Multimodal testing reveals subclinical neurovascular dysfunction in prediabetes, challenging the diagnostic threshold of diabetes

Kirthi, Varo; Reed, Kate; Alattar, Komeil; Zuckerman, Benjamin; Bunce, Catey; Nderitu, Paul; Alam, Uazman; Clarke, Bronagh; Hau, Scott; Al-Shibani, Fatima; Petropoulos, Ioannis N.; Malik, Rayaz A.; Pissas, Theodoros; Bergeles, Christos; Vas, Prashanth; Hopkins, David; Jackson, Timothy L.

doi:10.1111/dme.14952

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…They found that the PD and VD in both the SCP and DCP were reduced in patients with pre-diabetes compared to healthy controls. The finding is similar to Kirthi et al, who also found that patients with prediabetes had a decreased parafoveal VD in the SCP and DCP compared to normoglycemic controls [130]. A cross-sectional study found that only the VD in the SCP was decreased in patients with pre-diabetes compared to controls, whereas VD in the DCP was decreased in the diabetic group [131].…”

Section: Pre-diabetessupporting

confidence: 87%

“…Although Xu et al reported FAZ area to be significantly enlarged in patients with prediabetes [132], most studies have found no significant change in FAZ area and circularity in pre-diabetic patients compared to controls [129,130,133,134]. Ratra et al did, however, find that logmarBCVA was positively correlated with FAZ area in the pre-diabetic group [134].…”

Section: Pre-diabetesmentioning

confidence: 94%

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Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy

Wijesingha,

Tsai,

Keskin

et al. 2024

Diagnostics

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Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus, leading to visual impairment if left untreated. This review discusses the use of optical coherence tomography angiography (OCTA) as a diagnostic tool for the early detection and management of DR. OCTA is a fast, non-invasive, non-contact test that enables the detailed visualisation of the macular microvasculature in different plexuses. OCTA offers several advantages over fundus fluorescein angiography (FFA), notably offering quantitative data. OCTA is not without limitations, including the requirement for careful interpretation of artefacts and the limited region of interest that can be captured currently. We explore how OCTA has been instrumental in detecting early microvascular changes that precede clinical signs of DR. We also discuss the application of OCTA in the diagnosis and management of various stages of DR, including non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), diabetic macular ischaemia (DMI), and pre-diabetes. Finally, we discuss the future role of OCTA and how it may be used to enhance the clinical outcomes of DR.

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Section: Pre-diabetessupporting

confidence: 87%

Section: Pre-diabetesmentioning

confidence: 94%

Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy

Wijesingha,

Tsai,

Keskin

et al. 2024

Diagnostics

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“…Electroretinography (ERG) and optical coherence tomography (OCT) have also been investigated as clinical tests for the early detection of DR, with satisfactory results in both [36,[40][41][42][43][44][45][46]. This corroborates the existence of vascular and/or neuronal changes prior to the signs visible in fundus images, which can be detected using these techniques.…”

Section: Discussionmentioning

confidence: 80%

Contrast sensitivity function under three light conditions in patients with type 1 diabetes mellitus without retinopathy: a cross-sectional, case–control study

Silva‐Viguera

García-Romera

Bautista‐Llamas

2023

Graefes Arch Clin Exp Ophthalmol

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Purpose To determine whether patients with type 1 diabetes mellitus (T1DM), without any sign of diabetic retinopathy, have any alteration in Contrast Sensitivity Function (CSF), in relation to patients without this disease, and whether CSF assessment in three different light conditions can be an effective test in the early detection of diabetic retinopathy. Methods A prospective, cross-sectional, case-control study was preformed including 80 patients (40 with T1DM without diabetic retinopathy and 40 controls) between 11 and 47 years old. CSF was assessed at four spatial frequencies (3, 6, 12 and 18 cycles/degree) using the CSV-1000E test, under three light conditions: high (550 lx), medium (200 lx) and low (< 2 lx). Results A lower CSF in the T1DM group was found at the three light conditions studied. The most spatial frequency affected was 18 cpd, 0.08 log units (p = 0.048) in high, 0.10 log units (p = 0.010) in medium (p = 0.010) and 0.16 log units (p < 0.001) in low-light conditions in mean CS values. The least spatial frequency affected was 3 cpd (p > 0.05 in all three light conditions). Conclusion Patients with T1DM, without diabetic retinopathy, presented a loss of CS to sine-wave gratings, with respect to people with the same characteristics without the disease, mainly at medium and high frequencies, and in medium and low-light conditions.

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“…A significant reduction in corneal nerve fiber density, corneal nerve fiber length, and corneal nerve branch density using corneal confocal microscopy was reported in subjects with diabetes and no DR compared to healthy subjects [ 62 , 63 , 64 ]. In recent years, corneal nerve fiber density, corneal nerve fiber length, and corneal nerve branch density using corneal confocal microscopy have been suggested to correlate with HbA1c and the homeostatic model assessment of insulin resistance [ 65 ]. These studies show that changes in the ocular nerve structure due to DM occur even in the absence of ophthalmoscopic DR, which is clarified by an ERG, OCT, OCTA, corneal confocal microscopy, and fundus perimeter.…”

Section: Evaluation Of Diabetic Retinopathymentioning

confidence: 99%

Visual Evoked Potentials for the Detection of Diabetic Retinal Neuropathy

Miura

2023

IJMS

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Visual evoked potentials (VEP) are visually evoked signals that extract electroencephalographic activity in the visual cortex that can detect retinal ganglion cells, optic nerves, chiasmal and retrochiasmal dysfunction, including optic radiations, and the occipital cortex. Because diabetes causes diabetic retinopathy due to microangiopathy and neuropathy due to metabolic abnormalities and intraneural blood flow disorders, assessment of diabetic visual pathway impairment using VEP has been attempted. In this review, evidence on the attempts to assess the visual pathway dysfunction due to abnormal blood glucose levels using VEP is presented. Previous studies have provided significant evidence that VEP can functionally detect antecedent neuropathy before fundus examination. The detailed correlations between VEP waveforms and disease duration, HbA1c, glycemic control, and short-term increases and decreases in blood glucose levels are evaluated. VEP may be useful for predicting postoperative prognosis and evaluating visual function before surgery for diabetic retinopathy. Further controlled studies with larger cohorts are needed to establish a more detailed relationship between diabetes mellitus and VEP.

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Multimodal testing reveals subclinical neurovascular dysfunction in prediabetes, challenging the diagnostic threshold of diabetes

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 8 publications

References 30 publications

Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy

Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy

Contrast sensitivity function under three light conditions in patients with type 1 diabetes mellitus without retinopathy: a cross-sectional, case–control study

Visual Evoked Potentials for the Detection of Diabetic Retinal Neuropathy

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