title: Severity of coronary artery disease and retinal microvascular signs in patients with diagnosed versus undiagnosed diabetes: cross-sectional study.
abstract: BACKGROUND
  There is increasing evidence that a considerable proportion of patients with diabetes remain undiagnosed and untreated, however, it is unclear whether this is associated with more severe coronary artery disease (CAD) and microvasculature changes compared with diagnosed patients. We assessed CAD extent and severity, along with changes to the retinal microvascular structure in participants with undiagnosed versus diagnosed type 2 diabetes.
  
  
  METHODS
  Participants of the Australian Heart Eye Study were stratified into participants with previously diagnosed diabetes (n=489), undiagnosed diabetes (n=76) and no diabetes (n=1,112). Retinal vessel caliber was measured from digital retinal images. Extent and severity of CAD was assessed using Extent and Gensini scores from angiography findings, respectively.
  
  
  RESULTS
  Participants with undiagnosed and diagnosed diabetes versus those with no diabetes (reference group) had increased odds of being in the highest quartile of Gensini scores, multivariate adjusted odds ratios (OR) =7.02 [95% confidence interval (CI), 2.04-24.1] and OR =2.76 (95% CI, 1.67-4.55), respectively. Participants with undiagnosed and diagnosed diabetes versus those with no diabetes also had increased odds of being in the highest quartile of Extent scores, multivariate adjusted OR =7.63 (95% CI, 2.15-27.10) and OR =3.72 (95% CI, 2.22-6.27), respectively. No significant differences were observed in retinal vessel caliber between participants with undiagnosed versus diagnosed diabetes.
  
  
  CONCLUSIONS
  The present study demonstrated that participants with undiagnosed diabetes compared to those with previously diagnosed diabetes, had a stronger likelihood of having more severe and extensive CAD. However, retinal microvascular signs did not differ by diabetes status.
authors: Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
authors: Kevin
authors: K
authors: Phan
authors: Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
authors: Paul
authors: P
authors: Mitchell
authors: Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
authors: Gerald
authors: G
authors: Liew
authors: Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
authors: Adam J
authors: AJ
authors: Plant
authors: Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
authors: Sarah B
authors: SB
authors: Wang
authors: Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
authors: Joshua
authors: J
authors: Xu
authors: Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
authors: Joseph
authors: J
authors: Chiha
authors: Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
authors: Aravinda
authors: A
authors: Thiagalingam
authors: Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
authors: George
authors: G
authors: Burlutsky
authors: Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
authors: Bamini
authors: B
authors: Gopinath
keywords: Coronary artery disease (CAD); diabetes; microvascular; retinal