Associations Between HbA1c Across the Normal Range, Diagnosed, and Undiagnosed Diabetes and Retinal Layer Thickness in UK Biobank Cohort.
Associations Between HbA1c Across the Normal Range, Diagnosed, and Undiagnosed Diabetes and Retinal Layer Thickness in UK Biobank Cohort.
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DOI：
10.1167/tvst.12.2.25
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发表时间：
2023-02-01
影响因子：
3
通讯作者：
Patel, Praveen J
中科院分区：
文献类型：
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作者：
Chua, Sharon Y L;Welsh, Paul;Sun, Zihan;Balaskas, Konstantinos;Warwick, Alasdair;Steel, David;Sivaprasad, Sobha;Channa, Roomasa;Ko, Tony;Sattar, Naveed;Khawaja, Anthony P;Foster, Paul J;Patel, Praveen J
本研究的目的是调查糖化血红蛋白（HbA 1c）水平与糖尿病患者和非糖尿病患者视网膜亚层厚度之间的关系。我们纳入了41，453名年龄在40至69岁之间的英国生物银行参与者。糖尿病状态通过自我报告诊断或使用胰岛素来定义。参与者被分为几组：（1）HbA 1c <48 mmol/mol的人根据HbA 1c的正常范围被细分为五分之一;（2）先前诊断为糖尿病但没有糖尿病视网膜病变证据的人;（3）未诊断的糖尿病：>48 mmol/mol。总黄斑和视网膜亚层厚度来自光谱域光学相干断层扫描（SD-OCT）图像。采用多元线性回归分析糖尿病状态与视网膜层厚度之间的关系。与HbA 1c正常范围第二个五分位数的参与者相比，第五个五分位数的参与者感光层厚度较薄（-0.33 µm，P = 0.006）。被诊断为糖尿病的参与者黄斑视网膜神经纤维层较薄（mRNFL; −0.58 µm，P < 0.001），感光层厚度（-0.94 µm，P < 0.001），和总黄斑厚度（-1.61 µm，P < 0.001），而未确诊的糖尿病参与者感光层厚度减少（-1.22 µm，P = 0.009）和总黄斑厚度（-2.26 µm，P = 0.005）。与无糖尿病的参与者相比，糖尿病患者的mRNFL更薄（-0.50 µm，P < 0.001），感光层厚度（-0.77 µm，P < 0.001）和总黄斑厚度（-1.36 µm，P < 0.001）。HbA 1c在正常范围内较高的参与者感光细胞厚度略薄，而糖尿病（包括未诊断的糖尿病）患者的视网膜亚层和总黄斑厚度明显较薄。我们发现，早期视网膜神经变性发生在HbA 1c水平低于当前糖尿病诊断阈值的人群中;这可能会影响糖尿病前期个体的管理。
The purpose of this study was to investigate the association between glycated hemoglobin (HbA1c) levels and retinal sub-layer thicknesses in people with and without diabetes. We included 41,453 UK Biobank participants aged 40 to 69 years old. Diabetes status was defined by self-report of diagnosis or use of insulin. Participants were categorized into groups: (1) those with HbA1c <48 mmol/mol were subdivided into quintiles according to normal range of HbA1c; (2) those previously diagnosed with diabetes with no evidence of diabetic retinopathy; and (3) undiagnosed diabetes: >48 mmol/mol. Total macular and retinal sub-layer thicknesses were derived from spectral-domain optical coherence tomography (SD-OCT) images. Multivariable linear regression was used to evaluate the associations between diabetes status and retinal layer thickness. Compared with participants in the second quintile of the normal HbA1c range, those in the fifth quintile had a thinner photoreceptor layer thickness (−0.33 µm, P = 0.006). Participants with diagnosed diabetes had a thinner macular retinal nerve fiber layer (mRNFL; −0.58 µm, P < 0.001), photoreceptor layer thickness (−0.94 µm, P < 0.001), and total macular thickness (−1.61 µm, P < 0.001), whereas undiagnosed diabetes participants had a reduced photoreceptor layer thickness (−1.22 µm, P = 0.009) and total macular thickness (−2.26 µm, P = 0.005). Compared to participants without diabetes, those with diabetes had a thinner mRNFL (−0.50 µm, P < 0.001), photoreceptor layer thickness (−0.77 µm, P < 0.001), and total macular thickness (−1.36 µm, P < 0.001). Participants with higher HbA1c in the normal range had marginally thinner photoreceptor thickness, whereas those with diabetes (including undiagnosed diabetes) had meaningfully thinner retinal sublayer and total macular thickness. We showed that early retinal neurodegeneration occurs in people whose HbA1c levels are below the current diabetes diagnostic threshold; this might impact the management of pre-diabetes individuals.