Diabetic Retinopathy and Cognitive Decline in Older People With Type 2 Diabetes

Ding, Jie; Strachan, Mark W. J.; Reynolds, Rebecca M.; Frier, Brian M.; Deary, Ian J.; Gerald, F. Fowkes R.; Lee, Dean A.; McKnight, J.; Halpin, Patricia A.; Swa, Ken; Price, Jackie F.

doi:10.2337/db10-0752

Cited by 136 publications

(105 citation statements)

References 40 publications

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“…One recent study reported retinopathy and macrovascular disease each in one-third of people with type 2 diabetes of mean duration 9 years [12], and another 20-30% microvascular and 40% macrovascular complications in people with a mean of 4 years' duration [8]. Both populations were predominantly white.…”

Section: Discussionmentioning

confidence: 99%

“…There has been no recent systematic clinical phenotyping of current type 2 diabetes populations at the time of diagnosis, especially in areas of high and differential morbidity [8][9][10][11][12]. There are likely to be cohort effects: changes in screening bringing forward the diagnosis, advances in medical management at all stages of the diabetes continuum and socio-environmental processes such as migration of highrisk populations, rendering the distribution of risk factors for worse diabetes outcomes in longstanding cohorts such as the UKPDS potentially out of date.…”

Section: Introductionmentioning

confidence: 99%

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The clinical characteristics at diagnosis of type 2 diabetes in a multi-ethnic population: the South London Diabetes cohort (SOUL-D)

et al. 2013

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Aims/hypothesis This study aimed to investigate the clinical features of newly diagnosed type 2 diabetes in an urban multi-ethnic cohort. Methods A population-based cross-sectional design was used. People diagnosed with type 2 diabetes in the preceding 6 months were recruited from primary care practices in three adjacent inner-city boroughs of South London, serving a population in which 20% of residents are of black African or Caribbean ethnicity. Sociodemographic and biomedical data were collected by standardised clinical assessment and from medical records. Multiple logistic regression methods were used to report associations between ethnicity and diabetes-complication status.Results From 96 general practices, 1,506 patients were recruited. Their mean age was 55.6 (±11.07) years, 55% were men, 60% were asymptomatic at diagnosis and 51%, 38% and 11% were of white, black and South Asian/other ethnicity, respectively. Compared with white participants, black and South Asian/other participants were: younger (mean age 58.9 [±10.09], 52.4 [±11.19] and 51.5 [±10.42] years, respectively; p<0.0001); less likely to have neuropathy (10.1%, 3.6% and 4.4%; p<0.0001) or report coronary artery disease (12.7%, 4.8% and 7.3%; p<0.0001). In logistic regression, compared with white participants, black participants had lower levels of macrovascular complications (OR 0.52, 95% CI 0.32, 0.84; p = 0.01). Male sex was independently associated with microvascular disease (OR 1.69, 95% CI 1.26, 2.28; p<0.0001). Conclusions/interpretation The prevalence of complications at time of diagnosis was lower than expected, especially in black and South Asian/other ethnic groups. However, in multi-ethnic inner-city populations, onset of type 2 diabetes occurred almost 10 years earlier in nonwhite populations than in white participants, predicating a prolonged morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The clinical characteristics at diagnosis of type 2 diabetes in a multi-ethnic population: the South London Diabetes cohort (SOUL-D)

et al. 2013

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“…The retinal vascular bed can be directly visualised non-invasively with retinal photography. Some previous studies [8], including the cohort studied here [9], have shown a significant association between diabetic retinopathy signs (e.g. microaneurysms, retinal haemorrhages) and reduced cognitive performance in people with diabetes and in the general population.…”

Section: Introductionmentioning

confidence: 56%

Association of retinal arteriolar dilatation with lower verbal memory: the Edinburgh Type 2 Diabetes Study

et al. 2011

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Aims/hypothesis Retinal vascular calibre changes may reflect early subclinical microvascular disease in diabetes. Because of the considerable homology between retinal and cerebral microcirculation, we examined whether retinal vascular calibre, as a proxy of cerebral microvascular disease, was associated with cognitive function in older people with type 2 diabetes. Methods A cross-sectional analysis of 954 people aged 60-75 years with type 2 diabetes from the population-based Edinburgh Type 2 Diabetes Study was performed. Participants underwent standard seven-field binocular digital retinal photography and a battery of seven cognitive function tests. The Mill Hill Vocabulary Scale was used to estimate pre-morbid cognitive ability. Retinal vascular calibre was measured from an image field with the optic disc in the centre using a validated computer-based program.Results After age and sex adjustment, larger retinal arteriolar and venular calibres were significantly associated with lower scores for the Wechsler Logical Memory test, with standardised regression coefficients −0.119 and −0.084, respectively (p<0.01), but not with other cognitive tests. There was a significant interaction between sex and retinal vascular calibre for logical memory. In male participants, the association of increased retinal arteriolar calibre with logical memory persisted (p<0.05) when further adjusted for vocabulary, venular calibre, depression, cardiovascular risk factors and macrovascular disease. In female participants, this association was weaker and not significant. Conclusions/interpretation Retinal arteriolar dilatation was associated with poorer memory, independent of estimated prior cognitive ability in older men with type 2 diabetes. The sex interaction with stronger findings in men requires confirmation. Nevertheless, these data suggest that impaired cerebral arteriolar autoregulation in smooth muscle cells,

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“…According to recent studies no association was found between gender and cognition, except for the number of correct answers on BVRT (men have statistically more correct answers than women). It has been hypothesized that diabetes is a potential risk factor for cognitive decline predominantly in women compared to men, due to a higher risk of diabetes in females, related to microvascular disease and early loss of possible protective effects of estrogen on cognitive functioning 17 . Another possible explanation of that finding is that males have better abilities to remember and draw figures than women, due to their better logistical memory capacity.…”

Section: Discussionmentioning

confidence: 99%