), 93.77% in the inferior temporal field (F5), 92.40% in the superior nasal field (F6) and 93.75% in the inferior nasal field (F7), and specificity of 98.05% in total and 98.02% in F1, 98.06% in F2, 97.97% in F3, 97.91% in F4, 98.07% in F5, 98.03% in F6 and 98.23% in F7. The cost of time per image was (9.2± 0.6) s, 93.2% less time than manual labeling. Conclusion • The automated microaneurysm detection algorithm can accurately and efficiently identify microaneurysm lesions in color fundus photography.
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Objective: To investigate the effects of artesunate (ART) on diabetic retinopathy of rats by detecting the expression variation of matrixmetalloproteinase-9 (MMP-9) and inhibitory factor matrix metalloproteinase inhibitor-1 (TIMP-1) in retina. Methods: A total of 24 healthy male SD rats were randomly divided into negative control, model control and ART treated groups. The model control group and ART treated group were given injection of streptozotocin (STZ) to establish the type 1 diabetic rat model. After being raised for three months, the ART treated rats' abdomina were given ART injection for 10 d. All retinas of three groups were isolated. The expression of MMP-9 and TIMP-1 mRNA was detected by Real-time PCR (RT-qPCR) and the expression of MMP-9 protein was detected by immunohistochemical staining. Results: The expression of MMP-9 in ART treated group was significantly decreased compared with model control group (P < 0.05), whereas TIMP-1 in ART treated group was significantly increased (P < 0.05). The immunohistochemical staining showed that the positive expression of MMP-9 protein in ART treated group was significantly less than that in model control group. Conclusion: ART has inhibitory effects on the expression of MMP-9 in the diabetic retinopathy of rats.
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Objective To explore the ability of advanced oxidation protein products (AOPP)in predicting the progression of diabetic retinopathy (DR)in patients with type 2 diabetes mellitus (T2DM). Methods 363 T2DM patients were enrolled in this prospective cohort study. According to the quartile points of baseline AOPP level,patients were divided into four groups (Q1,Q2,Q3 and Q4 ). The progression rate of DR was calculated according to the changes of non-mydriatic fundus photography after a 5-year follow-up. Results With the increase of baseline AOPP level,the rate of progression of DR increased (19.51% vs 28.42% vs 37.36% vs 47.37%,P <0.01). Logistic regression analysis showed that baseline level of AOPP was an independent risk factor for the progression of DR (OR=1.833,95%CI:1.573~1.982,P<0.05).Area under the curve of AOPP in predicting DR is 0.883 (95% CI:0.842~0.924)with the sensitivity 86.1% and specificity 91.9%. Conclusion AOPP may be one of the biomarkers for the prediction of type 2 diabetic retinopathy progression.
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Objective To investigate the diagnostic value of serum MK (Midkine)and total bilirubin (TB)in diabetic retinopathy (DR). Methods A total of 148 patients with type 2 diabetes were divided into three groups:diabetes without retinopathy (NDR group,n = 50),diabetic with non proliferative retinopathy (NPDR group,n = 52 )and diabetic with proliferative retinopathy (PDR group,n = 46 ) according to whether retinal lesions were detected. The diagnostic value of serum MK and TB were investigated. Results Age,gender,body mass index (BMI),FPG,HbA1 c,TG,TC,LDL-C,HDL-C, SBP,DBP were not statistically different among the three groups (P >0.05).Duration,UAlb/Cr,SOD, MDA,AOPP,MK,TB and DB were statistically different among the three groups (P<0.05). Duration, ALB/CR,MDA,AOPP,and MK were higher,SOD,TB,DB were lower in PDR and NPDR group than in NDR group (P<0.05). Duration,UAlb/Cr,MDA,AOPP,and MK were higher,and SOD,TB,DB were lower in PDR group than in NPDR group (P <0.05).Logistic regression analysis showed that duration, ALB/CR,MDA,AOPP,and MK were risk factors (OR =1.36,1.71,1.27,1.65,2.35,P <0.05 )and SOD,TB,DB were protective factors for DR (OR =0.46,0.31,0.46,P <0.05). Diagnosis sensitivity, specificity,positive predictive value,negative predictive value and accuracy of TB combined with MK were higher than TB,MK alone(AUC=0.918,0.735,0.762,P <0.05). Conclusion DR may be associated with increased MK and decreased TB.Diagnostic efficacy of MK combined with TB is better than MK,TB alone.
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[Summary] MicroRNA (miRNA) is a class of endogenous small molecule non‐coding RNAs ,which can inhibit target gene expression via blocking protein translation or inducing mRNA degradation.MicroRNA is also involved in some important physiological processes ,such as cell development , differentiation ,proliferation and apoptosis. Recently ,studies have shown that miRNA plays a role in the development and progression of diabetic retinopathy (DR). This article summarized the research progress of correlation between miRNAs and DR.
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Objective To evaluate effect of Qi-ming granule on vision function of patients with mild, moderate non-proliferative diabetic retinopathy ( NPDR ) .Methods Using the randomized double blind and placebo-controlled clinical trial method.From Oct.2012 to Jun.2014, 36 patients with 68 eyes who included in the standard were randomly divided into treatment group,control group,given Qi-ming gran-ule and placebo respectively for 6 months, exam with mfERG before treatment and after treatment, evaluate the curative effect.Results After 6 months treatment of Qi-ming granule, the implicit time of the 4th ring of the N1 wave about the mfERG was shorter than that of preoperative( P <0.05), the amplitude density was more than both that of preoperative and control group( P <0.01), the amplitude density of the 5th ring increased compared to that of control group;The peak latency of 3 rd ring of P1 wave was shorter than that of control group( P <0.01), the amplitude density of 1st,3rd,5th ring restored compared with that of preopera-tive and control group( P <0.01), the amplitude density of 4th ring improve than that of control group( P<0.01).Conclusions Qi-ming granule can improve the multifocal ERG of patients with mild, moderate non-proliferative diabetic retinopathy, restore the vision function.
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Objective To evaluate the relationship between serum C‐P levels and microvascular complications in patients with T 2DM. Methods The clinical data of 434 patients with T2DM were retrospectively analyzed. All subjects were divided into three groups based on ΔC‐P (2 hC‐P - FC‐P) tertiles :ΔC‐P1(≤2.2 ng/ml) ,ΔC‐P2(2.3~4.0 ng/ml) and ΔC‐P3(≥4.1 ng/ml). Results The levels of BMI ,TG ,FC‐P were lower ,and the course and HbAl c were higher in ΔC‐P1 group. ΔC‐P level was positively associated with BMI and TG (P< 0.05) ,and negatively associated with prevalence of DR and chronic kidney disease (CKD)in diabetes ,course and HbA1 c.ΔC‐P levels decreased gradually with the progression of DR and CKD. Logistic regression analysis showed that lower ΔC‐P level was the independent risk factor for microvascular complications after adjustment for related risk factors. Conclusion Serum ΔC‐P level is an independent factor for the development of diabetic microvasculr complications in T 2DM.
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Objective To explore the association between serum neutrophil‐to‐lymphocyte ratio (NLR) and DR in T2DM patients . Methods A total of 128 T2DM patients were recruited and divided into three groups :PDR group (n=22) ,NPDR group(n= 44) ,and simple T2DM group(n=62) .The levels of FPG ,HbA1 c ,TC ,TG and NLR were measured in each group . Results Spearman correlation analysis revealed that DR was positively correlated with T 2DM duration ,SBP ,DBP ,FPG ,HbA1 c ,TC , TG ,LDL‐C ,NLR ,CKD (r= 0.524 ,0.277 ,0.279 ,0.194 ,0.271 ,0.208 ,0.223 ,0.358 ,0.621 , 0.362 ,P<0 .05 or P<0 .01) .Logistic multiple regression analysis showed that ,T2DM duration ,NLR and CKD were independent risk factors for DR . Conclusion NLR level is associated with DR .
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Background: There were 31.7 million diabetics in India in year 2000 with a projection to reach 79.4 million by year 2030. We must identify and treat high-risk persons before severe loss of vision occurs. We doctors of all specialities have to strive together to create awareness of the importance of routine eye evaluation for all diabetics as this blindness is largely irreversible once set in. Visual impairment as a result of Diabetic Retinopathy (DR) has a significant impact on patients’ quality of life. In communities in which intensive retinopathy screening programmes have been implemented, rates of vision loss have decreased. There is a need to increase the awareness among doctors of all specialities on the importance of retinal examination by ophthalmologists even in well controlled diabetics. Aims & Objective: A survey to assess the practice patterns among doctors about diabetic retinopathy referral, its complications, treatment modalities and the knowledge about timing of referral to ophthalmologists. Material and Methods: Questionnaires consisting of 16 questions pertaining to general awareness, clinical manifestations, complications and treatment was given to doctors in two sections A and B. Answers were analysed and tabulated. Results: 36 doctors of various specialities participated in the survey. 19.4% of doctors felt there was no need to refer all diabetics routinely for fundus examination. 80.6% (29 of 36) of doctors were regularly referring all diabetics to ophthalmologist, where as 19% did not. 86.1% of the participants felt there was no need to worry about retinopathy if blood sugar levels were controlled. Amongst the participants 75% were well aware of DR, its presentation, complications and 88.9% about its treatment. Conclusion: Diabetic retinopathy still is not well understood among general doctors and non-ophthalmologists. It is therefore advisable to educate consultants about the severity of the problem and need for early referral to prevent complications. General Practitioners can be educated about the timing to seek expert opinion for treatment.
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The present study was conducted to find out the role of serum lipids in the development of diabetic retinopathy in type II Diabetes Mellitus. One hundred fifty subjects aged 30-70 years attending OPD at Old Civil hospital, Surat, participated in the study and were divided into three groups. Group I included 50 healthy non-diabetic subjects who served as control. Group II included 50 diabetic subjects with no signs of diabetic retinopathy and Group III included 50 diabetics with diabetic retinopathy. Funduscopy under homatropine was done in all the subjects. Serum triglycerides and total cholesterol were estimated by enzymatic methods and High Density Lipoprotein by precipitation method. Serum Low density lipoprotein was calculated using Friedewald’s formula. It was found that triglyceride levels were significantly raised (p<0.05) in subjects with diabetic retinopathy as compared to those without diabetic retinopathy showing a positive association of Triglycerides with the incidence of diabetic retinopathy. Whereas no such association was found between low density lipoprotein and total cholesterol levels with the prevalence of diabetic retinopathy.
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BackgroundDiabetic retinopathy (DR) is the result of the cytokine network disorders,the imbalance of angiogenic factor and vascular inhibitory factor is the start factor.ObjectiveTo analyze the levels of CXC chemotatic factors of type 2 diabetes mellitus patients,evaluate the clinical application value of them in different clinical types of DR using receiver operating characteristic (ROC)analysis and to approach the new way of individualized treatment.Methods This was a prospective research.The gold standard was ophthalmolscope and fundus fluorescein angiography.The levels of CXC chemotatic factors and multiplicaiton factors were measured in 96 cases with type 2 diabetes mellitus (66 cases with retinopathy and 30 cases without retinopathy as control).The assessment tasks were performed for these index and courses of DR with ROC curve.Results The expression of age,course of disease has significant difference in different courses of DR ( F =8.507,P =0.001 ; F =28.143,P =0.000).Compared with the control group,the expression of growth-related oncogene-α ( GROα ) ( t =- 2.172,P =0.035,AUC =0.625 ),whole blood viscosity 200 ( t =- 3.724,P =0.001,AUC =0.904 ) and neutrophilic leukocyte (t=-2.562,P =0.013,AUC =0.577 ) has significant difference in the group of mild NPDR.Compared with the control group,the expression of interferon-γ-inducible protein 10 ( IP-10 ) ( t =-3.591,P =0.001,AUC =0.592 ),platelet derivation growth factor-BB ( PDGF-BB ) ( t =- 3.233,P =0.003,AUC =0.735 ),vascular endothelial growth factor(VEGF) ( t =- 3.617,P =0.001,AUC =0.776 ),C peptide ( t =- 3.366,P =0.002,AUC =0.962 ),leukocyte ( t=-3.201,P =0.003,AUC =0.852) and neutrophilic leukocyte(t =-4.201,P=0.000,AUC =0.852) has significant difference in the group of moderate and severe NPDR.ConclusionsCXC chemotatic factors may act as reactivator in the pathogenesis of DR,GROα and IP-10 may be useful for clinical monitoring of the severity of DR,and evaluating the imbalance state of chemotatic factors maybe a new approach to clinical monitoring and prognosis of DR.
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Objective To study the relationship between obesity and diabetic retinopathy (DR) in type 2 diabetes mellitus patients.Methods Seventy-two cases of type 2 diabetes mellitus patients were selectively divided into obesity group and non-obesity group according to BMI,obesity group were subdivided into A group(visceral type) and B group(subcutaneous type) according to waist-buttock girth ratio,the prevalance and severity of DR in two group were compared.Results DR in obesity group were significantly higher than those in non-obesity group,there were higher incidence of proliferative DR in obesity group,therefore,incidence of DR in A group was obviously higher than that in B group.Conclusions Obesity is one of the important factors to aggravate the DR in type 2 diabetes mellitus.
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Objective To study the relationship between diabetic retinopathy(DR) and Landsteiner-Wiener,Indian blood group genes.Methods Peripheral blood samples were collected from 50 DR patients,and 160 unrelated volunteer blood donors(the control).CDNA,including LW gene generated by reverse transcription polymerase chain reaction(RT-PCR),was subjected to sequence analysis,and the genomic DNAs,extracted from each sample,were sequenced directly for LW gene and IN gene.Woolf method was used for calculating relative risk(RR).Results In the 160 control samples,there was A at the nt380 locus in Exon1 of the LW gene,which were genotyped as LWa;and there was G at the nt252 locus in Exon2 of the IN gene,which were genotyped as INb.All the 53 samples from DR patients were LWa homozygous genotypes and all INb homozygous genotypes.Conclusion These two candidate genes are not associated with the incidence of DR.