Alterations in Retinal Microvascular Geometry in Young Type 1 Diabetes

• Published in: Diabetes care Vol. 33; no. 6; pp. 1331 - 1336
• Main Authors: Sasongko, Muhammad Bayu, Wang, Jie Jin, Donaghue, Kim C, Cheung, Ning, Benitez-Aguirre, Paul, Jenkins, Alicia, Hsu, Wynne, Lee, Mong-Li, Wong, Tien Y
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-06-2010
• Subjects: Adolescent; Adult; Biological and medical sciences; Blood pressure; Child; Cholesterol; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes. Impaired glucose tolerance; Diabetic retinopathy; Diabetics; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Hypertension; Male; Medical sciences; Metabolic diseases; Microvessels - pathology; Miscellaneous; Original Research; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retinal Diseases - etiology; Retinal Vessels - pathology; Risk factors; Rodents; Software; Studies; Young Adult; Young adults; Australia; Endocrinopathy; Human; Immunopathology; Nutrition; Alteration; Autoimmune disease; Metabolic diseases; Retina; Eye; Geometry; Visual system; Microcirculation; Type 1 diabetes; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc10-0055

OBJECTIVE: To describe retinal microvascular geometric parameters in young patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: Patients with type 1 diabetes (aged 12-20 years) had clinical assessments and retinal photography following standardized protocol at a tertiary-care hospital in Sydney. Retinal microvascular geometry, including arteriolar and venular tortuosity, branching angles, optimality deviation, and length-to-diameter ratio (LDR), were measured from digitized photographs. Associations of these geometric characteristics with diabetes duration, A1C level, systolic blood pressure (SBP), and other risk factors were assessed. RESULTS: Of 1,159 patients enrolled, 944 (81.4%) had gradable photographs and 170 (14.7%) had retinopathy. Older age was associated with decreased arteriolar (P = 0.024) and venular (P = 0.002) tortuosity, and female subjects had larger arteriolar branching angle than male subjects (P = 0.03). After adjusting for age and sex, longer diabetes duration was associated with larger arteriolar branching angle (P [less-than or equal to] 0.001) and increased arteriolar optimality deviation (P = 0.018), higher A1C was associated with increased arteriolar tortuosity (>8.5 vs. [less-than or equal to]8.5%, P = 0.008), higher SBP was associated with decreased arteriolar LDR (P = 0.002), and higher total cholesterol levels were associated with increased arteriolar LDR (P = 0.044) and decreased venular optimality deviation (P = 0.044). These associations remained after controlling for A1C, retinal vessel caliber, and retinopathy status and were seen in subjects without retinopathy. CONCLUSIONS: Key diabetes-related factors affect retinal microvascular geometry in young type 1 diabetes, even in those without evidence of retinopathy. These early retinal alterations may be markers of diabetes microvascular complications.