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Acta Diabetologica
Published in: Acta Diabetologica 4/2015

01-08-2015 | Original Article

Association between body mass index and diabetic retinopathy in Chinese patients with type 2 diabetes

Authors: Jun Lu, Xuhong Hou, Lei Zhang, Fusong Jiang, Cheng Hu, Yuqian Bao, Weiping Jia

Published in: Acta Diabetologica | Issue 4/2015

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Abstract

Aims

To explore the factors mediating the relationship between body mass index (BMI) and diabetic retinopathy (DR) in Chinese type 2 diabetes patients.

Methods

This is a cross-sectional study. Data of 2,533 patients with type 2 diabetes were studied from the Shanghai Diabetes Registry Database. DR was assessed using non-mydriatic fundus photography and graded as non-DR, mild–moderate (DR I–II), and sight-threatening (DR III–IV). BMI (kg/m2) was classified as normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). β cell function was evaluated by fasting C-peptide (FCP).

Results

DR was present in 701 (27.7 %) patients. Patients with DR had lower BMI (24.3 vs. 24.9 kg/m2, P = 0.001) and fasting C-peptide (1.46 vs. 1.86 ng/ml, P < 0.001) than those without DR. The association between BMI (2 kg/m2 interval) and DR was U-shaped; patients with BMI 28–29.9 kg/m2 had the lowest DR rate. Compared with normal weight, overweight was associated with reduced risk of any DR [odds ratio (OR) 0.73], DR I–II (OR 0.76), and DR III–IV (OR 0.64) after adjustment for sex, age at diabetes diagnosis, and duration of diabetes. This negative association attenuated after adjustment for other confounders and became nonsignificant after further adjustment for FCP. Patients with different BMI categories had similar DR risk when stratified by FCP tertiles.

Conclusion

Overweight patients have lower DR prevalence than normal weight individuals, which may be attributable to better β cell function in overweight patients.
Appendix
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Literature
1.
Garvey WT, Garber AJ, Mechanick JI et al (2014) American association of clinical endocrinologists and american college of endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract 20:977–989PubMedCrossRef
2.
Hou X, Lu J, Weng J et al (2013) Impact of waist circumference and body mass index on risk of cardiometabolic disorder and cardiovascular disease in Chinese adults: a national diabetes and metabolic disorders survey. PLoS ONE 8:e57319PubMedCentralPubMedCrossRef
3.
Khalangot M, Tronko M, Kravchenko V, Kulchinska J, Hu G (2009) Body mass index and the risk of total and cardiovascular mortality among patients with type 2 diabetes: a large prospective study in Ukraine. Heart 95:454–460PubMedCrossRef
4.
Eeg-Olofsson K, Cederholm J, Nilsson PM et al (2009) Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: an observational study in 13,087 patients. Diabetologia 52:65–73PubMedCrossRef
5.
6.
Logue J, Walker JJ, Leese G et al (2013) Association between BMI measured within a year after diagnosis of type 2 diabetes and mortality. Diabetes Care 36:887–893PubMedCentralPubMedCrossRef
7.
Gruberg L, Weissman NJ, Waksman R et al (2002) The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol 39:578–584PubMedCrossRef
8.
Karlberg C, Falk C, Green A, Sjolie AK, Grauslund J (2012) Proliferative retinopathy predicts nephropathy: a 25-year follow-up study of type 1 diabetic patients. Acta Diabetol 49:263–268PubMedCrossRef
9.
Pradeepa R, Surendar J, Indulekha K, Chella S, Anjana RM, Mohan V (2014) Relationship of diabetic retinopathy with coronary artery disease in Asian Indians with type 2 diabetes: The Chennai Urban Rural Epidemiology Study (CURES) Eye Study-3. Diabetes Technol Ther [Epub ahead of print]
10.
Miyamoto M, Kotani K, Okada K et al (2012) The correlation of common carotid arterial diameter with atherosclerosis and diabetic retinopathy in patients with type 2 diabetes mellitus. Acta Diabetol 49:63–68PubMedCrossRef
11.
12.
Trento M, Passera P, Trevisan M et al (2013) Quality of life, impaired vision and social role in people with diabetes: a multicenter observational study. Acta Diabetol 50:873–877PubMedCrossRef
13.
Ding J, Wong TY (2012) Current epidemiology of diabetic retinopathy and diabetic macular edema. Curr Diabetes Rep 12:346–354CrossRef
14.
Brown JB, Pedula KL, Summers KH (2003) Diabetic retinopathy: contemporary prevalence in a well-controlled population. Diabetes Care 26:2637–2642PubMedCrossRef
15.
Diabetes Prevention Program Research Group (2007) The prevalence of retinopathy in impaired glucose tolerance and recent-onset diabetes in the diabetes prevention program. Diabet Med 24:137–144PubMedCentralCrossRef
16.
Writing Team for the Diabetes C, Complications Trial, Epidemiology of Diabetes I, Complications Research G (2002) Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA 287:2563–2569CrossRef
17.
Keen H, Lee ET, Russell D, Miki E, Bennett PH, Lu M (2001) The appearance of retinopathy and progression to proliferative retinopathy: the WHO multinational study of vascular disease in diabetes. Diabetologia 44(Suppl 2):S22–S30PubMedCrossRef
18.
van Leiden HA, Dekker JM, Moll AC et al (2002) Blood pressure, lipids, and obesity are associated with retinopathy: the hoorn study. Diabetes Care 25:1320–1325PubMedCrossRef
19.
Cai X, Han X, Zhang S, Luo Y, Chen Y, Ji L (2014) Age at diagnosis and C-peptide level are associated with diabetic retinopathy in Chinese. PLoS ONE 9:e91174PubMedCentralPubMedCrossRef
20.
Azad N, Agrawal L, Emanuele NV, Klein R, Bahn GD, Reaven P (2014) Association of blood glucose control and pancreatic reserve with diabetic retinopathy in the veterans affairs diabetes trial (VADT). Diabetologia 57:1124–1131PubMedCrossRef
21.
Tolonen N, Hietala K, Forsblom C et al (2013) Associations and interactions between lipid profiles, retinopathy and nephropathy in patients with type 1 diabetes: the FinnDiane Study. J Intern Med 274:469–479PubMedCrossRef
22.
Henricsson M, Nystrom L, Blohme G et al (2003) The incidence of retinopathy 10 years after diagnosis in young adult people with diabetes: results from the nationwide population-based diabetes incidence study in Sweden (DISS). Diabetes Care 26:349–354PubMedCrossRef
23.
Zhang L, Krzentowski G, Albert A, Lefebvre PJ (2001) Risk of developing retinopathy in diabetes control and complications trial type 1 diabetic patients with good or poor metabolic control. Diabetes Care 24:1275–1279PubMedCrossRef
24.
Dirani M, Xie J, Fenwick E et al (2011) Are obesity and anthropometry risk factors for diabetic retinopathy? The diabetes management project. Invest Ophthalmol Vis Sci 52:4416–4421PubMedCrossRef
25.
van Leiden HA, Dekker JM, Moll AC et al (2003) Risk factors for incident retinopathy in a diabetic and nondiabetic population: the Hoorn study. Arch Ophthalmol 121:245–251PubMedCrossRef
26.
27.
Raman R, Rani PK, Gnanamoorthy P, Sudhir RR, Kumaramanikavel G, Sharma T (2010) Association of obesity with diabetic retinopathy: Sankara Nethralaya diabetic retinopathy epidemiology and molecular genetics study (SN-DREAMS Report no. 8). Acta Diabetol 47:209–215PubMedCrossRef
28.
29.
Gu Y, Wang C, Zheng Y et al (2013) Cancer incidence and mortality in patients with type 2 diabetes treated with human insulin: a cohort study in Shanghai. PLoS ONE 8:e53411PubMedCentralPubMedCrossRef
30.
Chinese Diabetes Society (2012) Guidelines for the prevention and treatment of type 2 diabetes in China (2010). Chin J Diabetes 20:81–117
31.
(2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894:i–xii, 1–253
32.
Wilkinson CP, Ferris FL 3rd, Klein RE et al (2003) Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 110:1677–1682PubMedCrossRef
33.
de Mutsert R, Sun Q, Willett WC, Hu FB, van Dam RM (2014) Overweight in early adulthood, adult weight change, and risk of type 2 diabetes, cardiovascular diseases, and certain cancers in men: a cohort study. Am J Epidemiol 179:1353–1365PubMedCentralPubMedCrossRef
34.
Hou X, Jia W, Bao Y et al (2008) Risk factors for overweight and obesity, and changes in body mass index of Chinese adults in Shanghai. BMC Public Health 8:389PubMedCentralPubMedCrossRef
35.
Rahier J, Guiot Y, Goebbels RM, Sempoux C, Henquin JC (2008) Pancreatic beta-cell mass in European subjects with type 2 diabetes. Diabetes Obes Metab 10(Suppl 4):32–42PubMedCrossRef
36.
Ahren J, Ahren B, Wierup N (2010) Increased beta-cell volume in mice fed a high-fat diet: a dynamic study over 12 months. Islets 2:353–356PubMedCrossRef
37.
Lachin JM, McGee P, Palmer JP (2014) Impact of C-peptide preservation on metabolic and clinical outcomes in the diabetes control and complications trial. Diabetes 63:739–748PubMedCentralPubMedCrossRef
38.
Steffes MW, Sibley S, Jackson M, Thomas W (2003) Beta-cell function and the development of diabetes-related complications in the diabetes control and complications trial. Diabetes Care 26:832–836PubMedCrossRef
39.
Panero F, Novelli G, Zucco C et al (2009) Fasting plasma C-peptide and micro- and macrovascular complications in a large clinic-based cohort of type 1 diabetic patients. Diabetes Care 32:301–305PubMedCentralPubMedCrossRef
40.
Suzuki K, Watanabe K, Motegi T, Kajinuma H (1989) High prevalence of proliferative retinopathy in diabetic patients with low pancreatic B-cell capacity. Diabetes Res Clin Pract 6:45–52PubMedCrossRef
41.
Boz M, Scheen AJ, Gerard PL, Castillo MJ, Lefebvre PJ (1995) Retinopathy, but not neuropathy, is influenced by the level of residual endogenous insulin secretion in type 2 diabetes. Diabete Metab 21:353–359PubMed
42.
Bo S, Cavallo-Perin P, Gentile L, Repetti E, Pagano G (2000) Relationship of residual beta-cell function, metabolic control and chronic complications in type 2 diabetes mellitus. Acta Diabetol 37:125–129PubMedCrossRef
43.
Genuth SM (1996) Clinical utility of C-peptide measurement in diabetes mellitus. Endocr Pract 2:266–268PubMedCrossRef
44.
45.
Marques RG, Fontaine MJ, Rogers J (2004) C-peptide: much more than a byproduct of insulin biosynthesis. Pancreas 29:231–238PubMedCrossRef
Metadata
Title
Association between body mass index and diabetic retinopathy in Chinese patients with type 2 diabetes
Authors
Jun Lu
Xuhong Hou
Lei Zhang
Fusong Jiang
Cheng Hu
Yuqian Bao
Weiping Jia
Publication date
01-08-2015
Publisher
Springer Milan
Published in
Acta Diabetologica / Issue 4/2015
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-014-0711-y

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