Retinal blood flow changes in type I diabetes. A long-term, follow-up study

Konno, Suguru; Yoshida, Akitoshi; Fujio, N; Goger, Douglas G.; Buzney, S M; Gt, Feke

doi:10.1016/s0002-9394(14)72041-0

Cited by 54 publications

(66 citation statements)

References 13 publications

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“…Cross-sectional data in the WESDR indicated that larger retinal venular diameter was associated with more severe diabetic retinopathy and independently with younger age, higher HbA 1c levels, longer duration of diabetes, higher BMI, and lower mean arterial blood pressure (23). Some of these observations are consistent with studies showing that larger venular diameters and increased blood flow are associated with diabetes status (19,21) and, in people with diabetes, with presence of retinopathy (17,18,20), higher HbA 1c levels (17), and longer duration of disease (22). However, there are no consistent explanations for these observations.…”

Section: Discussionsupporting

confidence: 72%

Retinal Vessel Diameters and the Incidence of Gross Proteinuria and Renal Insufficiency in People With Type 1 Diabetes

et al. 2004

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Early retinal vessel caliber changes may predict risk of diabetic nephropathy. We examined the association of retinal vessel diameters and the incidence of gross proteinuria and renal insufficiency in a populationbased cohort of people with type 1 diabetes (n ‫؍‬ 557). Baseline retinal photographs were digitized, and diameters of individual retinal vessels were measured and summarized. Incident cases of gross proteinuria and renal insufficiency were identified over a 16-year period. Larger retinal venular diameter was associated with higher cumulative incidence of gross proteinuria (18.6, 25.4, 37.7, and 50.4%, comparing increasing venular diameter quartiles) and renal insufficiency (10. A lthough diabetes accounts for 42% of end-stage renal disease in the U.S. (1), current methods to predict people at risk of diabetic nephropathy remain inadequate (2,3). Microangiopathy is believed to be a key pathogenic mechanism in the development of diabetic nephropathy (4 -6), and approaches that identify early stages of microvascular disease may potentially provide information regarding risk of this complication in individuals with diabetes.The retinal microcirculation, accessible to direct noninvasive visualization, shares similar physiological and pathological characteristics with the renal microcirculation (7-9). Previous studies have documented the strong association between advanced stages of diabetic retinal disease (e.g., proliferative retinopathy) and nephropathy (10 -15). However, the relationship of early retinal vessel caliber changes (e.g., arteriolar narrowing and venular dilatation) and risk of diabetic nephropathy is unknown, although altered retinal blood flow is clearly linked with the pathogenesis of diabetes (16 -22).In the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR), a population-based study of people with diabetes, we recently used a computer-assisted method to measure retinal vessel diameters from digitized fundus photographs (23). We have shown that narrowed retinal arterioles and dilated venules were related to severity of diabetic retinopathy, independent of duration of disease, glycemic control, blood pressure, and other risk factors. In the current study, we prospectively examine the association of retinal arteriolar and venular diameters and the 16-year incidence of gross proteinuria and renal insufficiency in the WESDR cohort. RESEARCH DESIGN AND METHODSThe WESDR has been described in detail in earlier publications (24,25). In brief, a probability sample of 10,135 diabetic patients who received primary care in an 11-county area in southern Wisconsin from 1979 to 1980, composed of "younger-onset" and "older-onset" individuals, was invited to participate in the baseline examination conducted from 1980 to 1982 (24,25). These analyses will be limited to the group of younger-onset individuals who were taking insulin and had been diagnosed before 30 years of age (n ϭ 1,210). The second examination was conducted at 4 years (1984 -1986) (26), the third at 10 years (1990 -1992) (27...

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Section: Discussionsupporting

confidence: 72%

Retinal Vessel Diameters and the Incidence of Gross Proteinuria and Renal Insufficiency in People With Type 1 Diabetes

et al. 2004

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“…The different results from these groups could be related to the methodologies used (video fluorescein angiography and laser Doppler velocimetry), the duration of diabetes, whether or not clinically observable diabetic retinopathy was present, the blood glucose levels at the time of the measurement, and the level of glycaemic control or haemoglobin A 1c in the studied patients [20,47]. Previous studies have shown that RBF is reduced early in diabetes followed by a transition to increased RBF, which correlates with diabetes duration and level of diabetic retinopathy [20,48]. A review article details a discussion on some of these issues affecting retinal haemodynamics measurement in early diabetes [49].…”

Section: Discussionmentioning

confidence: 99%

Angiotensin AT 1 receptor antagonism normalizes retinal blood flow and acetylcholine-induced vasodiliation in normotensive diabetic rats

et al. 2004

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Aims/hypothesis. The renin angiotensin system is emerging as a potential therapeutic target for diabetic retinopathy. This study examines the effects of angiotensin-converting-enzyme inhibition by captopril and angiotensin AT 1 receptor antagonism using candesartan-cilexetil on retinal blood flow and acetylcholinestimulated vasodilatation in normotensive diabetic rats. Methods. Non-diabetic or streptozotocin-induced diabetic rats were treated for 2 weeks with captopril (100 mg/kg/day) or candesartan cilexetil (2 mg/kg/day). Retinal haemodynamics were measured using video fluorescein angiography. Effects of exogenous acetylcholine on retinal haemodynamics were examined following intravitreal injection. Total retinal diacylglycerol was labelled using diacylglycerol kinase, separated by thin-layer chromatography, and quantified using autoradiography. Results. Diabetic rats had prolonged retinal mean circulation time and decreased retinal blood flow compared with non-diabetic rats. Treatment of diabetic rats with either captopril or candesartan blocked the development of these blood flow abnormalities. Intraviteral injection of acetylcholine (10 −5 mol/l) in non-diabetic rats increased retinal blood flow by 53.9±22.0% relative to baseline whereas this response to acetylcholine was blunted in diabetic rats (4.4±19.6%, p<0.001). Candesartan treatment of diabetic rats restored the acetylcholine-stimulated retinal blood flow response to 60.0±18.7% compared with a 56.2+20.1% response in candesartan-treated non-diabetic rats. Total retinal diacylglycerol levels were increased in diabetic rats (3.75±0.98 nmol/mg, p<0.05) compared with non-diabetic rats (2.13±0.25 nmol/mg) and candesartan-treatment of diabetic rats normalized diacylglycerol levels (2.10±0.25 nmol/mg, p<0.05). Conclusion/interpretation. This report provides evidence that angiotensin-converting enzyme inhibition and AT 1 receptor antagonism ameliorates retinal haemodynamic dysfunctions in normotensive diabetic rats. [Diabetologia (2004) 47:113-123]

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“…LaserDoppler velocimetry has been extensively used to measure blood flow velocities in retinal vessels of diabetic patients (Patel et al 1992;Kohner 1993;Feke et al 1994;Grunwald et al 1996;Konno et al 1996). Sonography and color-Doppler imaging has been used to measure blood flow velocities and flow parameters (Mendivil et al 1995;Goebel et al 1995;Kawagishi et al 1995;Evans et al 1997).…”

Section: R Etinal Blood Flow Abnormalitiesmentioning

confidence: 99%