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Paola Giorno, Fabiana Picconi, Fabio Scarinci, Simona Frontoni, Antonio Di Renzo, Monica Varano, Maria Cristina Parravano; Impact of glycemic variability on neurosensory retina in patients with type 1 diabetes mellitus. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6318.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic retinopathy (DR) is considered a retinal microvascular disorder. Recent studies demonstrated that retinal neurodegeneration might develop early in the course of DR, even before the onset of microvascular changes. The mechanisms by which hyperglycemia adversely affects the neurosensory retina are still not well understood. The aim of our study was to evaluate the impact of overall glycemic load and glycemic variability (GV) on the layers of retinal nerve tissue in patients with type 1 diabetes mellitus with no signs of DR or mild non proliferative DR .
29 subjects with DM1 and 13 healthy subjects (C) were included. All subjects underwent a complete ophthalmological examination and Spectralis OCT evaluation. The thickness map of retinal layers, using the automatic segmentation, was performed and values were compared among groups. All DM1 patients underwent a Continuous Glucose Monitoring (CGM), from which indexes of GV were calculated. Overall glycemic load was evaluated by analyzing HbA1c values.
Nasal retinal nerve fiber layer (RNFL) thickness was significantly different between DM1 patients and C (83.4±14.7 vs 90.8±13.8 μm, p=0.01). Inner nuclear layer (INL) thickness was significantly increased in nasal (97.38±12.53 vs 91.57±5.53μm, p<0.01), temporal (95±12.97vs 88.35±5.20μm, p<0.00), superior (98.65±13.42 vs 92.05±5.75μm, p<0.01) and inferior (95.61± 13.28 vs 90.33±5.50μm, p<0.02) quadrants in DM1 group vs controls. A significant relationship between RNFL thickness and Low blood glucose index (LBGi) (p=0.034) as well as between INL thickness and Continuous overall net glycemic activation-1 (CONGA-1, p=0.037), CONGA-2 (p=0.041), CONGA-4 (p=0.032) was found in DM1 patients. However, no significant relationship was found between OCT parameters and HbA1c values.
Retinal neurodegeneration is already present in DM1 patients with no or early signs of DR. VG, but not overall glycemic load, was found being the most detrimental for the development of structural changes of the neurosensory retina in DM1 patients, whereas the impact of overall glycemic load remains controversial.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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