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Retinopathy and microalbuminuria in type II diabetic patients
Masoud R Manaviat, Mohammad Afkhami, Mohammad R Shoja
BMC Ophthalmology , 2004, DOI: 10.1186/1471-2415-4-9
Abstract: In this cross-sectional study 590 patients suffering from diabetis type II were examined. Fundoscopy was performed by practising ophthalmologist. The ratio of urinary albumin to creatinine was assessed by clinitek 100 (Bayer corporation–USA). HbA1C, height and weight also were measured.The overall prevalence of retinopathy was 39.3% (232 patients), 5.4% of which showed to be prolifrative diabetic retinopathy (PDR). The diabetic retinopathy had significant inverse correlation with body mass index (BMI) (P = 0.02). HbA1C was higher in patients with PDR (mean = 10.5%) than in patients with no signs of retinopathy (mean = 9.5%) and this difference was statistically significant (P = 0.001). The prevalence of microalbuminuria was 25.9% while 14.5% of the patients revealed to have macroalbuminuria. As expected, diabetic retinopathy and renal involvement were highly positively correlated. (P = 0.001).Microalbuminuria is associated with diabetic retinopathy in type II diabetic patients and is a reliable marker of retinopathy.Diabetes mellitus is one of the most common metabolic diseases in which either the hormone insulin is lacking or the body's cells are insensitive to insulin effects. The multi-system effects of diabetes such as retinopathy, nephropathy, neuropathy and cardiovascular diseases are considered important impinging on the public health.Diabetic retinopathy is one of the leading causes of blindness in the world that increases the chance of loosing the sight about 25 times higher compared to normal individuals [1]. Using new surgical and medical techniques, the incidence of blindness can be reduced up to 90% [2]. Decrease in visual acuity in diabetic retinopathy is either associated with maculopathy or proliferative complications of it. Many studies have been undergone to find out the precipitated factors of retinopathy such as duration and type of diabetes, hyperglycemia, pregnancy, change in hormonal level, genetics and microalbuminuria.The occurrence of micro
Relationship between vitreous and serum vascular endothelial growth factor levels, control of diabetes and microalbuminuria in proliferative diabetic retinopathy
Baharivand N, Zarghami N, Panahi F, Dokht Ghafari M Y, Mahdavi Fard A, Mohajeri A
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S27423
Abstract: tionship between vitreous and serum vascular endothelial growth factor levels, control of diabetes and microalbuminuria in proliferative diabetic retinopathy Original Research (3430) Total Article Views Authors: Baharivand N, Zarghami N, Panahi F, Dokht Ghafari M Y, Mahdavi Fard A, Mohajeri A Published Date January 2012 Volume 2012:6 Pages 185 - 191 DOI: http://dx.doi.org/10.2147/OPTH.S27423 Received: 17 October 2011 Accepted: 18 November 2011 Published: 26 January 2012 Nader Baharivand1, Nosratollah Zarghami2, Farid Panahi3, Yazdan Dokht Ghafari M3, Ali Mahdavi Fard1, Abbas Mohajeri2 1Department of Ophthalmology, Nikookari Eye Hospital, 2Department of Clinical Biochemistry and Radiopharmacy, Drug Applied Research Center, 3Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Background: Diabetic retinopathy is a serious microvascular disorder of the retina. Vascular endothelial growth factor (VEGF) expression, induced by high glucose levels and hypoxia, is a main feature in retinopathy. The aim of this study was to evaluate the relationship between vitreous and serum VEGF levels and control of diabetes and microalbuminuria in patients with proliferative diabetic retinopathy. Methods: Sixty-five patients were enrolled in this case-control study, comprising 30 patients with proliferative diabetic retinopathy (cases) and 35 patients with nonproliferative diabetic retinopathy (controls). The vitreous VEGF level was compared with the serum VEGF level in both groups. Glycosylated hemoglobin (HbA1c), microalbuminuria, serum creatinine, and stage of nephropathy and retinopathy were also measured in patients with proliferative diabetic retinopathy, and the relationship between these parameters and serum and vitreous VEGF levels was investigated. Results: Mean vitreous and serum VEGF levels were significantly higher in cases compared with controls (P = 0.001, P = 0.011, respectively). There was also a significant correlation between vitreous and serum VEGF levels (P = 0.012, r = 0.453). VEGF levels in patients with well controlled blood glucose (P = 0.039), on drug treatment (P = 0.045) and at an early stage of nephropathy (P = 0.042) were significantly lower. There was a significant correlation between VEGF and albumin to creatinine ratio (P = 0.017, r = 0.432). Conclusion: Serum and vitreous VEGF levels was significantly lower in patients on oral therapy, in those with well controlled glycemia, and in those with early-stage retinopathy. Administration of anti-VEGF had a good effect in reducing the progression of proliferative diabetic retinopathy.
Proliferative diabetic retinopathy is associated with microalbuminuria in patients with type 2 diabetes
Boelter, M.C.;Gross, J.L.;Canani, L.H.;Costa, L.A.;Lisboa, H.R.;Três, G.S.;Lavinsky, J.;Azevedo, M.J.;
Brazilian Journal of Medical and Biological Research , 2006, DOI: 10.1590/S0100-879X2006000800006
Abstract: diabetic retinopathy is one of the leading causes of blindness in working-age individuals. diabetic patients with proteinuria or those on dialysis usually present severe forms of diabetic retinopathy, but the association of diabetic retinopathy with early stages of diabetic nephropathy has not been entirely established. a cross-sectional study was conducted on 1214 type 2 diabetic patients to determine whether microalbuminuria is associated with proliferative diabetic retinopathy in these patients. patients were evaluated by direct and indirect ophthalmoscopy and grouped according to the presence or absence of proliferative diabetic retinopathy. the agreement of diabetic retinopathy classification performed by ophthalmoscopy and by stereoscopic color fundus photographs was 95.1% (kappa = 0.735; p < 0.001). demographic information, smoking history, anthropometric and blood pressure measurements, glycemic and lipid profile, and urinary albumin were evaluated. on multiple regression analysis, diabetic nephropathy (or = 5.18, 95% ci = 2.91-9.22, p < 0.001), insulin use (or = 2.52, 95% ci = 1.47-4.31, p = 0.001) and diabetes duration (or = 1.04, 95% ci = 1.01-1.07, p = 0.011) were positively associated with proliferative diabetic retinopathy, and body mass index (or = 0.90, 95% ci = 0.86-0.96, p < 0.001) was negatively associated with it. when patients with macroalbuminuria and on dialysis were excluded, microalbuminuria (or = 3.3, 95% ci = 1.56-6.98, p = 0.002) remained associated with proliferative diabetic retinopathy. therefore, type 2 diabetic patients with proliferative diabetic retinopathy more often presented renal involvement, including urinary albumin excretion within the microalbuminuria range. therefore, all patients with proliferative diabetic retinopathy should undergo an evaluation of renal function including urinary albumin measurements.
Relationship between vitreous and serum vascular endothelial growth factor levels, control of diabetes and microalbuminuria in proliferative diabetic retinopathy  [cached]
Bahariv,N,Zarghami N,Panahi F
Clinical Ophthalmology , 2012,
Abstract: Nader Baharivand1, Nosratollah Zarghami2, Farid Panahi3, Yazdan Dokht Ghafari M3, Ali Mahdavi Fard1, Abbas Mohajeri21Department of Ophthalmology, Nikookari Eye Hospital, 2Department of Clinical Biochemistry and Radiopharmacy, Drug Applied Research Center, 3Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IranBackground: Diabetic retinopathy is a serious microvascular disorder of the retina. Vascular endothelial growth factor (VEGF) expression, induced by high glucose levels and hypoxia, is a main feature in retinopathy. The aim of this study was to evaluate the relationship between vitreous and serum VEGF levels and control of diabetes and microalbuminuria in patients with proliferative diabetic retinopathy.Methods: Sixty-five patients were enrolled in this case-control study, comprising 30 patients with proliferative diabetic retinopathy (cases) and 35 patients with nonproliferative diabetic retinopathy (controls). The vitreous VEGF level was compared with the serum VEGF level in both groups. Glycosylated hemoglobin (HbA1c), microalbuminuria, serum creatinine, and stage of nephropathy and retinopathy were also measured in patients with proliferative diabetic retinopathy, and the relationship between these parameters and serum and vitreous VEGF levels was investigated.Results: Mean vitreous and serum VEGF levels were significantly higher in cases compared with controls (P = 0.001, P = 0.011, respectively). There was also a significant correlation between vitreous and serum VEGF levels (P = 0.012, r = 0.453). VEGF levels in patients with well controlled blood glucose (P = 0.039), on drug treatment (P = 0.045) and at an early stage of nephropathy (P = 0.042) were significantly lower. There was a significant correlation between VEGF and albumin to creatinine ratio (P = 0.017, r = 0.432).Conclusion: Serum and vitreous VEGF levels was significantly lower in patients on oral therapy, in those with well controlled glycemia, and in those with early-stage retinopathy. Administration of anti-VEGF had a good effect in reducing the progression of proliferative diabetic retinopathy.Keywords: proliferative diabetic retinopathy, vascular endothelial growth factor, vitreous body
A Microalbuminuria Threshold to Predict the Risk for the Development of Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients  [PDF]
Haibing Chen, Zhi Zheng, Yan Huang, Kaifeng Guo, Junxi Lu, Lei Zhang, Haoyong Yu, Yuqian Bao, Weiping Jia
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0036718
Abstract: Objective To test the hypothesis that a microalbuminuria (MA) threshold can help predict the risk for the development of diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM)_ patients. Design We conducted a cross-sectional study of 4739 subjects with T2DM and a prospective study of 297 subjects with T2DM in China respectively. Methods Clinical and laboratory data were collected and biologic risk factors associated with any DR were analysed. Results In the cross-sectional study, we found that MA was an independent risk factor for DR development; further, when the patients were divided into MA deciles, odds ratio (ORs) of DR for the patients in the sixth MA decile (10.7 mg/24 h) was 1.579-fold (1.161–2.147) compared to that for patients in the first MA decile. Furthermore, the OR of DR increased with a gradual increase in MA levels. Similarly, in the prospective study, during a mean follow-up of 4.5 years, we found that 51 patients (29.0%) of the 176 subjects with high MA level (10.7–30 mg/24 h) developed DR, while 17 patients (14.1%) of the 121 subjects with lower MA (<10.7 mg/24 h) developed DR, and the relative risk ratio of the development of DR is 2.13(95% CI, 1.58–3.62, P<0.001). Conclusion These data suggest that an MA threshold can predict the risk for the development of DR in type 2 diabetes mellitus, although it is still within the traditionally established normal range.
Microalbuminuria y retinopatía diabética
Asensio-Sánchez,V.M.; Rodríguez-Delgado,B.; García-Herrero,E.; Cabo-Vaquera,V.; García-Loygorri,C.;
Archivos de la Sociedad Espa?ola de Oftalmología , 2008, DOI: 10.4321/S0365-66912008000200005
Abstract: objective: to study the prevalence of microalbuminuria and its association with more severe diabetic retinopathy in a group of insulin-dependent diabetic patients. materials and methods: during the period of january 1998 to december 2005 we examined 360 insulin-dependent diabetic patients with at least five years of evolution. we evaluated the presence of microalbuminuria by immunoanalysis. patients were evaluated by direct and indirect ophthalmoscopy and classified as non-retinopathy, non-proliferative, severe non-proliferative/proliferative, or macular edema. results: in this study, 24.1% of patients had microalbuminuria. most of the patients with microalbuminuria and macroalbuminuria were male and had a longer history of diabetes. microalbuminuria was associated with more severe diabetic retinopathy. conclusions: all patients with insulin-dependent diabetes of at least five years? evolution should undergo an evaluation of renal function including tests for microalbuminuria. in the presence of microalbuminuria an ophthalmologic follow-up may be particularly important.
Factores de riesgos asociados a retinopatía diabética Risk factors associated to diabetic retinopathy  [cached]
Julio César Molina Martín,Yaimara Hernández Silva,Luis Alberto Molina Martín
Revista Cubana de Oftalmolog?-a , 2006,
Abstract: La retinopatía diabética continúa siendo una de las causas de ceguera más frecuentes en el mundo. Es por eso que decidimos realizar una amplia revisión acerca de los factores de riesgos más importantes relacionados con ella, con el objetivo de actualizar los conocimientos existentes sobre este tema. En el trabajo se recoge que el tiempo de duración de la diabetes mellitus constituye el factor de riesgo más importante para desencadenar y desarrollar la retinopatía diabética. También se han descrito otros factores de gran significación: el control metabólico de la glicemia, las cifras de tensión arterial, los niveles de lípidos en sangre, la presencia de microalbuminuria y nefropatía, el tipo de tratamiento usado, entre otros. En la revisión se evidencia que con un estricto control y seguimiento de estos factores de riesgos, ayudaremos a prevenir o atenuar en gran medida la aparición y posterior desarrollo de es este tipo de retinopatía Diabetic retinopathy is one of the most frequent cause of blindness in the word, this is the reason why we decided to make an extensive review on the most important risk factors associated to this illness in order to update our knowledge on this topic. The duration of diabetes is the most important factor to develop diabetic retinopathy. Other factors of great significance such as metabolic control of glycemia, blood pressure levels, serum lipid levels, microalbuminuria, nephropathy, treatment type, among others, have also been described. This review evidenced that the strict control and follow-up of these risk factors will help to prevent or greatly reduce the occurence and further development of this type of retinopathy
Prevalencia de la retinopatía diabética en pacientes del nivel primario de salud Prevalence of diabetic retinopathy in patients at the primary health care
Nelson Crespo Valdés,José de la C. Padilla González,Rebeca González Fernández,Nelson Crespo Mojena
Revista Cubana de Medicina General Integral , 2004,
Abstract: Se estudiaron prospectivamente con igual protocolo de estudio 559 pacientes diabéticos del nivel primario de salud procedentes de las áreas de los policlínicos "Federico Capdevila" y "René Bedia" del municipio Boyeros; "Luis Pasteur" y "Turcios Lima" del municipio 10 de Octubre, así como "Bernardo Posse" del municipio San Miguel del Padrón en el período comprendido de 1986 al a o 2000, para determinar las características clínicas de la diabetes mellitus. La retinopatía diabética se encontró en el 20,5 % de los casos, correspondiendo 90 pacientes (16,1 %) a la retinopatía no proliferativa y 25 (4,4 %) a la retinopatía proliferativa. Se demostró que el tiempo de duración clínica de la diabetes tenía relación con la presencia de retinopatía, pues 23 pacientes del grupo de 15 a os y más tuvieron una prevalencia de retinopatía del 44,2 %. Para relacionar la presencia de microalbuminuria y retinopatía 60 pacientes diabéticos fueron estudiados, resultando positivos a la prueba 20, y de ellos el 80 % tenía algún grado de retinopatía. La afectación según el grado de control quedó evidenciada al tener 31 pacientes con un control malo y retinopatía (30,6), frente a 10 pacientes con un control bueno y retinopatía (18,8 %). El 3,0 % de los pacientes eran ciegos legales. Five hundred fifty nine diabetic patients from the primary health care areas of "Federico Capdevila" and René Bedia" polyclinics in Boyeros municipality, of "Luis Pasteur" and "Turcios Lima" polyclinics in 10 de Octubre municipality and "Bernardo Posse" in San Miguel del Padrón municipality was prospectively studied using the same study protocol for all the cases. The objective of the study carried out from 1986 to 2000 was to determine the clinical characteristics of diabetes mellitus. Diabetic retinopathy was found in 20,5 % of cases, 90 patients(16,1 %) showed non-proliferative retinopathy whereas 25 (4.4 %) had proliferative type. It was proved that clinical duration of diabetes was related to the presence of retinopathy since 23 patients in the 15 years-old and over group showed retinopathy prevalence of 44,2 %. Sixty diabetic patients were analyzed to relate the presence of microalbuminuria and retinopathy, 20 were positive and 80 % of them had some degree of retinopathy. This paper reflects how the degree of diabetic control influences the effects since 31 patients with poor diabetic control had retinopathy (30,6 %) whereas only 10 patients with good diabetic control presented with retinopathy (18,8 %). Three percent of patients were legally blind.
Erytrocyte membrane anionic charge in type 2 diabetic patients with retinopathy
Yasemin Budak, Hakan Demirci, Muberra Akdogan, Dilek Yavuz
BMC Ophthalmology , 2004, DOI: 10.1186/1471-2415-4-14
Abstract: The aim of this study is to evaluate the relationship between retinopathy and erythrocyte anionic charge and urinary glycosaminoglycan excretion in type 2 diabetic patients.49 subjects (58 ± 7 yrs, M/F 27/22) with type 2 diabetes with proliferative retinopathy (n = 13), nonproliferative retinopathy (n = 13) and without retinopathy (n = 23) were included in the study. 38 healthy subjects were selected as control group (57 ± 5 yrs, M/F 19/19). Erythrocyte anionic charge (EAC) was determined by the binding of the cationic dye, alcian blue. Urinary glycosaminoglycan and microalbumin excretion were measured.EAC was significantly decreased in diabetic patients with retinopathy (255 ± 30 ng alcian blue/106 RBC, 312 ± 30 ng alcian blue/106 RBC for diabetic and control groups respectively, p < 0.001). We did not observe an association between urinary GAG and microalbumin excretion and diabetic retinopathy. EAC is found to be negatively corralated with microalbuminuria in all groups.We conclude that type 2 diabetic patients with low erythrocyte anionic charge are associated with diabetic retinopathy. Reduction of negative charge of basement membranes may indicate general changes in microvasculature rather than retinopathy. More prospective and large studies needs to clarify the role of glycosaminoglycans on progression of retinopathy in type 2 diabetic patients.Diabetic retinopathy is the leading cause of blindness in diabetic adults [1,2]. During the first two decades of the disease, nearly all patients with type 1 diabetes and > 60 % of type 2 diabetes have retinopathy. The duration of the diabetes is probably the strongest predictor for development and progression of retinopathy [3]. The incidence of retinopathy positively correlates with HbA1c [4].Diabetic patients with evidence of nephropathy are characterized by a 5 to 10 times higher incidence of proliferative retinopathy [5]. Albuminuria not only is associated with kidney disease but, is also a strong predictor of car
Low Serum Magnesium Level Is Associated with Microalbuminuria in Chinese Diabetic Patients  [PDF]
Baihui Xu,Jichao Sun,Xinru Deng,Xiaolin Huang,Wanwan Sun,Yu Xu,Min Xu,Jieli Lu,Yufang Bi
International Journal of Endocrinology , 2013, DOI: 10.1155/2013/580685
Abstract: Whether serum magnesium deficiency is independently associated with the prevalence of microalbuminuria is still unclear. The objective of the present study was to elucidate the association between serum magnesium and microalbuminuria in diabetic patients. A cross-sectional study was conducted in 1829 diabetic subjects (aged ≥ 40 years) from Shanghai, China. Subjects were divided into three groups according to serum magnesium tertiles. A first-voided early-morning spot urine sample was obtained for urinary albumin-creatinine ratio (UACR) measurement. Microalbuminuria was defined as 30?mg/g ≤ UACR < 300?mg/g. Overall, 208 (11.37%) of the study population had microalbuminuria, with similar proportions in both genders ( ). The prevalence of microalbuminuria in tertile 1 of serum magnesium was higher than the prevalence in tertile 2 and tertile 3 (15.98%, 9.72%, and 8.46%, resp.; for trend <0.0001). After adjustment for age, sex, BMI, blood pressure, lipidaemic profile, HbA1c, eGFR, history of cardiovascular disease, HOMA-IR, antihypertensive and antidiabetic medication, and diabetes duration, we found that, compared with the subjects in tertile 3 of serum magnesium, those in tertile 1 had 1.85 times more likeliness to have microalbuminuria. We concluded that low serum magnesium level was significantly associated with the prevalence of microalbuminuria in middle-aged and elderly Chinese. 1. Introduction Magnesium (Mg) is the fourth most abundant cation in the human body and is a critical cofactor in many enzymatic reactions [1, 2]. It plays an important role in many fundamental biological processes. Mg depletion is a common feature in diabetic patients [3, 4]. An Australian study demonstrated that hypomagnesaemia was 10.51-fold more common between patients with new diabetes and 8.63-fold more common between patients with known diabetes as compared with control subjects without diabetes [3]. In another large cohort of young American adults participating in the Coronary Artery Risk Development in Young Adults (CARDIA) study, it was shown that Mg intake was inversely longitudinally associated with the incidence of diabetes [4]. Microalbuminuria was first reported in diabetic patients by Viberti et al. in 1982 [5]. It has been shown to be associated with increased risk of cardiovascular morbidity and mortality in diabetic patients [6]. Furthermore, the presence of microalbuminuria is generally associated with a poorer glycometabolic control and a higher prevalence of chronic complications including diabetic retinopathy, peripheral vascular disease, and diabetic
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