Influence of Metabolic Parameters and Treatment Method on OCT Angiography Results in Children with Type 1 Diabetes

Abstract

Aim. To evaluate the influence of metabolic parameters and the treatment method in children with type 1 diabetes (T1D) on the optical coherence tomography angiography (OCTA) results as early markers of diabetic retinopathy (DR). Material and Methods. This prospective study enrolled 175 consecutive children with T1D. OCTA was performed using AngioVue (Avanti, Optovue). Whole superficial capillary vessel density (wsVD), fovea superficial vessel density (fsVD), parafovea superficial vessel density (psVD), whole deep vessel density (wdVD), fovea deep vessel density (fdVD), parafovea deep vessel density (pdVD), foveal thickness (FT), parafoveal thickness (PFT), and foveal avascular zone (FAZ) in superficial plexus were evaluated and analyzed in relation to individual characteristics, i.e., sex, weight, height, body mass index (BMI), and metabolic factors: current and mean value of glycated hemoglobin A1c (HbA1c). Furthermore, the analysis concerned the diabetes duration, age at the T1D onset, and type of treatment—multiple daily insulin injections (MDI) or continuous subcutaneous insulin infusion (CSII). Results. In the study group, we did not identify any patient with DR in fundus ophthalmoscopy. Age at the onset of diabetes correlated negatively with FAZ ( r = − 0.17 , p < 0.05 ). The higher level of HbA1c corresponded to a decrease of wsVD ( r = − 0.13 , p < 0.05 ). We found significantly lower fsVD ( 32.25 ± .1 vs. 33.98 ± .1 , p < 0.01 ), wdVD ( 57.87 ± .1 vs. 58.64 ± .9 , p < 0.01 ), and pdVD ( 60.60 ± .2 vs. 61.49 ± .1 , p < 0.01 ) and larger FAZ area ( 0.25 ± .1 vs. 0.23 ± .1 , p < 0.05 ) in the CSII vs. MDI group. Conclusion. The metabolic parameters, age of the onset of diabetes, and treatment method affected the OCTA results in children with T1D. Further studies and observation of these young patients are needed to determine if these findings are important for early detection of DR or predictive of future DR severity.

Gender-Specific Risk Factors for the Development of Retinal Changes in Children with Type 1 Diabetes

“…In both genders, OCT and OCTA results were frequently influenced by current level of HbA1c, duration of CSII use and pH at the diabetes onset. This is interesting and different from our other studies, where the current level of HbA1c was not such an important factor [ 13 , 14 ]. It is consistent with the study by Romero et al, of patients with T1D with 15 years’ follow up, where gender was not a significant factor for DR in the multivariate logistic regression model, but the most important determinants were arterial hypertension, macroangiopathy, LDL-cholesterol, and higher (>8%) HbA1c [ 19 ].…”

“…Increased insulin resistance or hiperinsulinemia in patients with T1D (receiving insulin) could be determined directly only by an insulin clamp procedure, but clinically could be indirectly measured by a parameter of a daily insulin dose per kilogram of weight (DID/kg), total daily insulin (TDI) or insulin dose at breakfast. In our analysis, these parameters exist more frequently in the group of girls, similarly to other characteristic factors for metabolic syndrome (MS) (LDL -C, TG and uric acid), including weight, although this parameter has not been significant in the previous studies [ 13 , 14 ]. The fasting hyperinsulinemia in healthy individuals, independently of the age and arterial hypertension, has a negative impact on the retinal vessel status [ 38 ].…”

“…It should be highlighted that for all parameters, multiple regression models were statistically significant, despite the lack of differences for most of the OCT parameters between boys and girls. In our previous study, we detected significantly higher central foveal and parafoveal thickness in the group of boys, but it rather confirms the physiological differences between genders, not especially in diabetic children [ 14 ]. We should point out that almost all (except the HbA1c) metabolic parameters in both genders were strictly within the norm for healthy population ( Table 1 ).…”

“…Commercially available RTVue XR Avanti with AngioVue (Optovue, Fremont, CA, USA), with 3 mm × 3 mm images of macula centered on the foveola, was used to perform OCTA. The technique for taking scans was previously described and used in our earlier studies [ 13 , 14 ]. All subjects were dilated with 1% tropicamide eye drops before examination.…”

“…OCT and OCTA now give new tools for non-invasive, measurable, repeatable diagnostic of retina and ophthalmic vascularity [ 12 ]. In our previous studies in numerous groups of children and adolescents with T1D with no signs of retinopathy, we revealed associations with OCT and OCTA results with many metabolic and demographic parameters [ 13 , 14 ]. We hypothesize that early detection of suboptimal risk factors allow for the planning of subsequent interventions—either pharmacological or lifestyle—which significantly improve clinical outcomes.…”