Glycemic variability and diabetes retinopathy: A missing link

Hsu, Cherng-Ru; Chen, Yu‐Tsung; Sheu, Wayne Huey Herng

doi:10.1016/j.jdiacomp.2014.11.013

Cited by 70 publications

(47 citation statements)

References 54 publications

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“…However, if not properly treated, it is very likely that DR progresses to the advanced stage, during which severe pathologies often lead to irreversible blindness [3]. Factors like poor metabolic control and hyperglycemia play an important role in the development of DR since intensive glycemic control generally inhibits the progression of DR [4,5,6]. Unfortunately, many patients have difficulty maintaining the optimal metabolic level.…”

Section: Introductionmentioning

confidence: 99%

Zerumbone, a Phytochemical of Subtropical Ginger, Protects against Hyperglycemia-Induced Retinal Damage in Experimental Diabetic Rats

Tzeng

Liou

Tzeng³

et al. 2016

Nutrients

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Diabetic retinopathy (DR), the most ordinary and specific microvascular complication of diabetes, is a disease of the retina. Zerumbone (ZER) is a monocyclic sesquiterpene compound, and based on reports, it is the predominant bioactive compound from the rhizomes of Zingiber zerumbet. The aim of the current study is to evaluate the protective effect of zerumbone against DR in streptozotocin (STZ)-induced diabetic rats. STZ-diabetic rats were treated with ZER (40 mg/kg) once a day orally for 8 weeks. ZER administration significantly (p < 0.05) lowered the levels of plasma glucose (32.5% ± 5.7% lower) and glycosylated hemoglobin (29.2% ± 3.4% lower) in STZ-diabetic rats. Retinal histopathological observations indicated that disarrangement and reduction in thickness of retinal layers were reversed in ZER-treated diabetic rats. ZER downregulated both the elevated levels of advanced glycosylated end products (AGEs) and the higher levels of the receptors for AGEs (RAGE) in retinas of diabetic rats. What’s more, ZER significantly (p < 0.05) ameliorated diabetes-induced upregulation of tumor necrosis factor-α, interleukin (IL)-1 and IL-6. ZER also attenuated overexpression of vascular endothelial growth factor and intercellular adhesion molecule-1, and suppressed activation of nuclear factor (NF)-κB and apoptosis in the retinas of STZ-diabetic rats. Our results suggest ZER possesses retinal protective effects, which might be associated with the blockade of the AGEs/RAGE/NF-κB pathway and its anti-inflammatory activity.

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Section: Introductionmentioning

confidence: 99%

Zerumbone, a Phytochemical of Subtropical Ginger, Protects against Hyperglycemia-Induced Retinal Damage in Experimental Diabetic Rats

Tzeng

Liou

Tzeng³

et al. 2016

Nutrients

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“…С одной стороны, относительно низкая частота развития микроангиопатий в группе па-циентов, получающих АИЧ, может быть результатом преимуществ фармакокинетики АИЧ, которые, как по-казывают многочисленные исследования, обусловливают меньшую вариабельность гликемии [14,15]. Все больше исследований убедительно демонстрируют взаимосвязь вариабельности гликемии с развитием поздних ослож-нений диабета [16,17]. В нашем исследовании не оце-нивалась вариабельность гликемии в целом и показатели препрандиальной и постпрандиальной гликемии в от-дельности, что не дает нам право рассматривать данное объяснение иначе, чем одно из возможных.…”

Section: ограничения исследованияunclassified

Comparative analysis of glycemic control effectiveness and microvascular complications in patients with type 1 diabetes mellitus, treated with genetically engineered human insulin or human insulin analogues: A 10-year retrospective observational study

Shestakova¹,

Efremova²,

Bolotskaya³

et al. 2016

Diabetes mellitus

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The treatment of diabetes mellitus generally involves genetically engineered human insulin (GICH) or genetically engineered analogues of human insulin (AIC). Compared to GICH, AIC better physiologically mimics endogenous insulin functionally. It would thus be logical to assume that long-term (multi-year) application of AIC leads to a lower incidence of diabetic angiopathy compared to GICH. To date, however, no long-term comparisons of both classes of insulin preparations (in terms of efficacy of glycemic control or incidence of microvascular complications in patients with type 1 diabetes) have been performed. Aims. To retrospectively compare the efficacy of glycemic control and incidence of microvascular complications (nephropathy and retinopathy) in patients with type 1 diabetes treated for at least 10 years with either GICH or AIC. Materials and methods. Based on data from electronic databases (diabetes registry) from several regions within the Russian Federation, the following patient samples were examined (n=260): group 1 received GICH for 10 years (n = 130) and group 2 received AIC for 10 years (n = 130). Patients in both groups underwent pairwise matching for baseline clinical characteristics (sex, age of diabetes onset, duration of disease and HbA1clevel). All patients were observed by endocrinologists in the clinic. Results. After 10 years of follow up, HbA1с levels declined more significantly in group 2 than in group 1 (1.30% vs. 0.81%, respectively, P 0.05). By the end of the observation period, the presence of diabetic retinopathy (any stage) increased in both groups and was not significantly different between groups; the presence of diabetic nephropathy was also increased in both groups, but the increase was significantly lower in group 2 than in group 1 (20.5% vs. 33.9%, respectively, P 0.05). Overall, the risk of microvascular complications was significantly higher in group 1 than in group 2 [HR (hazard ratio): 1.84; 95% CI: 1.372.48), specifically, the risk of diabetic retinopathy (HR: 1.37; 95% CI: 0.981.90). Conclusions. A 10-year retrospective analysis of patients treated with AIC for type 1 diabetes in the clinic showed a significantly more effective reduction in HbA1c levels and a lower incidence of diabetic nephropathy, compared with patients treated with GICH.

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“…Among studies on type 2 DM with preserved renal function, glucose variability is positively associated with the development of diabetic retinopathy, neuropathy, and nephropathy [8–11], but its effects on macrovascular events remain uncertain. Wan et al evaluated the association of HbA 1c variability with cardiovascular events in patients with type 2 DM and found that high variability was associated with increased cardiovascular events [12].…”

Section: Introductionmentioning

confidence: 99%

“…Wan et al evaluated the association of HbA 1c variability with cardiovascular events in patients with type 2 DM and found that high variability was associated with increased cardiovascular events [12]. On the other hand, the cross-sectional analysis within the Italian Renal Insufficiency and Cardiovascular Events (RIACE) multi-center study showed no impact of HbA 1c variability [11]. Thus, current literature is conflicting and limited, especially on different renal functions.…”

Section: Introductionmentioning

confidence: 99%

Greater HbA1c variability is associated with increased cardiovascular events in type 2 diabetes patients with preserved renal function, but not in moderate to advanced chronic kidney disease

et al. 2017

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Emerging evidence suggests that glycemic variability may be a more reliable measure of glycemic control than mean HbA1c in type 2 diabetes mellitus. This study aimed to determine if HbA1c variability is associated with cardiovascular events in type 2 diabetic patients and if different renal functions affect such association. This longitudinal study enrolled 8259 diabetic patients from the Kaohsiung Medical University Research Database in 2009 and were followed-up until 2015. Intra-individual HbA1C variability was defined as the standard deviation (SD) of HbA1c and cardiovascular events were defined as hospitalization for coronary artery disease, unstable angina, myocardial infarction, stroke, peripheral artery disease, and cardiovascular death. The patients were grouped into two based on their estimated glomerular filtration rate (eGFR) ≥ 60 or < 60 min/ml/1.73m2. In a mean follow-up period of 6.3 years, cardiovascular events were recorded in 8.9% of the patients. In an adjusted Cox model, high HbA1c SD (hazard ratio, 1.290; 95% confidence interval, 1.008–1.650; p = 0.043), but not mean HbA1c, was associated with significantly increased risk of cardiovascular events in patients with eGFR ≥ 60 min/ml/1.73m2. This association was not seen in patients with eGFR < 60 min/ml/1.73m2. In this study, greater HbA1c variability is associated with increased risk of cardiovascular among patients with preserved renal function, but not in those with moderate to advanced chronic kidney disease.

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Glycemic variability and diabetes retinopathy: A missing link

Cited by 70 publications

References 54 publications

Zerumbone, a Phytochemical of Subtropical Ginger, Protects against Hyperglycemia-Induced Retinal Damage in Experimental Diabetic Rats

Zerumbone, a Phytochemical of Subtropical Ginger, Protects against Hyperglycemia-Induced Retinal Damage in Experimental Diabetic Rats

Comparative analysis of glycemic control effectiveness and microvascular complications in patients with type 1 diabetes mellitus, treated with genetically engineered human insulin or human insulin analogues: A 10-year retrospective observational study

Greater HbA1c variability is associated with increased cardiovascular events in type 2 diabetes patients with preserved renal function, but not in moderate to advanced chronic kidney disease

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