engleski

Inflammation and visceral obesity: possible link to pathogenesis of diabetic retinopathy in type 2 diabetes

Background and aims. Diabetic retinopathy (DR), a microvascular and visually devastating diabetic complication, is the leading cause of new blindness among working-age adults in developed countries. Its pathogenesis is insufficiently understood and presumed to possibly involve chronic, low-grade inflammation. The aim of this study was to investigate the relationship between inflammation markers, other markers of endothelial dysfunction and anthropometric parameters and their association with DR in patients with type 2 diabetes. Materials and methods. This was a cross-sectional study including 107 patients with type 2 diabetes (67 male / 40 female, mean age 66.74 ± 8.01 years, mean diabetes duration 15.05 ± 5.69 years). Markers of inflammation: C-reactive protein (CRP) and fibrinogen as well as other markers of endothelial dysfunction: glycated hemoglobin value (HbA1c ; HbA1c median), total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides were determined using routine laboratory methods. HbA1c was evaluated at the beginning of the study from a single venous blood sample, and HbA1c median was obtained by statistical analysis of data from the National Registry for Diabetes (CroDiabNet). Anthropometric parameters assessed were body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and conicity index (C index). Ophthalmologic examination included best corrected visual acuity (BCVA), Goldmann applanation tonometry, slit lamp biomicroscopy of the anterior eye segment, binocular indirect slit lamp fundoscopy and color fundus photography after mydriasis of two fields (macular field, disc/nasal field) of both eyes according to the EURODIAB retinal photography methodology. Results. According to the EURODIAB standards patients were divided into three groups: group 1 (no retinopathy ; n=65), group 2 (mild / moderate nonproliferative diabetic retinopathy ; n=19) and group 3 (severe NPDR / proliferative diabetic retinopathy ; n=23). The groups did not differ in the levels of inflammation markers, other markers of endothelial dysfunction and anthropometric parameters. C-reactive protein was positively correlated with fibrinogen (p=0.022), HbA1c (p=0.050), LDL cholesterol (p=0.043), BMI (p=0.038), WC (p=0.000), WHR (p=0.038) and C index (p=0.008). HbA1c was positively correlated with cholesterol (p=0.022), LDL cholesterol (p=0.010), BMI (p=0.009) and WC (p=0.047). Logistic regression analyses showed that diabetes duration (OR=1.17, 95%CI 1.08-1.27) and prolonged poor glycemic control (HbA1c median) (OR=1.76, 95%CI 1.08-2.86) were the main predictors of DR in patients with type 2 diabetes. Conclusions. This study showed that the association between visceral obesity, inflammation and other risk factors plays an important role in endothelial impairment involved in the pathogenesis of diabetic retinopathy. These findings point to the need for testing the effects of treatment aimed at reducing visceral obesity, decreasing inflammatory activity and improving endothelial function as a means of preventing or limiting the progression of retinopathy.

diabetic retinopathy; type 2 diabetes; endothelial dysfunction

nije evidentirano