Retinopathy in type 2 diabetes mellitus is associated with increased intima-media thickness and endothelial dysfunction.
BACKGROUND
Microangioathy and macroangiopathy in type 2 diabetes mellitus (T2DM) frequently coexist. Both types of vascular complications share traditional risk factors. It is not clear whether the presence of microangiopathy, such as diabetic retinopathy (DR), constitutes a predictor of atherosclerosis in T2DM. Here we described the search for the association between DR and intima-media thickness (IMT) in T2DM. We also compared endothelial function in subjects with and without DR.


METHODS
We examined 182 consecutive patients with T2DM for at least 5 years (mean age at examination 56.3 +/- 6.52 years). We assessed (i) IMT of carotid artery by ultrasound and (ii) endothelial function by flow-mediated dilatation (FMD) method as well as by measurement of concentrations of von Willebrand factor (vWF) and s-ICAM-1. All patients underwent ophthalmological examination. Statistical analysis included Student's, Mann-Whitney, chi-square, Fisher tests and multiple regression.


RESULTS
DR was found in 71 (39.0%) subjects. IMT was higher in patients with DR than those without DR (0.87 mm vs. 0.79 mm, respectively, P = 0.0001). FMD was lower in the complication group than in subjects without DR (8.38% vs. 10.45%, respectively, P = 0.0023). Concentrations of s-ICAM-1 and vWF were not different between the groups. In multiple regression analysis, DR was among the predictors of increased IMT (P = 0.016) and decreased FMD (P = 0.002). We did not find a significant association of DR with vWF and s-ICAM-1 (P = 0.09 and P = 0.11, respectively).


CONCLUSIONS
DR is associated with increased IMT and endothelial dysfunction in T2DM. Impaired endothelial function may be a common denominator of pathogenesis of microvascular complications and atherosclerosis in T2DM.
Malecki
M T
MT
Department of Metabolic Diseases, Medical College, Jagiellonian University, Krakow, Poland. malecki_malecki@yahoo.com
Osmenda
G
G
Walus-Miarka
M
M
Skupien
J
J
Cyganek
K
K
Mirkiewicz-Sieradzka
B
B
damek-Guzik
T A
TA
Guzik
T J
TJ
Sieradzki
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology*; D003925:Diabetic Angiopathies / Q000473:pathology*; D003930:Diabetic Retinopathy / Q000473:pathology; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D017539:Tunica Intima / Q000473:pathology*; D017540:Tunica Media / Q000473:pathology*; D014841:von Willebrand Factor / Q000378:metabolism
D014841:von Willebrand Factor