Diabetic retinopathy (DR) is the most frequent complication of diabetes. The main risk factors are disease duration, a poor glycemic control, and the presence of hypertension. However, there is an important variation in risk which indicates that other factors, such as genetic heritability or glycemic variability, play an important role in accounting for the susceptibility to DR development. Another important concept is that DR is an independent predictor of both microvascular and macrovascular complications. Thus, the presence of DR should be taken into account when evaluating the cardiovascular risk of a diabetic subject. Moreover, the evaluation of retinal neurodegeneration could help to identify those diabetic subjects at risk of cognitive impairment, an emerging complication of the type 2 diabetic population. When evaluating a diabetic subject, the awareness of the presence of DR has also therapeutic implications. In this regard, a worsening of DR could occur after a rapid improvement of blood glucose. In summary, a critical review on the importance of the presence of DR in the general management of subjects with diabetes is provided.

Type 2 diabetes mellitus (T2D) and Alzheimer's disease (AD) are two of the most common diseases of aging around the world. Given the frequency with which T2D and AD occur, the notion that people with T2D may be at increased risk for AD has large societal consequences, and understanding the mechanistic links between these diseases is imperative for the development of effective AD prevention and treatment strategies. Apart from being an accelerator of AD, T2D is associated with a progressive cognitive decline. Impaired insulin signaling, inflammation, the accumulation of advanced glycation end-products and oxidative stress all play an essential role in the pathogenesis of both AD and diabetic complications. Therefore, it is reasonable to postulate that these pathways are involved in the increased risk of dementia that occurs in the T2D population. The early diagnosis of cognitive impairment and the identification of the subset of patients at a higher risk of developing AD is a challenge for healthcare providers, and meeting it will permit us to implement a personalized medicine, which is an essential issue in diabetes care with significant therapeutic implications. The main gaps that should be filled to achieve this objective are examined.

Diabetic retinopathy (DR) is the major cause of acquired blindness in working-age adults. Current treatments for DR (laser photocoagulation, intravitreal corticosteroids, intravitreal antivascular endothelial growth factor (VEGF) agents, and vitreo-retinal surgery) are applicable only at advanced stages of the disease and are associated with significant adverse effects. Therefore, new pharmacological treatments for the early stages of the disease are needed. Vitreous fluid obtained from diabetic patients undergoing vitreoretinal surgery is currently used to explore the events that are taking place in the retina for clinical research. However, several confounding factors such as vitreous haemorrhage and concentration of vitreous proteins should be considered in the analysis of the results. In this paper we will focus on the vitreous fluid as a tool for exploring the mediators of DR and in particular the molecules related to inflammatory pathways. In addition, their role in the pathogenesis of DR will be discussed. The usefulness of new technologies such as flow cytometry and proteomics in identifying new candidates involved in the inflammatory process that occurs in DR will be overviewed. Finally, a more personalized treatment based on vitreous fluid analysis aiming to reduce the burden associated with DR is suggested.