Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes

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FinnDiane Study Grp , Eriksson , M , Summanen , P , Gordin , D , Forsblom , C , Shams , S , Liebkind , R , Tatlisumak , T , Putaala , J , Groop , P-H , Martola , J & Thorn , L M 2021 , ' Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes ' , BMJ Open Diabetes Research & Care , vol. 9 , no. 1 , 002274 . https://doi.org/10.1136/bmjdrc-2021-002274

Title: Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes
Author: FinnDiane Study Grp; Eriksson, Marika; Summanen, Paula; Gordin, Daniel; Forsblom, Carol; Shams, Sara; Liebkind, Ron; Tatlisumak, Turgut; Putaala, Jukka; Groop, Per-Henrik; Martola, Juha; Thorn, Lena M.
Contributor organization: Nefrologian yksikkö
HUS Abdominal Center
CAMM - Research Program for Clinical and Molecular Metabolism
HUS Head and Neck Center
Department of Ophthalmology and Otorhinolaryngology
Research Programs Unit
HUS Neurocenter
Neurologian yksikkö
Department of Neurosciences
University Management
Department of Medicine
Per Henrik Groop / Principal Investigator
Marja-Riitta Taskinen Research Group
HUS Medical Imaging Center
HUS Diagnostic Center
Department of General Practice and Primary Health Care
Date: 2021
Language: eng
Number of pages: 7
Belongs to series: BMJ Open Diabetes Research & Care
ISSN: 2052-4897
DOI: https://doi.org/10.1136/bmjdrc-2021-002274
URI: http://hdl.handle.net/10138/335182
Abstract: Introduction Cerebral small-vessel disease is common in neurologically asymptomatic individuals with type 1 diabetes. The retinal vasculature is thought to mirror the brain's vasculature, but data on this association are limited in type 1 diabetes. Our aim was to study associations between diabetic retinopathy severity and cerebral small-vessel disease in type 1 diabetes. Research design and methods For this cross-sectional study, we enrolled 189 participants with type 1 diabetes (median age 40 (33-45) years; 53% female; diabetes duration 21.6 (18.2-30.7) years) and 29 healthy age-matched and sex-matched controls as part of the Finnish Diabetic Nephropathy Study. Participants underwent a clinical investigation, brain MRI, and fundus imaging. Signs of cerebral small-vessel disease in brain MRIs were analyzed in relation to diabetic retinopathy severity (Early Treatment Diabetic Retinopathy Study (ETDRS) score). Results In type 1 diabetes, participants with cerebral small-vessel disease had higher ETDRS scores (35 (20-61) vs 20 (20-35), p=0.022) and a higher prevalence of proliferative diabetic retinopathy than those without cerebral small-vessel disease (25% vs 9%, p=0.002). In adjusted analysis, proliferative diabetic retinopathy was associated with cerebral small-vessel disease (OR 2.57 (95% CI 1.04 to 6.35)). Median ETDRS score (35 (20-65) vs 20 (20-35), p=0.024) and proliferative diabetic retinopathy prevalence were higher (29% vs 13%, p=0.002) in participants with versus without cerebral microbleeds. ETDRS scores increased by number of cerebral microbleeds (p=0.001), both ETDRS score (OR 1.05 (95% CI 1.02 to 1.09)) and proliferative diabetic retinopathy (8.52 (95% CI 1.91 to 37.94)) were associated with >2 cerebral microbleeds in separate multivariable analysis. We observed no association with white matter hyperintensities or lacunar infarcts. Conclusions Presence of cerebral small-vessel disease on brain MRI, particularly cerebral microbleeds, is associated with the severity of diabetic retinopathy.
Subject: diabetes mellitus
type 1
magnetic resonance imaging
diabetic retinopathy
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Rights: cc_by_nc
Usage restriction: openAccess
Self-archived version: publishedVersion

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