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

• Published in: PloS one Vol. 12; no. 3; p. e0174377
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.03.2017; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Autonomic nervous system; Biology and Life Sciences; Breathing; Cardiovascular diseases; Complications; Defects; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - diagnostic imaging; Diabetes Mellitus, Type 2 - pathology; Diabetes Mellitus, Type 2 - physiopathology; Diabetic Cardiomyopathies - physiopathology; Diabetic Neuropathies - physiopathology; Diabetic neuropathy; Diabetic retinopathy; Diabetic Retinopathy - diagnostic imaging; Diabetic Retinopathy - pathology; Diabetic Retinopathy - physiopathology; Dysautonomia; Edema; Endocrinology; Eye; Eye (anatomy); Female; Glaucoma; Glucose; Heart rate; Hemoglobin; Humans; Hypertension; Internal medicine; Kidney diseases; Male; Medicine; Medicine and Health Sciences; Metabolism; Middle Aged; Neurodegeneration; Neurofibrils; Neuropathy; Optical Coherence Tomography; Optics; Patients; Posture; Retina; Retina - diagnostic imaging; Retina - pathology; Risk factors; Science; Tomography; Tomography, Optical Coherence; Type 2 diabetes; Valsalva Maneuver
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0174377

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. 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. 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. Cardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.