Short-term poor glycemic control and retinal microvascular changes in pediatric Type 1 Diabetes patients in Singapore: a pilot study

Lamoureux, Ecosse L.; Wong, Tien Yin; Lek, Ngee

doi:10.1186/s12886-017-0449-8

Cited by 10 publications

(9 citation statements)

References 14 publications

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“…A similar research that measured arterial bifurcations in the retina of a normal human eye and derived quantitative information supported these theoretical studies above [54]. Under different pathological conditions, such as diabetes [55,56], branching pattern of retinal vessel should change.…”

Section: Plos Onesupporting

confidence: 53%

Exploring the effect of hypertension on retinal microvasculature using deep learning on East Asian population

Dai

et al. 2020

PLoS ONE

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Hypertension is the leading risk factor of cardiovascular disease and has profound effects on both the structure and function of the microvasculature. Abnormalities of the retinal vasculature may reflect the degree of microvascular damage due to hypertension, and these changes can be detected with fundus photographs. This study aimed to use deep learning technique that can detect subclinical features appearing below the threshold of a human observer to explore the effect of hypertension on morphological features of retinal microvasculature. We collected 2012 retinal photographs which included 1007 from patients with a diagnosis of hypertension and 1005 from normotensive control. By method of vessel segmentation, we removed interference information other than retinal vasculature and contained only morphological information about blood vessels. Using these segmented images, we trained a small convolutional neural networks (CNN) classification model and used a deep learning technique called Gradient-weighted Class Activation Mapping (Grad-CAM) to generate heat maps for the class "hypertension". Our model achieved an accuracy of 60.94%, a specificity of 51.54%, a precision of 59.27%, and a recall of 70.48%. The AUC was 0.6506. In the heat maps for the class "hypertension", red patchy areas were mainly distributed on or around arterial/venous bifurcations. This indicated that the model has identified these regions as being the most important for predicting hypertension. Our study suggested that the effect of hypertension on retinal microvascular morphology mainly occurred at branching of vessels. The change of the branching pattern of retinal vessels was probably the most significant in response to elevated blood pressure.

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Section: Plos Onesupporting

confidence: 53%

Exploring the effect of hypertension on retinal microvasculature using deep learning on East Asian population

Dai

et al. 2020

PLoS ONE

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“…Glycemic control is the main factor involved in appearance and progression of DR in these patients. Interestingly, the presence of morphological abnormalities in retinal microvasculature is even observed in childhood type 1 diabetic patients with short-term poor glycemic control [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Diabetic retinopathy is associated with the presence and burden of subclinical carotid atherosclerosis in type 1 diabetes

Carbonell

Castelblanco

Valldeperas

et al. 2018

Cardiovasc Diabetol

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BackgroundCardiovascular (CV) disease due to atherosclerosis is a major cause of morbidity and mortality in adult patients with diabetes, either type 1 or type 2 diabetes. The aim of the study was to assess the association of the frequency and the burden of subclinical carotid atherosclerotic disease in patients with type 1 diabetes according to the presence and severity of diabetic retinopathy (DR).MethodsA cross-sectional study was conducted in 340 patients with type 1 diabetes (41.5% with DR), and in 304 non-diabetic individuals. All participants were free from previous CV disease and chronic kidney disease (CKD). B-mode carotid ultrasound imaging was performed in all the study subjects. Patients with type 1 diabetes underwent a full eye examination, and DR patients were divided into two groups: mild disease and advanced disease.ResultsIn the group of patients with type 1 diabetes, the percentage of patients with carotid plaques was higher in those with DR compared with those without DR (44.7% vs. 24.1%, p < 0.001). Patients with DR also presented a higher incidence of ≥ 2 carotid plaques (25.5% vs. 11.1%, p < 0.001). Apart from other traditional cardiovascular risk factors, the presence of advanced stages of DR was independently associated with the presence (p = 0.044) and the burden (≥ 2 carotid plaques; p = 0.009) of subclinical carotid atherosclerosis.ConclusionsIn patients with type 1 diabetes without previous CV disease or established CKD, the presence of advanced stages of DR is associated with a higher atherosclerotic burden in the carotid arteries. The presence of DR identifies patients at risk for carotid atherosclerotic disease.Electronic supplementary materialThe online version of this article (10.1186/s12933-018-0706-z) contains supplementary material, which is available to authorized users.

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“…18 Although retinopathy is common (the current global prevalence of diabetic retinopathy is estimated to be 126 million of the 382 million people with diabetes) there is a need to identify risk markers in retinopathy. 19 There is a need to develop new biomarkers and to better understand diabetic retinopathy. 20 Periodontitis is an infectious disease with an inflammatory response resulting in progressive clinical attachment loss as well as alveolar bone loss.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, poorly glycemic control in children has been associated with retinal microvascular changes, potentially leading to retinal complications future in life 18 . Although retinopathy is common (the current global prevalence of diabetic retinopathy is estimated to be 126 million of the 382 million people with diabetes) there is a need to identify risk markers in retinopathy 19 . There is a need to develop new biomarkers and to better understand diabetic retinopathy 20 …”

Section: Introductionmentioning

confidence: 99%

Periodontal conditions, retinopathy, and serum markers in individuals with type 1 diabetes

Widén

Holmer

Sättlin

et al. 2020

Journal of Periodontology

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Background: The prevalence of diabetes is high and increasing. Periodontitis has been identified as a risk factor in both type 1 and 2 diabetes. The study purpose was to assess periodontal conditions, retinopathy, and serum glutamic acid decarboxylase antibody (GADA) titers in relation to retinopathy in individuals with type 1 diabetes (T1D). Methods: The study is a case series. Adult individuals with a diagnosis of T1D (n = 85) monitored ≥5 years were recruited from an endocrinology clinic. Peripheral venous blood samples were analyzed including assessments of serum HbA1c levels and GADA titers. Medical and periodontal conditions were examined, and the data assessed. Independent t tests, binary and multivariate analyses, χ 2 and odds ratios were employed. Results: Gingivitis was found in 68.2%, periodontitis in 21.2%, and retinopathy in 64.7%, GADA (≥35 U/mL) in 54.1%, and serum HbA1c > 48 mmol/mol in 94.3% of the individuals. The unadjusted odds ratio for periodontitis to differentiate a diagnosis of retinopathy was 7.3 (95%CI 1.6, 4.4, P <0.01). Multivariate analyses identified the following dependent factors to differentiate retinopathy; age, T1D duration, gingivitis, periodontitis at P < 0.001, sex, and serum GADA at P < 0.01, and by the number of remaining teeth at P < 0.05. Conclusion: Retinopathy as a complication to T1D is linked to the duration of diabetes, age of the individual and with increasing severity to periodontitis. Periodontal intervention studies are warranted.

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Short-term poor glycemic control and retinal microvascular changes in pediatric Type 1 Diabetes patients in Singapore: a pilot study

Cited by 10 publications

References 14 publications

Exploring the effect of hypertension on retinal microvasculature using deep learning on East Asian population

Exploring the effect of hypertension on retinal microvasculature using deep learning on East Asian population

Diabetic retinopathy is associated with the presence and burden of subclinical carotid atherosclerosis in type 1 diabetes

Periodontal conditions, retinopathy, and serum markers in individuals with type 1 diabetes

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