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Review
. 2015 Nov;58(11):2476-85.
doi: 10.1007/s00125-015-3717-2. Epub 2015 Aug 2.

Retinal Microvascular Calibre and Risk of Diabetes Mellitus: A Systematic Review and Participant-Level Meta-Analysis

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Free PMC article
Review

Retinal Microvascular Calibre and Risk of Diabetes Mellitus: A Systematic Review and Participant-Level Meta-Analysis

Charumathi Sabanayagam et al. Diabetologia. .
Free PMC article

Abstract

Aims/hypothesis: The calibre of the retinal vessels has been linked to diabetes mellitus but studies have not shown consistent results. We conducted a participant-level meta-analysis to evaluate the association between retinal arteriolar and venular calibre and diabetes.

Methods: We performed a systematic review on MEDLINE and EMBASE for articles published up to December 2014. We identified five population-based prospective cohort studies that provided individual-level data on 18,771 diabetes-free participants. We used discrete time proportional hazards models to estimate pooled HRs of diabetes associated with 1 SD (20 μm) change in retinal vascular calibre.

Results: We identified 2,581 incident cases of diabetes over a median follow-up period of 10 years (interquartile interval of 3.4-15.8 years). After adjustment for demographic, lifestyle and clinical factors, retinal venular calibre was significantly associated with incident diabetes (pooled HR 1.09 [95% CI 1.02, 1.15] per SD increase in venular calibre). This association persisted in analyses excluding individuals with <5 years of follow-up (1.07 [1.0, 1.12]) or those with impaired fasting glucose at baseline (1.10 [1.03, 1.17]); in subgroup analyses, the association was stronger in men than in women but was consistent across subgroups of race/ethnicity, smoking status, hypertension and BMI categories. Retinal arteriolar calibre was not associated with diabetes (0.95 [0.86, 1.06] per SD decrease in arteriolar calibre).

Conclusions/interpretation: Wider retinal venules but not narrower retinal arterioles were associated with a modestly increased risk for diabetes. Knowledge of pathological mechanisms underlying wider retinal venule may provide further insights concerning microvascular alterations in diabetes.

Keywords: Cohort studies; Diabetes; Meta-analysis; Retinal vessels; Systematic review.

Figures

Fig. 1
Fig. 1
Search strategy for studies included in the meta-analysis
Fig. 2
Fig. 2
(a) Forest plot of the adjusted HRs for incident diabetes by CRAE. Heterogeneity: τ2=0.01; χ2=10.28, df=4 (p=0.04); I2=61%. Test for overall effect: Z=0.96 (p=0.34). Forest plot shows multivariable adjusted HRs (model 3) of diabetes per 20 μm decrease in CRAE. (b) Forest plot of the adjusted hazard ratios for incident diabetes by CRVE. Heterogeneity: τ2=0.00; χ2=5.76, df=4 (p=0.22); I2=31%. Test for overall effect: Z=2.63 (p=0.009). Forest plot shows multivariable adjusted HRs (model 3) of diabetes per 20 μm increase in CRVE. (a, b) The summary estimates presented were calculated using a random effects model. Squares indicate the individual HR in each study. The size of each square is proportional to the percentage weight of that individual study in the meta-analysis and the horizontal line indicates 95% CI. Pooled HR and 95% CI are indicated by a black diamond

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