Abstract
Purpose :
Type 1 Diabetes Mellitus (T1DM) is a lifelong autoimmune disease that results in insulin deficiency due to destruction of pancreatic beta cells. Over 1.75 million Americans are affected by T1DM, with increasing rates of 2-3% per year globally. High concentrations of lipofuscin, a waste by-product also found in the retinal pigment epithelium (RPE), could potentially negatively impact a healthy retina. From our previous published work in lipofuscin concentration in vegetarians (fluorescence index 75) versus non-vegetarians (fluorescence index 88) in control populations, we hypothesize vegetarian T1DM participants using a continuous glucose monitor (CGM) and an insulin pump may have less lipofuscin accumulation in the RPE than non-vegetarian T1DM participants who use CGM and an insulin pump.
Methods :
Fifty-two participants (38.4% males, 15.4% vegetarian, 84.6% white) with self-reported diets were included in the analysis during a T1DM conference. Retinal images were captured at a 45 degree angle using a Canon CR-2 Plus AF (Tokyo, Japan) non-mydriatic retinal camera with a resolution of 21Mp. Fundus Auto-Fluorescence (FAF) images were captured at 300-watt seconds to record measurable levels of lipofuscin. FAF levels (mean) were measured using Photoshop V7.0.1 (San Francisco, CA) in the ganglion cell complex area between the macula and optic nerve head (av. 251,786 pixels). Means, SDs, t-tests, and multiple linear regression were used for analysis.
Results :
On average, participant age was 16.15 years, T1DM duration 7.10 years, and lengths of CGM and insulin pump use 4.88 and 4.17 years, respectively. Average reported vegetarian diet duration was 4.14 years. Average FAF levels between vegetarian and nonvegetarian participants were significantly different (p<.05). On regression analysis, a vegetarian diet had a slightly positive correlation with measured lipofuscin levels when controlled for BMI and T1DM duration (95% conf. int., p<.05). HbA1C of vegetarians vs non-vegetarians was 7.6 vs 6.9. Non-vegetarians used a pump for >1.5 years more than vegetarians.
Conclusions :
It is important to understand how factors such as RPE lipofuscin concentration, lifestyle choices and insulin pump can help manageT1DM complications. Further studies will be performed to include a larger number of vegetarian participants with T1DM.
This is a 2020 ARVO Annual Meeting abstract.