Insulin Resistance and Proliferative Retinopathy: A Cross-Sectional, Case-Control Study in 115 Patients with Type 2 Diabetes

Abstract

In this cross-sectional, case-control study we explored the association of proliferative diabetic retinopathy (PDR) with insulin resistance (IR) in type 2 diabetics with serum creatinine less than 2.0 mg/dl. For each PDR case, one reference case with background diabetic retinopathy (BDR) and two controls without retinopathy were identified. IR was evaluated by hyperinsulinemic euglycemic clamp; retinopathy was evaluated by indirect ophthalmoscopy and photography. Patients were matched by age, gender, and body mass index. PDR patients (n = 28) had higher IR and low-density lipoprotein cholesterol and triglyceride levels than BDR patients (n = 29), but comparable levels of glycosylated hemoglobin. Compared with patients without retinopathy (n = 58), those with PDR had higher IR, low-density lipoprotein cholesterol, and albuminuria (P < 0.05); those with BDR had higher glycosylated hemoglobin (P < 0.05), but comparable IR. At multivariate regression analysis, IR was the only independent marker of PDR among patients with retinopathy (P = 0.016). IR also retained its independent predictive value at multiple comparison among all groups (by Kruskal-Wallis test, P = 0.019). In type 2 diabetes, IR is an independent specific marker of proliferative retinopathy that may characterize patients at increased risk for blindness who may benefit most from early screening and therapeutic intervention. Longitudinal studies are needed to evaluate the role of IR in the pathogenesis of proliferative retinopathy.

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

“…11 Hadjadj et al 10 investigated the association between DR and insulin resistance score using a WHO recommendation 23 (that is, hypertension, personal history of lipid disorders, personal history of type 2 diabetes and obesity were considered). They found a significant association of DR with insulin resistance in type 1 diabetic patients.…”

“…They found a significant association of DR with insulin resistance in type 1 diabetic patients. Parvanova et al 11 have reported that proliferative retinopathy is associated with insulin resistance using a hyperinsulinemic-euglycemic clamp in 115 patients with type 2 diabetes mellitus. In this study, the DR was associated with BMI, triglyceride levels, HDL-C levels, fasting plasma glucose, fasting plasma insulin concentration and the HOMA index values.…”

“…[9][10][11] During the tests, which were performed between 0900 and 1100 hours, all subjects were in a supine position in a quiet room with dimmed lights. Autonomic function tests were performed in the morning after an overnight (X12 h) fast.…”

“…[7][8][9] Furthermore, DR is reported to be associated with insulin resistance in type 2 diabetic patients. 10,11 Although these results strongly suggest that DR, insulin resistance and autonomic dysfunction are related to each other, the significance of DR for diabetic cardiovascular autonomic function has not been adequately investigated.…”

Effects of Manidipine and Delapril in Hypertensive Patients With Type 2 Diabetes Mellitus

“…14 GDR was calculated as the mean of the glucose infusion rate per kilogram of body weight required to maintain steady-state euglycemia during the last 30 minutes of a hyperinsulinemic-euglycemic clamp. 15 …”