Retinal Arteriolar Narrowing Predicts Incidence of Diabetes

Abstract

OBJECTIVE—To examine the relationship of retinal vascular caliber to incident diabetes in a population-based cohort. RESEARCH DESIGN AND METHODS—The Australian Diabetes, Obesity and Lifestyle (AusDiab) Study recruited adults aged 25+ years across Australia in 1999–2000, with a follow-up 5 years later in 2004–2005. Participants' glycemic status was classified using fasting plasma glucose (FPG) and 2-h oral glucose tolerance (2-h plasma glucose [2hPG]) tests. Diabetes was diagnosed if FPG was ≥7.0 mmol/l or 2hPG was ≥11.1 mmol/l. Retinal vascular caliber was measured from baseline retinal photographs using a computer-assisted program. RESULTS—Of the 803 participants without diabetes at baseline, 108 (13.4%) developed diabetes at follow-up: 7 (2.8%) of 246 participants with normal glucose tolerance, 9 (13.6%) of 66 participants with impaired fasting glucose, and 92 (18.7%) of 491 participants with impaired glucose tolerance. After multivariate analysis, participants with narrower retinal arteriolar caliber had a higher risk of diabetes (odds ratio 2.21 [95% CI 1.02–4.80], comparing smallest versus highest arteriolar caliber tertiles, P = 0.04 for trend). There was no association between retinal venular caliber and incident diabetes. CONCLUSIONS—Narrower retinal arteriolar caliber predicted risk of diabetes. These data provide further evidence that microvascular changes may contribute to the pathogenesis of diabetes.

Microvascular Dysfunction Is Associated With a Higher Incidence of Type 2 Diabetes Mellitus

“…All articles were published in English after 1994. We found 15 prospective population-based cohort studies, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] 3 prospective nested case-control studies, [31][32][33] and 5 prospective case-cohort studies. [34][35][36][37][38] The studies examined mainly white participants from Europe, the United States, and Australia.…”

“…20,21,24,29,30 Table I in the online-only Data Supplement shows a higher incidence of T2DM with smaller baseline arteriolar diameters and AVR. In contrast, venular diameters were not significantly associated with the incidence of T2DM.…”

Reproducibility of the Retinal Vascular Response to Flicker Light in Asians

“…Recent studies show that structural retinal microvascular changes, such as the presence of retinopathy or variations in retinal vascular caliber, are predictive of a range of systemic and ocular conditions, such as diabetes, stroke, coronary heart disease and heart failure, and diabetic retinopathy. [1][2][3][4][5][6][7] It has been hypothesized that dilation of retinal vessels in response to diffuse luminance flicker may reflect intrinsic endothelial function, 8 mediated possibly by nitric oxide. [9][10][11][12] Thus, such measurements may allow in vivo quantification of retinal endothelial function, which may help in understanding the physiological and pathological alterations of retinal microcirculation in various ocular and systemic diseases.…”

Retinal Vascular Geometry in Asian Persons with Diabetes and Retinopathy

“…Previous studies, largely in white populations, have shown that one particular retinal vascular change-retinal vascular caliber (diameter)-is a marker of early microvascular damage related to diabetes and associated complications (e.g., DR, nephropathy, and cardiovascular disease). [4][5][6][7][8][9][10][11][12][13] The human circulatory system is believed to conform to an optimum design principle, 14 which allows sufficient blood distribution with the least amount of energy. Deviation from this optimal architecture therefore results in suboptimal and less efficient peripheral circulation.…”