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M. B. Sasongko, J. J. Wang, N. Cheung, K. Donaghue, A. Jenkins, P. Benitez-Aguirre, T. Y. Wong; Retinal Microvascular Structural Changes and Complications in Type 1 Diabetes Mellitus. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3902.
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To determine cross-sectional associations of retinal microvascular structural characteristics (branching angle and tortuosity) with early diabetes complications in young people with type 1 Diabetes Mellitus.
A total of 810 children and adolescents aged 12-20 years with type I diabetes from a tertiary referral hospital in Sydney, Australia were enrolled between 1990-2002. Clinical assessment and retinal photography were performed according to standardized protocols at the same initial visit. Retinal microvascular branching angles and tortuosity were measured from retinal photographs using a semi-automated computer-assisted program. We assessed associations of these characteristics with diabetic duration, concurrent HbA1c level, and the presence of diabetic complications (retinopathy, early elevation of albumin excretion rate (AER) (mean >7.5ug/min) and nerve dysfunction).
Of 637 patients with gradable photographs (77.4%), arteriolar branching angle and tortuosity were positively associated with diabetes duration and HbA1c level. After controlling for age, sex, body mass index, blood pressure, pubertal stage, and concurrent total cholesterol and HbA1c level, arteriolar branching angle and tortuosity were associated with diabetic retinopathy and an elevation of AER. Patients with retinopathy had larger arteriolar branching angle (mean difference 2.43O; 95% CI 0.39-4.47; P=0.02) and increased arteriolar tortuosity (corresponding mean difference 0.0117; 95% CI 0.0054-0.0181; P<0.001). Similarly, persons with AER>7.5ug/min had larger arteriolar branching angle (mean difference 1.81O; 95% CI 0.34-3.28; P=0.016) and increased arteriolar tortuosity (mean difference 0.0068; 95% CI 0.0010-0.0127; P=0.022).
In young people with type 1 diabetes, larger arteriolar branching angles and increased arteriolar tortuosity were associated with retinopathy and an early marker for diabetic nephropathy, mean AER>7.5ug/min. These findings suggest that these retinal vessel structural alterations may represent early microvascular damage in persons with type 1 diabetes.
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