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Inflammation and visceral obesity in the pathogenesis of diabetic retinopathy in type 2 diabetes.

Purpose. 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. Methods. This was a cross-sectional study including 107 patients with type 2 diabetes. Markers of inflammation: C-reactive protein (CRP) and fibrinogen plus other markers of endothelial dysfunction: glycated hemoglobin (HbA1c ; HbA1cmedian), total cholesterol, HDL, LDL and triglycerides were determined using routine laboratory methods. HbA1c was evaluated at the beginning of the study and HbA1cmedian was obtained by statistical analysis of data from the National Registry for Diabetes. Anthropometric parameters assessed were body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and conicity index (C index). Ophthalmologic examination included BCVA, Goldmann tonometry, 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 NPDR ; n=19) and group 3 (severe NPDR/PDR ; 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 (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 total cholesterol (p=0.022), LDL (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 (HbA1cmedian) (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.

diabetic retinopathy, inflammation, type 2 diabetes

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