Differences in Risk Factors for Diabetic Retinopathy in Type 1 and Type 2 Diabetes Mellitus Patients in North-East Poland

Abstract

Background and Objective: Nowadays, diabetes is one of the main causes of blindness in the world. Identification and differentiation of risk factors for diabetic retinopathy depending on the type of diabetes gives us the opportunity to fight and prevent this complication. Aim of the research: To assess differences in the risk factors for diabetic retinopathy in type 1 and type 2 diabetes mellitus patients in Warmia and Mazury Region, Poland. Materials and Methods: Risk factors for diabetic retinopathy (DR) were assessed on the basis of an original questionnaire, which included: personal data, clinical history of diabetes and eye disease. Elements of clinical examination: blood pressure, BMI, waist circumference. Indicators of diabetes metabolic control: mean glycemia, glycated hemoglobin (HbA1c), total cholesterol and triglycerides, creatinine, glomerular filtration rate (GFR), albumin–creatinine ratio in urine. Results: The study group included 315 (26%) patients with DM1 and 894 (74%) patients with DM2. Risk factors were estimated on the basis of logistic regression and verified with Student’s t-test. Statistically significant dependencies were found in both groups between the occurrence of diabetic retinopathy and diabetes duration, HbA1c, triglyceride concentrations, indicators of kidney function and cigarette smoking status. In the DM2 group, the development of DR was significantly influenced by the implemented models of diabetic treatment. Conclusions: In the whole study group, the risk of DR was associated with the duration of diabetes, HbA1c, triglyceride concentrations and smoking. In DM1 patients, the risk of DR was associated with diabetic kidney disease in the G1A1/A2 stage of chronic kidney disease, and in DM2 patients with the G2 stage of chronic kidney disease. An important risk factor for DR in DM2 patients was associated with late introduction of insulin therapy.

Impact of Diabetic Retinopathy on Vulnerability of Atherosclerosis in Type 1 Diabetes: the Role of Lipid Ratios as a Metabolic Biomarker

“…In addition, our study also indicates that tobacco strongly advanced the progression of DR. A similar conclusion was found by Uruska et al, (2014) regarding patients with T1D. Other authors also established a causal link between smoking and the incidence of DR (Matuszewski et al, 2020;Campagna et al, 2019). Interestingly, body corpulence elevated the probability of DR in our study population.…”

“…Our findings showed significant effects of age and duration of diabetes on the presence of DR. The findings concord with Matuszewski et al who found that aged patients (≥ 30 years) with long-lasting diabetes (≥ 15 years) had higher risk to develop more severe DR (Matuszewski et al, 2020). The results are also consistent with previous studies in the literature (Carbonell et al, 2018;Rajalakshmi et al, 2014;Araszkiewicz et al, 2011).…”

“…We also detected a sustained increase in HbA1c levels in DR patients, proposing an early interaction between these two conditions. Previous studies reported impaired microvascular function in the retina (retinal arteriolar dilation response to flickering light) was associated with higher levels of HbA1c (Carbonell et al, 2018;Araszkiewicz et al, 2011;Matuszewski et al, 2020;Kaštelan et al, 2014). With regard to decreased glomerular filtration rate (known as diabetic nephropathy), we also noticed an incremental increase in UAER (≥ 30 mg/24h) in patients who developed DR, which may allow the findings to be more credible.…”

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“…Moreover, patients did not recognize retinopathy and were not diagnosed with it at an early stage since early DR does not significantly affect their eyesight. Matuszewski et al (2020) found that hyperglycemia is a major risk factor and a modifiable factor for DR, regardless of diabetes type. Kumari et al (2019) reported that patients with poor blood sugar control have a quadrupled risk of developing DR.…”

Diabetic Retinopathy: An Overview on Mechanisms, Pathophysiology and Pharmacotherapy

“…DR is a persistent ocular fundus condition that accounts for 80% of visual loss in individuals with diabetes and therefore affects the quality of life, as well as elevating the financial burden on society [51,52]. Risk factors of diabetic retinopathy include its duration, the presence of diabetic nephropathy, neuropathy, foot ulcer and amputation, along with hypertension, the level of cholesterol and triglyceride in the serum, fasting blood glucose, the level of HbA1c and the age of the patient [53].…”