Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes.

Choi, Jin A.; Kim, Hyo Won; Kwon, Jin-Woo; Shim, Yun-sub; Jee, Dong Hyun; Yun, Jae-Seung; Ahn, Yu-Bae; Park, Chan Kee; Ko, Seung-Hyun

Background: To investigate changes in the neural retina according to the presence of retinal nerve fiber layer (RNFL) defects in type 2 diabetes, and to determine the association between inner retina thickness and the severity of diabetic complications. Methods: We studied non-glaucomatous patients with type 2 diabetes and control subjects Circumpapillary RNFL and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured by spectral-domain optical coherence tomography. In patients with type 2 diabetes, a cardiovascular autonomic function test (AFT) was performed, which included the heart rate parameter of beat-beat variation—with deep breathing, in response to the Valsalva maneuver, and on postural change from lying to standing. The results of each test were scored as 0 for normal and 1 for abnormal. A total AFT score of 1 was defined as early cardiovascular autonomic neuropathy (CAN), and an AFT score≥ 2 as definite CAN. Results: We compared control eyes (n = 70), diabetic eyes with RNFL defects (n = 47), and eyes without RNFL defects (n = 30). The average RNFL and GCIPL thicknesses were significantly different among groups (all, P<0.05). On post-hoc testing, diabetic eyes with RNFL defects had a significantly thinner average GCIPL thickness than those without RNFL defects. On multivariate analyses, significantly thinner average GCIPL was seen in early CAN staging (B = -4.32, P = 0.016) and in definite CAN staging (B = -10.33, P<0.001), compared with no CAN involvement, after adjusting for confounding parameters. Conclusions: Cardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.

TYPE 2 diabetes complications; RETINAL ganglion cells; SEVERITY of illness index; HEART beat; OPTICAL coherence tomography

PLoS ONE, 2017, Vol 12, Issue 3, p1

1932-6203

Academic Journal

10.1371/journal.pone.0174377