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Neural dysfunction and retinopathy in persons with type 1 diabetes
Barbara E K Klein1, Kayla L Horak1, Kristine E Lee1
1a Ophthalmology & Visual Sciences , University of Wisconsin-Madison , Madison , WI , USA.
Ophthalmic Epidemiology
|July 10, 2018
Summary
Sensory neuropathy and heart rate variability are linked to diabetic retinopathy and macular edema in long-term type 1 diabetes. Understanding these associations may reveal the sequence of diabetes complications.
Area of Science:
- Endocrinology
- Diabetology
- Neurology
Background:
- Type 1 diabetes (T1D) can lead to microvascular and neuropathic complications.
- Long-term T1D management requires understanding the interplay between these complications.
Purpose of the Study:
- To investigate the cross-sectional and longitudinal associations between microvascular complications (proliferative diabetic retinopathy - PDR, macular edema - ME) and neuropathic complications (sensory neuropathy - SN, heart rate variability) in individuals with long-term T1D.
Main Methods:
- A cohort of individuals with T1D was followed from 1979-1980, with examinations approximately every 5 years.
- Statistical analyses examined cross-sectional associations between complications at each visit and longitudinal associations by modeling incidence between examinations.
Main Results:
- Sensory neuropathy (SN) and heart rate variability (HRV) measures (RMSD, SDNN) were cross-sectionally associated with prevalent PDR and ME.
- PDR and ME were significantly associated with incident SN.
- SN was significantly associated with incident PDR, but not incident ME.
Conclusions:
- Sensory neuropathy and HRV are significantly associated with prevalent microvascular complications in long-term T1D.
- There is a significant bidirectional relationship between neuropathy and retinopathy.
- Further research is needed to determine the earliest markers and temporal sequence of diabetes complications.
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