Diabetes & Metabolism Journal

Original Articles

Complications
Glycemic Control and Retinal Microvascular Changes in Type 2 Diabetes Mellitus Patients without Clinical Retinopathy: Kangmin Lee, Ga Hye Lee, Seung Eun Lee, Jee Myung Yang, Kunho Bae; Diabetes Metab J. 2024;48(5):983-992. Published online March 13, 2024; DOI: https://doi.org/10.4093/dmj.2023.0149

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Background
To investigate the association of glycemic control and retinal microvascular changes in patients with type 2 diabetes mellitus (T2DM) without diabetic retinopathy (DR).
Methods
This retrospective, observational, cohort study included patients with T2DM without DR. The patients were categorized into intensive control (IC; mean glycosylated hemoglobin [HbA1c] ≤7.0%) and moderate control (MC; mean HbA1c >7.0%) groups. Optical coherence tomography (OCT) and swept-source OCT angiography (OCTA) image parameters were compared between three groups, including healthy controls.
Results
In total, 259 eyes of 259 participants (88 IC, 81 MC, and 90 controls) were included. The foveal avascular zone area was significantly larger in the MC group than IC and control groups (all P<0.05). The IC group had lower vessel density in the superficial retinal layer and deep retinal layer than the controls (all P<0.05). The choriocapillaris (CC) flow deficit (FD) was significantly greater in the MC group than in the IC and control groups (18.2%, 16.7%, and 14.2%, respectively; all P<0.01). In multivariate regression analysis, CC-FD was associated with the mean HbA1c level (P=0.008). There were no significant differences in OCT parameters among the groups.
Conclusion
OCTA revealed that early CC impairment is associated with HbA1c levels; the CC changes precede clinically apparent DR. The OCTA parameters differed among the groups according to the degree of glycemic control. Our results suggest that microvascular changes precede DR and are closely related to glycemic control.

Citations

Citations to this article as recorded by

Quantitative evaluation of the topographical maps of three-dimensional choroidal vascularity index in gestational diabetes mellitus: a cross-sectional observational study
Ligang Jiang, Yimei Ji, Xin Jiang, Yune Zhao
BMC Pregnancy and Childbirth.2026;[Epub] CrossRef
Impact of Vascular Risk Factors on Longitudinal Changes in Diabetic Macular Edema After Intravitreal Therapy
Carmen Alba-Linero, José Coín Ruiz, Marta Mérida Luque, Javier Espíldora-Hernández, Mario Gutiérrez Bedmar
Diabetology.2026; 7(4): 65. CrossRef
Correlation of Glycemic Risk Index with Retinal Structure and Blood Flow in Patients without Diabetic Retinopathy
丁元曹
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The Correlation Between Macular Vessel Density and Its Clinical Parameters in Diabetes Mellitus Type 2
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Indian Journal of Ophthalmology.2025; 73(11): 1698. CrossRef
Prevalence and determinants of comorbidities among patients with type 2 diabetes mellitus in Nepal: a cross-sectional study
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Intravitreal Ranibizumab for Subfoveal Choroidal Neovascularization from Age-Related Macular Degeneration with Combined Severe Diabetic Retinopathy: So Young Han, Jeong Hun Bae, Jaeryung Oh, Hyeong Gon Yu, Su Jeong Song; Diabetes Metab J. 2015;39(1):46-50. Published online February 16, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.1.46

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Background

To evaluate the efficacy of intravitreal ranibizumab for subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD) with combined severe diabetic retinopathy (DR).

Methods

This retrospective, interventional case series included eleven patients (mean age, 70.09 years; range, 54 to 83 years) with at least severe non-proliferative DR and subfoveal CNV secondary to AMD. Each subject was treated with intravitreal injections of 0.5 mg ranibizumab. The primary outcomes included change in best-corrected visual acuity and central subfield thickness (CST) on optical coherence tomography (OCT).

Results

The mean follow-up time was 16.7±14 months (range, 6 to 31 months). Mean visual acuity improved from 1.21±0.80 logarithm of the minimum angle of resolution (logMAR) to 1.0±0.6 logMAR (P=0.107), 0.95±0.62 logMAR (P=0.044), 1.10±0.68 logMAR (P=0.296), and 1.13±0.66 logMAR (P=0.838) at 1, 3, 6, and 12 months after injection, respectively. Eight patients (72.7%) gained or maintained vision (mean 0.32 logMAR), whereas three patients (27.3%) lost more than one line of vision (mean 0.51 logMAR). The mean OCT CST was 343.9±134.6 µm at baseline, and the mean CST at 1, 3, 6, 12 months after the injection was 367.8±172.1 (P=0.864), 346.2±246.2 (P=0.857), 342±194.1 (P=0.551), and 294.2±108.3 µm (P=0.621), respectively.

Conclusion

Intravitreal ranibizumab injection can be considered to be a therapy for the stabilization of subfoveal CNV secondary to AMD with combined severe DR. However, these patients might exhibit limited visual improvement after treatment.

Citations

Citations to this article as recorded by

Comparative study of widefield swept-source optical coherence tomography angiography in eyes with concomitant age-related macular degeneration and diabetic retinopathy
Matthew Finn, Grace Baldwin, Itika Garg, Hannah E Wescott, Thomas Koch, Filippos Vingopoulos, Rebecca Zeng, Hanna Choi, Diane Sayah, Deeba Husain, Nimesh A Patel, Leo A Kim, Joan W Miller, David M Wu, Demetrios G Vavvas, John B Miller
British Journal of Ophthalmology.2024; 108(7): 963. CrossRef
Outcomes of intravitreal anti-VEGF therapy in eyes with both neovascular age-related macular degeneration and diabetic retinopathy
Francesco Bandello, Federico Corvi, Carlo La Spina, Lucia Benatti, Lea Querques, Vittorio Capuano, Jonathan Naysan, Xuejing Chen, David Sarraf, Maurizio Battaglia Parodi, Eric Souied, K Bailey Freund, Giuseppe Querques
British Journal of Ophthalmology.2016; 100(12): 1611. CrossRef

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