title: Relationship between modified homeostasis model assessment/correlative serum factors and diabetic retinopathy among type 2 diabetics with insulin therapy in Guangzhou, China.
abstract: OBJECTIVE
  To explore the related risk factors for diabetic retinopathy (DR) in type 2 diabetes with insulin therapy.
  
  
  METHODS
  We studied the relationships among blood glucose, serum C-peptide, plasma insulin, beta-cell function and the development of DR. Beta-cell function was assessed by a modified homeostasis model assessment (modified HOMA) which was gained by using C-peptide to replace insulin in the homeostasis model assessment (HOMA) of beta-cell function. We also studied the relationships between modified HOMA index and serum C-peptide response to 100g tasteless steamed bread to determine the accuracy of modified HOMA.
  
  
  RESULTS
  Our study group consisted of 170 type 2 diabetic inpatients with DR (age: 58.35±13.87y, mean±SD) and 205 type 2 diabetic inpatients with no DR (NDR) (age: 65.52±11.59y). DR patients had higher age, longer diabetic duration, higher hypertension grade, higher postprandial plasma glucose, higher fluctuation level of plasma glucose, lower body mass index (BMI), lower postprandial serum insulin and C-peptide, lower fluctuation level of serum insulin and C-peptide (P<0.05). In our logistic regression model, duration of diabetes, hypertension grade, fasting plasma insulin and glycosylated hemoglobin (HbA1C) were significantly associated with the presence of DR after adjustment for confounding factors (P<0.05).
  
  
  CONCLUSIONS
  Our results suggested although modified HOMA showed significant correlation to the occurrence of DR on Spearman's rank-correlation analysis, logistic regression showed no significant association between these two variables after adjustment for relevant confounding factors (such as age, sex, duration of diabetes, BMI, hypertension grade, HbA1C, plasma insulin). Duration of diabetes, hypertension grade, fasting plasma insulin and HbA1C were independently associated with the development of DR in Chinese type 2 diabetics.
authors: Department of Ophthalmology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China.
authors: Li
authors: L
authors: Hu
authors: Department of Ophthalmology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China.
authors: Dong-Hao
authors: DH
authors: Li
keywords: diabetic retinopathy; insulin; modified homeostasis model assessment