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Open Access 01-05-2017 | Original Article

Retinal neurodegeneration in patients with type 1 diabetes mellitus: the role of glycemic variability

Authors: Fabiana Picconi, Mariacristina Parravano, Dorina Ylli, Patrizio Pasqualetti, Sara Coluzzi, Ilaria Giordani, Ilaria Malandrucco, Davide Lauro, Fabio Scarinci, Paola Giorno, Monica Varano, Simona Frontoni

Published in: Acta Diabetologica | Issue 5/2017

Abstract

Aims

Recent studies have identified neuroretinal abnormalities in persons affected by diabetes mellitus, before the onset of microvascular alterations. However, the role of glycemic variability (GV) on early retinal neurodegeneration is still not clarified.

Methods

To explore the relationship between glycemic control and neuroretinal characteristics, 37 persons with Type 1 diabetes mellitus (Type 1 DM) divided into two groups with no signs (noRD) and with mild non-proliferative diabetic retinopathy (NPDR) compared to 13 healthy control participants (C) were recruited. All persons underwent an optical coherence tomography with automatic segmentation of all neuroretinal layers. Measurements of mean of nasal (N)/temporal (T)/superior (S)/inferior (I) macular quadrants for individual layer were also calculated. Metabolic control was evaluated by glycated hemoglobin (HbA1c), and indexes of GV were calculated from continuous glucose monitoring.

Results

The difference among the three groups in terms of RNFL thickness was significantly dependent on quadrant (F(6;132) = 2.315; p = 0.037). This interaction was due to a specific difference in RNFL-N thickness, where both Type 1 DM groups showed a similar reduction versus C (−3.9 for noDR and −4.9 for NPDR), without any relevant difference between them (−1.0). Inner nuclear layer (INL) was increased in all quadrants in the two Type 1 DM groups compared to C (mean difference = 7.73; 95% CI: 0.32–15.14, p = 0.043; mean difference = 7.74; 95% CI: 0.33–15.15, p = 0.043, respectively). A negative correlation between RNFL-N and low blood glucose index (r = −0.382, p = 0.034) and positive correlation between INL and continuous overall net glycemic action −1, −2, −4 h (r = 0.40, p = 0.025; r = 0.39, p = 0.031; r = 0.41, p = 0.021, respectively) were observed in Type 1 DM patients. The triglycerides were positively and significantly correlated to INL (r = 0.48, p = 0.011), in Type 1 DM subjects. GV and triglycerides resulted both independent predictors of increased INL thickness. No correlation was found with HbA1c.

Conclusions

Early structural damage of neuroretina in persons with Type 1 DM patients is related to glucose fluctuations. GV should be addressed, even in the presence of a good metabolic control.

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Title: Retinal neurodegeneration in patients with type 1 diabetes mellitus: the role of glycemic variability
Authors: Fabiana Picconi
Mariacristina Parravano
Dorina Ylli
Patrizio Pasqualetti
Sara Coluzzi
Ilaria Giordani
Ilaria Malandrucco
Davide Lauro
Fabio Scarinci
Paola Giorno
Monica Varano
Simona Frontoni
Publication date: 01-05-2017
Publisher: Springer Milan
Published in: Acta Diabetologica / Issue 5/2017
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-017-0971-4

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