Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes.
BACKGROUND
To investigate changes in the neural retina according to the presence of retinal nerve fiber layer (RNFL) defects in type 2 diabetes, and to determine the association between inner retina thickness and the severity of diabetic complications.


METHODS
We studied non-glaucomatous patients with type 2 diabetes and control subjects Circumpapillary RNFL and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured by spectral-domain optical coherence tomography. In patients with type 2 diabetes, a cardiovascular autonomic function test (AFT) was performed, which included the heart rate parameter of beat-beat variation-with deep breathing, in response to the Valsalva maneuver, and on postural change from lying to standing. The results of each test were scored as 0 for normal and 1 for abnormal. A total AFT score of 1 was defined as early cardiovascular autonomic neuropathy (CAN), and an AFT score≥ 2 as definite CAN.


RESULTS
We compared control eyes (n = 70), diabetic eyes with RNFL defects (n = 47), and eyes without RNFL defects (n = 30). The average RNFL and GCIPL thicknesses were significantly different among groups (all, P<0.05). On post-hoc testing, diabetic eyes with RNFL defects had a significantly thinner average GCIPL thickness than those without RNFL defects. On multivariate analyses, significantly thinner average GCIPL was seen in early CAN staging (B = -4.32, P = 0.016) and in definite CAN staging (B = -10.33, P<0.001), compared with no CAN involvement, after adjusting for confounding parameters.


CONCLUSIONS
Cardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.
Department of Ophthalmology and Visual Science St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Jin A
JA
Choi
Department of Ophthalmology and Visual Science St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Hyo Won
HW
Kim
Department of Ophthalmology and Visual Science St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Jin-Woo
JW
Kwon
Department of Ophthalmology and Visual Science St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Yun-Sub
YS
Shim
Department of Ophthalmology and Visual Science St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Dong Hyun
DH
Jee
Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Jae-Seung
JS
Yun
Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Yu-Bae
YB
Ahn
Department of Ophthalmology and Visual Science Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Chan Kee
CK
Park
Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Seung-Hyun
SH
Ko
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D058065:Diabetic Cardiomyopathies / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000000981:diagnostic imaging / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014636:Valsalva Maneuver