Analysis Of Clinical Feature Of Middle-aged And Elder With Type 2 Diabetic Retinopathy

Objective: To explore the clinical feature of middle-aged and elder patients with type 2 diabetic retinopathy,and provide clues for prevention and early diagnosis of DR.Methods:(1)We collected data from 1339 patients with T2 DM who were treated at the Yantai Yuhuangding Hospital endocrinology unit from October 2016 to March 2018.General data including gender,age,diabetes course,smoking,drinking,height,weight,waist circumference,hip circumference,waist mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP).The laboratory data including glycosylated hemoglobin(HAb1c),fasting plasma glucose(FPG),liver meritorious service,urea,serum creatinine(Scr),total cholesterol(CHOL),triglyceride(TG),low density lipoprotein cholesterol(LDL-c),high density lipoprotein cholesterol(HDL-C),apolopoprotein A1(apo A1),apolopoprotein B(apo B)24-hour proteinuria,microalbuminuria(Albu),albumin-to-creatinine(ACR),fasting C-peptide,1h C-peptide,2h C-peptide,homeostasis model assessment-insulin resistance index(HOMA-IR),25-hydroxyvitamin D,adrencorticotrophic hormone(ACTH),cortisol at 8am,cortisol at 4pm.(2)All patients received fundus examination in the ophthalmology department of our hospital.Those who were detected to be abnormal under fundus examination were further subject to performed fundus angiography.According to the ophthalmoscope and fundus angiography examination patients were divided into non-diabetic retinopathy group(NDR)and diabetic retinopathy(DR),which in turn into non-proliferative diabetic retinopathy group(NPDR)and proliferative diabetic retinopathy(PDR).(3)SPSS 17.0 software was used for statistical analysis.Results:(1)There were differences in the course of diabetes,SBP,BMI,FBG,Hb A1 c,C-peptide,25-hydroxyvitamin,ACTH,blood lipid and hypoglycemic regimen among the three groups.The difference was statistically significant.(2)The incidence of DR to people who received insulin treatment was more than other hypoglycemic regimen.There were statistically significant differences in the dosage of insulin among DR groups.The dosage of insulin was positively correlated with the degree of the fundus lesions and serum total cholesterol,while negatively correlated with glycated albumin levels.The cut-off value of the amount of insulin in DR was 37.5U/d and 4.5years.(3)Metformin dosage was negatively correlated with degree of DR,glycated albumin,glycated hemoglobin but was positively pancreatic islet function.Taking metformin was an independent protective factor against DR.(4)The level of 25-hydroxyvitamin D among the three DR groups was different.25-hydroxyvitamin D was negatively correlated with the degree of DR.After excluding the effects of age,gender and other confounding factors,25-hydroxyvitamin D was a protective factor of DR.(5)The level of ACTH in patients in the PDR group was higher than that in the NPDR group and NDR group,excluding the confounding factors such as age,course of disease,blood glucose,blood lipid,blood pressure,blood lipid and obesity.ACTH is a risk factor for DR.(6)The characteristics of dyslipidemia was different between DR and carotid atherosclerosis.LDL-c is an independent risk factor for carotid atherosclerosis,and apo A1 is an independent protective factor for DR.Conclusion:(1)The dosage of insulin was positively correlated with the severity of DR,and insulin may be a risk factor for DR.(2)For patients with type 2 diabetes mellitus,oral metformin is a protective factor against DR.(3)25-hydroxyvitamin D is a protective factor for DR.(4)ACTH is a risk factor for DR.(5)LDL-c is an independent risk factor for carotid atherosclerosis in T2 DM,and apo A1 is an independent protective factor for DR.