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L.-A. Khuu, E. Palka, J. Flanagan, T. Wong, W.-C. Lam, S. N. Markowitz, R. Devenyi, M. Brent, M. Mandelcorn, C. Hudson; Retinal Hemodynamics, Systemic Markers of Endothelial Function and Inflammation in Type 2 Diabetes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1335.
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To investigate the associations between retinal hemodynamics, systemic markers of endothelial function and inflammation and glucose control in patients with type 2 diabetes with non-proliferative diabetic retinopathy (NPDR).
Retinal blood flow measurements and blood serum samples were obtained from 26 NPDR type 2 diabetes subjects (mean age 61.65; SD= 8.5 years; M:F 14:12). The presence or absence of NPDR was determined by stereo fundus photography. The sample was stratified into mild-to-moderate (n=16) and moderate-to-severe (n=10) DR groups. Retinal blood flow was measured in the supero-temporal arteriole using the Canon Laser Blood Flowmeter. A minimum of 6 measurements were acquired to establish values for vessel diameter, blood velocity, max:min velocity ratio and blood flow. Blood samples were collected to derive levels of intercellular adhesion molecule (ICAM-1), vascular adhesion molecule (VCAM-1), E-selectin, von Willebrand factor (vWF) and glycosylated hemoglobin (A1c).
Diameter, velocity and flow were the same across the groups. However, max:min velocity ratio was elevated in the moderate-to-severe NPDR group (0.49 vs. 0.60, p=0.042). Max:min velocity ratio was correlated with age (r=0.425, p=0.039) and showed a marginal correlation with vWF (r=0.371, p=0.10). A marginal correlation between blood velocity and HS C-reactive protein (r=-0.395, p=0.095) was identified. The was a strong correlation between E-selectin and A1c (r=0.477, p=0.029). Not surprisingly, there were strong correlations between the measures of retinal hemodynamic parameters (r>0.41, p<0.05) and also between the endothelial function parameters (r>0.48, p<0.03).
A reduction in the compliance (i.e. increased rigidity) of the arteriolar circulation with increase in severity of NPDR from mild-to-moderate to moderate-to-severe was found. A strong association between long-term glucose control and endothelial function was revealed. Markers of endothelial function and inflammation showed marginal associations with retinal hemodynamics in patients with NPDR.
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