Diabetic retinopathy is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients

Abstract

Diabetic retinopathy (DR) and cardiovascular autonomic dysfunction are associated with high mortality in type 2 diabetic patients. This preliminary study was therefore designed to test the hypothesis that DR is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients without insulin treatment. Seventy persons were diagnosed to have type 2 diabetes in the examination from June 2004 to May 2006. The study group consisted of 29 type 2 diabetic patients with DR (age: 58 ± 6 years, mean ± s.d.) and 41 type 2 diabetic patients with no DR (NDR) (n¼41, 58 ± 5 years). Cardiovascular autonomic function was assessed by baroreflex sensitivity (BRS), heart rate variability, plasma norepinephrine concentration and cardiac 123 I-metaiodobenzylguanidine (MIBG) scintigraphic findings. DR patients had lower BRS, early and delayed 123 I-MIBG myocardial uptake values and higher percent washout rate (WR) of 123 I-MIBG than the NDR patients. With respect to metabolic findings, DR patients had higher fasting plasma insulin concentration (Po0.0001) and higher homeostasis model assessment (HOMA) index (Po0.00001) than the NDR patients. Multiple logistic regression analysis revealed that the presence of DR was independently predicted by HOMA index and the percent WR of 123 I-MIBG (Po0.01 and Po0.05, respectively). Our results suggest that DR is associated with depressed cardiovascular autonomic function and insulin resistance and that HOMA index and the percent WR of 123 I-MIBG are independently associated with DR in Japanese patients with type 2 diabetes mellitus.

Intake of Gnetum Africanum and Dacryodes Edulis, Imbalance of Oxidant/Antioxidant Status and Prevalence of Diabetic Retinopathy in Central Africans

“…These findings confirmed the significant association between DR and higher ACVR among Indians diabetics [59]. Despite their lack of independent association with DR, atherogenosis and insulin resistance may also exacerbate inflammation, endothelial dysfunction, and oxidative stress related to DR development [60].…”

Obesity, metabolic syndrome and diabetic retinopathy: Beyond hyperglycemia

“…These findings support the relationship between the metabolic syndrome, namely the obesity and hypertriglyceridemia, and the development and/or progression of DR. Given that these conditions are strongly associated with type 2 diabetes, and are components of the metabolic syndrome, it would be logical to look into their contribution to the incidence of retinopathy in this population[87]. Other studies found positive correlations between the comorbid metabolic syndrome and type 2 diabetes with all cardiovascular complications including DR[88,89].…”

Microangiopathy and visual deficits characterize the retinopathy of a spontaneously hypertensive rat model with type 2 diabetes and metabolic syndrome

“…This is in line with results from clinical studies demonstrating that in addition to hyperglycemia, other metabolic factors and blood pressure are involved in the manifestation and progression of retinopathy in humans. 4,54,55 In this regard, SHR/N-cp together with other non-STZ-based rat models [56][57][58][59][60][61][62][63][64] are useful tools to dissect the complexity of causative factors and disease mechanisms contributing to the varying spectrum of diabetic retinopathy. 55 Studies in these models have indeed revealed the contrasting impairment of the retina in the presence of cardiometabolic risk factors.…”