J Korean Med Sci.  2020 Jun;35(23):e179. 10.3346/jkms.2020.35.e179.

Relationship between Clinical Features of Diabetic Retinopathy and Systemic Factors in Patients with Newly Diagnosed Type II Diabetes Mellitus

• Hwang H
• Kim JY
• Oh TK
• Chae JB
• Kim DY

• KMID: 2502921
• DOI: http://doi.org/10.3346/jkms.2020.35.e179

Abstract

Background
We investigated the relationship between clinical features of diabetic retinopathy (DR) and systemic factors in patients with newly diagnosed type II diabetes mellitus (T2DM).
Methods
Retrospective review of newly diagnosed T2DM-patients who underwent complete ophthalmic examinations at the time of T2DM diagnosis were conducted. We reviewed DM related systemic factor data and investigated systemic factors related to the presence of DR at T2DM diagnosis. In DR patients, the relationship between DR severity and systemic factors was analyzed.
Results
Of 380 patients, forty (10.53%) patients had DR at the initial ophthalmologic examination. Glycated hemoglobin (HbA1C), fasting plasma glucose (FPG), urine albumin to creatinine ratio (UACR), and urine microalbumin level were significantly higher in DR patients than in patients without DR. In the multivariate logistic regression analysis, high HbA1C was a significant risk factor for the presence of DR at new T2DM diagnosis (odds ratio, 2.372; P < 0.001). HbA1C, FPG, UACR, and urine microalbumin level showed significantly positive correlations with DR severity.
Conclusion
In patients with newly diagnosed T2DM, 10.53% have DR at initial ophthalmologic examination and high HbA1C, FPG, UACR and urine microalbumin levels. These factors are significantly positively correlated with DR severity. Therefore, more careful fundus examination is needed for newly diagnosed T2DM patients with high HbA1C, FPG, UACR, and urine microalbumin levels.

Keyword

Diabetic Retinopathy; Type 2 Diabetes Mellitus; First Diagnosis; HbA1C; Fasting Plasma Glucose; Urine Microalbumin; Urine Albumin to Creatinine Ratio

Figure

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  Fig. 1 The correlation between the DR grade and laboratory exams. There was a significant positive correlation between the DR grade and HbA1C, FPG, UACR and urine microalbumin level. Of the relevant factors, Spearman's rho was the largest in HbA1C.DR = diabetic retinopathy, HbA1C = glycated hemoglobin, FPG = fasting plasma glucose, UACR = urine albumin to creatinine ratio, eGFR = estimated glomerular filtration rate, HDL = high-density lipoprotein, LDL = low-density lipoprotein, BMI = body mass index.

• 

  Fig. 2 A case of a patient with high level of HbA1C at the first diagnosis of T2DM. Fifty-five-year-old woman with high level of HbA1C at the first diagnosis of T2DM. HbA1C was 11.6%, UACR was 117.30 mg/g Cr and urine microalbumin was 113.40 μg/mL at the first diagnosis of T2DM. Fundus examination (A) and fluorescein angiography (B) revealed multiple new vessels on both eyes and tractional retinal detachment in the left eye.HbA1C = glycated hemoglobin, T2DM = type II diabetes mellitus, UACR = urine albumin to creatinine ratio.

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  Fig. 3 A case of a patient with moderate level of HbA1C at the first diagnosis of T2DM. Forty-nine-year-old woman with moderate level of HbA1C at the first diagnosis of T2DM. HbA1C was 8.50%, UACR was 58.70 mg/g and urine microalbumin was 19.00 μg/mL at the first diagnosis of T2DM. In the DR exam, both eyes were classified as severe NPDR.HbA1C = glycated hemoglobin, T2DM = type II diabetes mellitus, UACR = urine albumin to creatinine ratio, DR = diabetic retinopathy, NPDR = non-proliferative diabetic retinopathy.

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  Fig. 4 A case of a patient with low of HbA1C at the first diagnosis of T2DM. Forty-eight-year-old woman with low level of HbA1C at the first diagnosis of T2DM. HbA1C was 7.10%, UACR was 6.10 mg/g and urine microalbumin was 7.50 μg/mL at the first diagnosis of T2DM. In the DR exam, both eyes were classified as NDR.HbA1C = glycated hemoglobin, T2DM = type II diabetes mellitus, UACR = urine albumin to creatinine ratio, DR = diabetic retinopathy, NDR = no diabetic retinopathy.

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