Title
Endothelial dysfunction and low-grade inflammation and the progression of retinopathy in Type 2 diabetes
Author
Spijkerman, A.M.W.
Gall, M.A.
Tarnow, L.
Twisk, J.W.R.
Lauritzen, E.
Lund-Andersen, H.
Emeis, J.
Parving, H.H.
Stehouwer, C.D.A.
TNO Kwaliteit van Leven
Publication year
2007
Abstract
Aims: To study whether microalbuminuria, endothelial dysfunction and low-grade inflammation are associated with the presence and progression of diabetic retinopathy. Methods: Patients with Type 2 diabetes (n = 328) attending a diabetes clinic were followed for 10 years and examined annually during the last 7 years. Retinopathy was assessed after pupillary dilatation by direct ophthalmoscopy (baseline) and two-field 60°fundus photography (follow-up). Urinary albumin excretion, and markers of endothelial function (von Willebrand factor, tissue-type plasminogen activator, soluble E-selectin (sE-selectin), and soluble vascular cell adhesion molecule 1) and inflammatory activity (C-reactive protein and fibrinogen) were determined. Results: The prevalence of retinopathy was 33.8%. The median diabetes duration at baseline was 7 years (interquartile range 2-12 years). The highest tertiles of baseline urinary albumin excretion and glycated haemoglobin (HbA1c) were associated with prevalent retinopathy: odds ratio (OR) 95% confidence interval (CI) 2.80 (1.44-5.46) and 2.19 (1.11-4.32), respectively. Progression of retinopathy occurred in 188 patients. The second and third tertiles of baseline sE-selectin were associated with progression of retinopathy [1.44 (1.04-2.01) and 1.61 (1.19-2.18)] but not independently of HbA1c. None of the other markers was significantly associated with the presence or progression of retinopathy. High baseline HbA1c was significantly associated with progression of retinopathy: 1.65 (1.21-2.25). Conclusions: In this population of patients with Type 2 diabetes who attended a diabetes clinic, there was some evidence for a role of endothelial dysfunction in the progression of retinopathy. We could not demonstrate a role for low-grade inflammation. Our study emphasizes the importance of glycaemic control in the development and progression of retinopathy. © 2007 The Authors.
Subject
Biomedical Research
Endothelium
Inflammation
Retinopathy
Type 2 diabetes
albumin
biological marker
C reactive protein
endothelial leukocyte adhesion molecule 1
fibrinogen
hemoglobin A1c
tissue plasminogen activator
vascular cell adhesion molecule 1
von Willebrand factor
adult
article
clinical assessment
confidence interval
controlled study
diabetic patient
diabetic retinopathy
disease association
disease course
disease severity
endothelial dysfunction
eye fundus
female
follow up
hospital
human
inflammation
major clinical study
male
microalbuminuria
mydriasis
non insulin dependent diabetes mellitus
ophthalmoscopy
photography
prevalence
risk factor
statistical analysis
urinary excretion
Blood Glucose
C-Reactive Protein
Cohort Studies
Diabetes Mellitus, Type 2
Diabetic Retinopathy
Disease Progression
Endothelium, Vascular
Female
Follow-Up Studies
Humans
Male
Middle Aged
Retinal Vasculitis
Retinal Vessels
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http://resolver.tudelft.nl/uuid:b1bf4e88-cfc5-4efc-b091-8d48fa004ec7
DOI
https://doi.org/10.1111/j.1464-5491.2007.02217.x
TNO identifier
240175
ISSN
0742-3071
Source
Diabetic Medicine, 24 (9), 969-976
Document type
article