Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes
Introduction Cerebral small-vessel disease is common in neurologically asymptomatic individuals with type 1 diabetes. The retinal vasculature is thought to mirror the brain’s vasculature, but data on this association are limited in type 1 diabetes. Our aim was to study associations between diabetic...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e002274.full |
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| author | Turgut Tatlisumak Jukka Putaala Daniel Gordin Paula Summanen Carol Forsblom Per-Henrik Groop Juha Martola Marika I Eriksson Sara Shams Ron Liebkind Lena M Thorn |
| author_facet | Turgut Tatlisumak Jukka Putaala Daniel Gordin Paula Summanen Carol Forsblom Per-Henrik Groop Juha Martola Marika I Eriksson Sara Shams Ron Liebkind Lena M Thorn |
| author_sort | Turgut Tatlisumak |
| collection | DOAJ |
| description | Introduction Cerebral small-vessel disease is common in neurologically asymptomatic individuals with type 1 diabetes. The retinal vasculature is thought to mirror the brain’s vasculature, but data on this association are limited in type 1 diabetes. Our aim was to study associations between diabetic retinopathy severity and cerebral small-vessel disease in type 1 diabetes.Research design and methods For this cross-sectional study, we enrolled 189 participants with type 1 diabetes (median age 40 (33–45) years; 53% female; diabetes duration 21.6 (18.2–30.7) years) and 29 healthy age-matched and sex-matched controls as part of the Finnish Diabetic Nephropathy Study. Participants underwent a clinical investigation, brain MRI, and fundus imaging. Signs of cerebral small-vessel disease in brain MRIs were analyzed in relation to diabetic retinopathy severity (Early Treatment Diabetic Retinopathy Study (ETDRS) score).Results In type 1 diabetes, participants with cerebral small-vessel disease had higher ETDRS scores (35 (20–61) vs 20 (20–35), p=0.022) and a higher prevalence of proliferative diabetic retinopathy than those without cerebral small-vessel disease (25% vs 9%, p=0.002). In adjusted analysis, proliferative diabetic retinopathy was associated with cerebral small-vessel disease (OR 2.57 (95% CI 1.04 to 6.35)). Median ETDRS score (35 (20–65) vs 20 (20–35), p=0.024) and proliferative diabetic retinopathy prevalence were higher (29% vs 13%, p=0.002) in participants with versus without cerebral microbleeds. ETDRS scores increased by number of cerebral microbleeds (p=0.001), both ETDRS score (OR 1.05 (95% CI 1.02 to 1.09)) and proliferative diabetic retinopathy (8.52 (95% CI 1.91 to 37.94)) were associated with >2 cerebral microbleeds in separate multivariable analysis. We observed no association with white matter hyperintensities or lacunar infarcts.Conclusions Presence of cerebral small-vessel disease on brain MRI, particularly cerebral microbleeds, is associated with the severity of diabetic retinopathy. |
| format | Article |
| id | doaj-art-dff09ee2bc614a13bbe21364fd1d1ca4 |
| institution | DOAJ |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
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| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-dff09ee2bc614a13bbe21364fd1d1ca42025-08-20T02:50:19ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2021-002274Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetesTurgut Tatlisumak0Jukka Putaala1Daniel Gordin2Paula Summanen3Carol Forsblom4Per-Henrik Groop5Juha Martola6Marika I Eriksson7Sara Shams8Ron Liebkind9Lena M Thorn10Department of Clinical Neurosciences, Sahlgrenska University Hospital, Goteborg, SwedenUniversity of Helsinki, Helsinki, FinlandDepartment of Nephrology, Helsinki University Central Hospital, Helsinki, FinlandFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, FinlandFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, FinlandDepartment of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, FinlandDepartment of Radiology, Karolinska University Hospital, Stockholm, SwedenResearch Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, FinlandDepartment of Radiology, Karolinska University Hospital, Stockholm, SwedenDepartment of Neurology, Helsinki University Central Hospital, Helsinki, FinlandFolkhälsan Research Center, Helsinki, FinlandIntroduction Cerebral small-vessel disease is common in neurologically asymptomatic individuals with type 1 diabetes. The retinal vasculature is thought to mirror the brain’s vasculature, but data on this association are limited in type 1 diabetes. Our aim was to study associations between diabetic retinopathy severity and cerebral small-vessel disease in type 1 diabetes.Research design and methods For this cross-sectional study, we enrolled 189 participants with type 1 diabetes (median age 40 (33–45) years; 53% female; diabetes duration 21.6 (18.2–30.7) years) and 29 healthy age-matched and sex-matched controls as part of the Finnish Diabetic Nephropathy Study. Participants underwent a clinical investigation, brain MRI, and fundus imaging. Signs of cerebral small-vessel disease in brain MRIs were analyzed in relation to diabetic retinopathy severity (Early Treatment Diabetic Retinopathy Study (ETDRS) score).Results In type 1 diabetes, participants with cerebral small-vessel disease had higher ETDRS scores (35 (20–61) vs 20 (20–35), p=0.022) and a higher prevalence of proliferative diabetic retinopathy than those without cerebral small-vessel disease (25% vs 9%, p=0.002). In adjusted analysis, proliferative diabetic retinopathy was associated with cerebral small-vessel disease (OR 2.57 (95% CI 1.04 to 6.35)). Median ETDRS score (35 (20–65) vs 20 (20–35), p=0.024) and proliferative diabetic retinopathy prevalence were higher (29% vs 13%, p=0.002) in participants with versus without cerebral microbleeds. ETDRS scores increased by number of cerebral microbleeds (p=0.001), both ETDRS score (OR 1.05 (95% CI 1.02 to 1.09)) and proliferative diabetic retinopathy (8.52 (95% CI 1.91 to 37.94)) were associated with >2 cerebral microbleeds in separate multivariable analysis. We observed no association with white matter hyperintensities or lacunar infarcts.Conclusions Presence of cerebral small-vessel disease on brain MRI, particularly cerebral microbleeds, is associated with the severity of diabetic retinopathy.https://drc.bmj.com/content/9/1/e002274.full |
| spellingShingle | Turgut Tatlisumak Jukka Putaala Daniel Gordin Paula Summanen Carol Forsblom Per-Henrik Groop Juha Martola Marika I Eriksson Sara Shams Ron Liebkind Lena M Thorn Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes BMJ Open Diabetes Research & Care |
| title | Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes |
| title_full | Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes |
| title_fullStr | Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes |
| title_full_unstemmed | Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes |
| title_short | Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes |
| title_sort | cerebral small vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes |
| url | https://drc.bmj.com/content/9/1/e002274.full |
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