title: Impaired RBC deformability is associated with diabetic retinopathy in patients with type 2 diabetes.
abstract: OBJECTIVE
  Red blood cell (RBC) deformability, the ability of RBCs to change shape under stress, is known to be decreased in type 2 diabetes (T2D). However, as yet little is known of the association between RBC deformability and diabetic complications in T2D. For this reason, this study has investigated the association between RBC deformability and diabetic complications.
  
  
  METHODS
  In this cross-sectional study, 452 T2D patients were initially enrolled. RBC deformability was measured using a microfluidic ektacytometer and expressed as an elongation index at 3Pa (EI@3Pa, %).
  
  
  RESULTS
  A final total of 373 patients (mean age: 60.04±11.93 years; males: 201) were included in the study. When categorized into quartiles of RBC deformability, the lower EI@3Pa groups had higher glycated haemoglobin (HbA1c), triglycerides and prevalence of diabetic retinopathy compared with the higher quartiles (P<0.05 for trend). In particular, the EI@3Pa was significantly lower in patients with retinopathy than in those without retinopathy (30.53±1.95 vs 31.20±1.53, P=0.001). Between the lowest EI@3Pa quartile (Q1) to the highest (Q4, reference), the odds ratio (OR) for Q1 was 2.81 (95% CI: 1.21-6.49, P=0.004 for trend), after adjusting for age, gender, presence of hypertension and smoking, duration of diabetes, HbA1c, glomerular filtration rate and triglycerides.
  
  
  CONCLUSIONS
  In terms of diabetic complications, the lowest EI@3Pa group was closely associated with only the risk of diabetic retinopathy in our study. These results suggest that RBC deformability might be contributory to the development of the microvascular complication.
authors.affiliation: Yeungnam University College of Medicine, Department of Internal Medicine, Daegu, Republic of Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Moon
authors.affiliation: HaeDong Internal Medicine Clinic, Daegu, Republic of Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Yeungnam University College of Medicine, Department of Internal Medicine, Daegu, Republic of Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Yeungnam University College of Medicine, Department of Internal Medicine, Daegu, Republic of Korea.
authors.forename: I R
authors.initials: IR
authors.lastname: Park
authors.affiliation: Yeungnam University College of Medicine, Department of Internal Medicine, Daegu, Republic of Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Yeungnam University College of Medicine, Department of Internal Medicine, Daegu, Republic of Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Yeungnam University College of Medicine, Department of Ophthalmology, Daegu, Republic of Korea.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: Yeungnam University College of Medicine, Department of Laboratory Medicine, Daegu, Republic of Korea.
authors.forename: Y K
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Yeungnam University College of Medicine, Department of Internal Medicine, Daegu, Republic of Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Yoon
authors.affiliation: Yeungnam University College of Medicine, Department of Internal Medicine, Daegu, Republic of Korea. Electronic address: kcwon@med.yu.ac.kr.
authors.forename: K C
authors.initials: KC
authors.lastname: Won
authors.affiliation: Yeungnam University College of Medicine, Department of Internal Medicine, Daegu, Republic of Korea.
authors.forename: H W
authors.initials: HW
authors.lastname: Lee
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000503:physiopathology*; D004907:Erythrocyte Deformability / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Diabetic retinopathy; Microvascular complication; RBC deformability; Type 2 diabetes