Retinopathy in type 2 diabetes mellitus is associated with increased intima-media thickness and endothelial dysfunction

Eur J Clin Invest. 2008 Dec;38(12):925-30. doi: 10.1111/j.1365-2362.2008.02051.x.


Background: Microangioathy and macroangiopathy in type 2 diabetes mellitus (T2DM) frequently coexist. Both types of vascular complications share traditional risk factors. It is not clear whether the presence of microangiopathy, such as diabetic retinopathy (DR), constitutes a predictor of atherosclerosis in T2DM. Here we described the search for the association between DR and intima-media thickness (IMT) in T2DM. We also compared endothelial function in subjects with and without DR.

Material and methods: We examined 182 consecutive patients with T2DM for at least 5 years (mean age at examination 56.3 +/- 6.52 years). We assessed (i) IMT of carotid artery by ultrasound and (ii) endothelial function by flow-mediated dilatation (FMD) method as well as by measurement of concentrations of von Willebrand factor (vWF) and s-ICAM-1. All patients underwent ophthalmological examination. Statistical analysis included Student's, Mann-Whitney, chi-square, Fisher tests and multiple regression.

Results: DR was found in 71 (39.0%) subjects. IMT was higher in patients with DR than those without DR (0.87 mm vs. 0.79 mm, respectively, P = 0.0001). FMD was lower in the complication group than in subjects without DR (8.38% vs. 10.45%, respectively, P = 0.0023). Concentrations of s-ICAM-1 and vWF were not different between the groups. In multiple regression analysis, DR was among the predictors of increased IMT (P = 0.016) and decreased FMD (P = 0.002). We did not find a significant association of DR with vWF and s-ICAM-1 (P = 0.09 and P = 0.11, respectively).

Conclusions: DR is associated with increased IMT and endothelial dysfunction in T2DM. Impaired endothelial function may be a common denominator of pathogenesis of microvascular complications and atherosclerosis in T2DM.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Atherosclerosis / pathology*
  • Carotid Arteries / pathology*
  • Diabetes Mellitus, Type 2 / pathology*
  • Diabetic Angiopathies / pathology*
  • Diabetic Retinopathy / pathology
  • Endothelium, Vascular / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Regression Analysis
  • Risk Factors
  • Tunica Intima / pathology*
  • Tunica Media / pathology*
  • von Willebrand Factor / metabolism


  • von Willebrand Factor