Diabetic Retinopathy Progression and Endocrine Correlates: A Multicenter Study

Abstract

The research is a multicentric study, and it is aimed at researching the further development of diabetic retinopathy (DR) and its reliance on an all-encompassing endocrine data to identify the predictors of the severity and the progression of the disease.  One hundred patients were measured in various tertiary hospitals, retinal imaging and bio-chemical indicators (HbA1c, fasting glucose, insulin resistance indices ( HOMA-IR ) and lipid profile, thyroid hormone, cortisol level, and pro-inflammatory cytokines.  Statistical modelling demonstrated that incremental and steady change in the level of HbA1c and augmented insulin resistance were the most powerful predictors of diabetic retinopathy (DR) progression. Much greater proportions of mild/moderate non-proliferative DR to proliferative DR were identified in the group of patients with poor glycemic control during the long-term period.  This was worsened by dyslipidemia, which in this instance was the high triglycerides and LDL-cholesterol that worsened the microvascular health.  The retinal structural alteration and the predisposition to neovascularization were directly linked to endocrine problems (subclinical hypothyroidism and high cortisol levels).  The mechanism relationships between systemic cytokines (IL-6, CRP, TNF-a) and retinal edema and hemorrhagic changes were strong, which showed that a mechanistic relationship exists between systemic cytokines and pathology of the eye.  Multivariate regression and predictive modelling have demonstrated a massive level of accuracy (AUC >0.85) in course predictions of diabetic retinopathy by using only endocrine markers.  The point of the research is that the use of endocrine signs in the DR screening plans can greatly improve the early detection, risk assessment, and preventive strategy.  These findings have significance in the sense that there is a need to apply a multidisciplinary approach to integrate ophthalmologic monitoring with endocrine support to minimize effects of the diabetes-related visual impairment