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Glucose variability and inner retinal sensory neuropathy in persons with type 1 diabetes mellitus
Purpose To quantify early neuroretinal alterations in patients with type 1 diabetes mellitus (T1DM) and to assess whether glycemic variability contributes to alterations in neuroretinal structure or function. Methods Thirty patients with T1DM and 51 controls underwent comprehensive ophthalmic examin...
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| Published in: | Eye (London) 2016-06, Vol.30 (6), p.825-832 |
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| creator | Stem, M S Dunbar, G E Jackson, G R Farsiu, S Pop-Busui, R Gardner, T W |
| description | Purpose
To quantify early neuroretinal alterations in patients with type 1 diabetes mellitus (T1DM) and to assess whether glycemic variability contributes to alterations in neuroretinal structure or function.
Methods
Thirty patients with T1DM and 51 controls underwent comprehensive ophthalmic examination and assessment of retinal function or structure with frequency doubling perimetry (FDP), contrast sensitivity, dark adaptation, fundus photography, and optical coherence tomography (OCT). Diabetic participants wore a subcutaneous continuous glucose monitor for 5 days, from which makers of glycemic variability including the low blood glucose index (LGBI) and area under the curve (AUC) for hypoglycemia were derived.
Results
Sixteen patients had no diabetic retinopathy (DR), and 14 had mild or moderate DR. Log contrast sensitivity for the DM group was significantly reduced (mean±SD=1.63±0.06) compared with controls (1.77±0.13,
P |
| doi_str_mv | 10.1038/eye.2016.48 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4906457</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1811905526</sourcerecordid><originalsourceid>FETCH-LOGICAL-c549t-88b59de8fa64a88eee1c4bbf31b7033dfe0837953aac7d9703d5165f2ccbca583</originalsourceid><addsrcrecordid>eNqFkUFLHDEYhkNRutttT94l4KXQzjaZSWYyF6FIq4LgRaG3kMl8s5tlNhmTjGX-fbOuFRXBUyDfkydv8iJ0RMmSkkL8gAmWOaHlkokPaE5ZVWaccXaA5qTmJMvz_M8MfQphQ0gaVuQjmuUVKVg6M0fqvB-1C4DvlTeqMb2JE1a2xcZa8NhDNFb1OIANzk_YwujdoOJ6SgAewAdnA_5r4hrHaQBMcZssECHgLfRJNobP6LBTfYAvj-sC3f7-dXN2kV1dn1-e_bzKNGd1zIRoeN2C6FTJlBAAQDVrmq6gTQpbtB0QUVQ1L5TSVVunvZbTkne51o1WXBQLdLr3DmOzhVaDjV71cvBmq_wknTLy5cSatVy5e8lqUjJeJcHXR4F3dyOEKLcm6PQKZcGNQVJBaU04z8v30RRUlCnjLtbJK3TjRp_-9IFiIq8EZYn6tqe0dyF46J5yUyJ3LcvUsty1LNnOefz8qU_s_1oT8H0PhDSyK_DPLn3D9w8IjrPf</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1794827814</pqid></control><display><type>article</type><title>Glucose variability and inner retinal sensory neuropathy in persons with type 1 diabetes mellitus</title><source>PubMed (Medline)</source><creator>Stem, M S ; Dunbar, G E ; Jackson, G R ; Farsiu, S ; Pop-Busui, R ; Gardner, T W</creator><creatorcontrib>Stem, M S ; Dunbar, G E ; Jackson, G R ; Farsiu, S ; Pop-Busui, R ; Gardner, T W</creatorcontrib><description>Purpose
To quantify early neuroretinal alterations in patients with type 1 diabetes mellitus (T1DM) and to assess whether glycemic variability contributes to alterations in neuroretinal structure or function.
Methods
Thirty patients with T1DM and 51 controls underwent comprehensive ophthalmic examination and assessment of retinal function or structure with frequency doubling perimetry (FDP), contrast sensitivity, dark adaptation, fundus photography, and optical coherence tomography (OCT). Diabetic participants wore a subcutaneous continuous glucose monitor for 5 days, from which makers of glycemic variability including the low blood glucose index (LGBI) and area under the curve (AUC) for hypoglycemia were derived.
Results
Sixteen patients had no diabetic retinopathy (DR), and 14 had mild or moderate DR. Log contrast sensitivity for the DM group was significantly reduced (mean±SD=1.63±0.06) compared with controls (1.77±0.13,
P
<0.001). OCT analysis revealed that the inner temporal inner nuclear layer (INL) was thinner in patients with T1DM (34.9±2.8
μ
m) compared with controls (36.5±2.9
μ
m) (
P
=0.023), although this effect lost statistical significance after application of the Bonferroni correction for multiple comparisons. Both markers of glycemic variability, the AUC for hypoglycemia (
R
=−0.458,
P
=0.006) and LGBI (
R
=−0.473,
P
=0.004), were negatively correlated with inner temporal INL thickness.
Conclusions
Patients with T1DM and no to moderate DR exhibit alterations in inner retinal structure and function. Increased glycemic variability correlates with retinal thinning on OCT imaging, suggesting that fluctuations in blood glucose may contribute to neurodegeneration.</description><identifier>ISSN: 0950-222X</identifier><identifier>EISSN: 1476-5454</identifier><identifier>DOI: 10.1038/eye.2016.48</identifier><identifier>PMID: 27034201</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/699/2743/137/138 ; 692/699/3161/3175 ; Adult ; Blood Glucose - metabolism ; Clinical Study ; Contrast Sensitivity - physiology ; Dark Adaptation - physiology ; Diabetes Mellitus, Type 1 - diagnosis ; Diabetes Mellitus, Type 1 - physiopathology ; Diabetic Retinopathy - diagnosis ; Diabetic Retinopathy - physiopathology ; Female ; Glycated Hemoglobin A - metabolism ; Glycemic Index - physiology ; Humans ; Laboratory Medicine ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Ophthalmology ; Pharmaceutical Sciences/Technology ; Retina - physiopathology ; Surgery ; Surgical Oncology ; Tomography, Optical Coherence ; Visual Field Tests</subject><ispartof>Eye (London), 2016-06, Vol.30 (6), p.825-832</ispartof><rights>Royal College of Ophthalmologists 2016</rights><rights>Copyright Nature Publishing Group Jun 2016</rights><rights>Copyright © 2016 Royal College of Ophthalmologists 2016 Royal College of Ophthalmologists</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c549t-88b59de8fa64a88eee1c4bbf31b7033dfe0837953aac7d9703d5165f2ccbca583</citedby><cites>FETCH-LOGICAL-c549t-88b59de8fa64a88eee1c4bbf31b7033dfe0837953aac7d9703d5165f2ccbca583</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906457/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906457/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27034201$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stem, M S</creatorcontrib><creatorcontrib>Dunbar, G E</creatorcontrib><creatorcontrib>Jackson, G R</creatorcontrib><creatorcontrib>Farsiu, S</creatorcontrib><creatorcontrib>Pop-Busui, R</creatorcontrib><creatorcontrib>Gardner, T W</creatorcontrib><title>Glucose variability and inner retinal sensory neuropathy in persons with type 1 diabetes mellitus</title><title>Eye (London)</title><addtitle>Eye</addtitle><addtitle>Eye (Lond)</addtitle><description>Purpose
To quantify early neuroretinal alterations in patients with type 1 diabetes mellitus (T1DM) and to assess whether glycemic variability contributes to alterations in neuroretinal structure or function.
Methods
Thirty patients with T1DM and 51 controls underwent comprehensive ophthalmic examination and assessment of retinal function or structure with frequency doubling perimetry (FDP), contrast sensitivity, dark adaptation, fundus photography, and optical coherence tomography (OCT). Diabetic participants wore a subcutaneous continuous glucose monitor for 5 days, from which makers of glycemic variability including the low blood glucose index (LGBI) and area under the curve (AUC) for hypoglycemia were derived.
Results
Sixteen patients had no diabetic retinopathy (DR), and 14 had mild or moderate DR. Log contrast sensitivity for the DM group was significantly reduced (mean±SD=1.63±0.06) compared with controls (1.77±0.13,
P
<0.001). OCT analysis revealed that the inner temporal inner nuclear layer (INL) was thinner in patients with T1DM (34.9±2.8
μ
m) compared with controls (36.5±2.9
μ
m) (
P
=0.023), although this effect lost statistical significance after application of the Bonferroni correction for multiple comparisons. Both markers of glycemic variability, the AUC for hypoglycemia (
R
=−0.458,
P
=0.006) and LGBI (
R
=−0.473,
P
=0.004), were negatively correlated with inner temporal INL thickness.
Conclusions
Patients with T1DM and no to moderate DR exhibit alterations in inner retinal structure and function. Increased glycemic variability correlates with retinal thinning on OCT imaging, suggesting that fluctuations in blood glucose may contribute to neurodegeneration.</description><subject>692/699/2743/137/138</subject><subject>692/699/3161/3175</subject><subject>Adult</subject><subject>Blood Glucose - metabolism</subject><subject>Clinical Study</subject><subject>Contrast Sensitivity - physiology</subject><subject>Dark Adaptation - physiology</subject><subject>Diabetes Mellitus, Type 1 - diagnosis</subject><subject>Diabetes Mellitus, Type 1 - physiopathology</subject><subject>Diabetic Retinopathy - diagnosis</subject><subject>Diabetic Retinopathy - physiopathology</subject><subject>Female</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Glycemic Index - physiology</subject><subject>Humans</subject><subject>Laboratory Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Ophthalmology</subject><subject>Pharmaceutical Sciences/Technology</subject><subject>Retina - physiopathology</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Tomography, Optical Coherence</subject><subject>Visual Field Tests</subject><issn>0950-222X</issn><issn>1476-5454</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqFkUFLHDEYhkNRutttT94l4KXQzjaZSWYyF6FIq4LgRaG3kMl8s5tlNhmTjGX-fbOuFRXBUyDfkydv8iJ0RMmSkkL8gAmWOaHlkokPaE5ZVWaccXaA5qTmJMvz_M8MfQphQ0gaVuQjmuUVKVg6M0fqvB-1C4DvlTeqMb2JE1a2xcZa8NhDNFb1OIANzk_YwujdoOJ6SgAewAdnA_5r4hrHaQBMcZssECHgLfRJNobP6LBTfYAvj-sC3f7-dXN2kV1dn1-e_bzKNGd1zIRoeN2C6FTJlBAAQDVrmq6gTQpbtB0QUVQ1L5TSVVunvZbTkne51o1WXBQLdLr3DmOzhVaDjV71cvBmq_wknTLy5cSatVy5e8lqUjJeJcHXR4F3dyOEKLcm6PQKZcGNQVJBaU04z8v30RRUlCnjLtbJK3TjRp_-9IFiIq8EZYn6tqe0dyF46J5yUyJ3LcvUsty1LNnOefz8qU_s_1oT8H0PhDSyK_DPLn3D9w8IjrPf</recordid><startdate>20160601</startdate><enddate>20160601</enddate><creator>Stem, M S</creator><creator>Dunbar, G E</creator><creator>Jackson, G R</creator><creator>Farsiu, S</creator><creator>Pop-Busui, R</creator><creator>Gardner, T W</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160601</creationdate><title>Glucose variability and inner retinal sensory neuropathy in persons with type 1 diabetes mellitus</title><author>Stem, M S ; Dunbar, G E ; Jackson, G R ; Farsiu, S ; Pop-Busui, R ; Gardner, T W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c549t-88b59de8fa64a88eee1c4bbf31b7033dfe0837953aac7d9703d5165f2ccbca583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>692/699/2743/137/138</topic><topic>692/699/3161/3175</topic><topic>Adult</topic><topic>Blood Glucose - metabolism</topic><topic>Clinical Study</topic><topic>Contrast Sensitivity - physiology</topic><topic>Dark Adaptation - physiology</topic><topic>Diabetes Mellitus, Type 1 - diagnosis</topic><topic>Diabetes Mellitus, Type 1 - physiopathology</topic><topic>Diabetic Retinopathy - diagnosis</topic><topic>Diabetic Retinopathy - physiopathology</topic><topic>Female</topic><topic>Glycated Hemoglobin A - metabolism</topic><topic>Glycemic Index - physiology</topic><topic>Humans</topic><topic>Laboratory Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Ophthalmology</topic><topic>Pharmaceutical Sciences/Technology</topic><topic>Retina - physiopathology</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Tomography, Optical Coherence</topic><topic>Visual Field Tests</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stem, M S</creatorcontrib><creatorcontrib>Dunbar, G E</creatorcontrib><creatorcontrib>Jackson, G R</creatorcontrib><creatorcontrib>Farsiu, S</creatorcontrib><creatorcontrib>Pop-Busui, R</creatorcontrib><creatorcontrib>Gardner, T W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Eye (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stem, M S</au><au>Dunbar, G E</au><au>Jackson, G R</au><au>Farsiu, S</au><au>Pop-Busui, R</au><au>Gardner, T W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Glucose variability and inner retinal sensory neuropathy in persons with type 1 diabetes mellitus</atitle><jtitle>Eye (London)</jtitle><stitle>Eye</stitle><addtitle>Eye (Lond)</addtitle><date>2016-06-01</date><risdate>2016</risdate><volume>30</volume><issue>6</issue><spage>825</spage><epage>832</epage><pages>825-832</pages><issn>0950-222X</issn><eissn>1476-5454</eissn><abstract>Purpose
To quantify early neuroretinal alterations in patients with type 1 diabetes mellitus (T1DM) and to assess whether glycemic variability contributes to alterations in neuroretinal structure or function.
Methods
Thirty patients with T1DM and 51 controls underwent comprehensive ophthalmic examination and assessment of retinal function or structure with frequency doubling perimetry (FDP), contrast sensitivity, dark adaptation, fundus photography, and optical coherence tomography (OCT). Diabetic participants wore a subcutaneous continuous glucose monitor for 5 days, from which makers of glycemic variability including the low blood glucose index (LGBI) and area under the curve (AUC) for hypoglycemia were derived.
Results
Sixteen patients had no diabetic retinopathy (DR), and 14 had mild or moderate DR. Log contrast sensitivity for the DM group was significantly reduced (mean±SD=1.63±0.06) compared with controls (1.77±0.13,
P
<0.001). OCT analysis revealed that the inner temporal inner nuclear layer (INL) was thinner in patients with T1DM (34.9±2.8
μ
m) compared with controls (36.5±2.9
μ
m) (
P
=0.023), although this effect lost statistical significance after application of the Bonferroni correction for multiple comparisons. Both markers of glycemic variability, the AUC for hypoglycemia (
R
=−0.458,
P
=0.006) and LGBI (
R
=−0.473,
P
=0.004), were negatively correlated with inner temporal INL thickness.
Conclusions
Patients with T1DM and no to moderate DR exhibit alterations in inner retinal structure and function. Increased glycemic variability correlates with retinal thinning on OCT imaging, suggesting that fluctuations in blood glucose may contribute to neurodegeneration.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>27034201</pmid><doi>10.1038/eye.2016.48</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0950-222X |
| ispartof | Eye (London), 2016-06, Vol.30 (6), p.825-832 |
| issn | 0950-222X 1476-5454 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4906457 |
| source | PubMed (Medline) |
| subjects | 692/699/2743/137/138 692/699/3161/3175 Adult Blood Glucose - metabolism Clinical Study Contrast Sensitivity - physiology Dark Adaptation - physiology Diabetes Mellitus, Type 1 - diagnosis Diabetes Mellitus, Type 1 - physiopathology Diabetic Retinopathy - diagnosis Diabetic Retinopathy - physiopathology Female Glycated Hemoglobin A - metabolism Glycemic Index - physiology Humans Laboratory Medicine Male Medicine Medicine & Public Health Middle Aged Ophthalmology Pharmaceutical Sciences/Technology Retina - physiopathology Surgery Surgical Oncology Tomography, Optical Coherence Visual Field Tests |
| title | Glucose variability and inner retinal sensory neuropathy in persons with type 1 diabetes mellitus |
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