Diabetic retinopathy (DR) is a leading cause of vision impairment and blindness among individuals with diabetes mellitus. Current clinical diagnostic criteria mainly base on visible vascular structure changes, which are insufficient to identify diabetic patients without clinical DR (NDR) but with dysfunctional retinopathy. This review focuses on retinal endothelial cells (RECs), the first cells to sense and respond to elevated blood glucose. As blood glucose rises, RECs undergo compensatory and transitional phases, and the correspondingly altered molecules are likely to become biomarkers and targets for early prediction and treatment of NDR with dysfunctional retinopathy. This article elaborated the possible pathophysiological processes focusing on RECs and summarized recently published and reliable biomarkers for early screening and emerging intervention strategies for NDR patients with dysfunctional retinopathy. Additionally, references for clinical medication selection and lifestyle recommendations for this population are provided. This review aims to deepen the understanding of REC biology and NDR pathophysiology, emphasizes the importance of early detection and intervention, and points out future directions to improve the diagnosis and treatment of NDR with dysfunctional retinopathy and to reduce the occurrence of DR.

Complications of Type 2 diabetes mellitus (T2DM) leading to vision loss may increase the risk of dementia. The relationship between diabetic retinopathy severity and visual acuity (VA) has been explored, but the impact of dementia on vision-related functional performance in patients with T2DM is less understood.

To investigate the association of diabetes-related eye problems with dementia and the impact of dementia on vision-related quality of life (VRQoL) and activities of daily living (ADLs) in patients with T2DM.

Retrospective cohort and nested case-control study.

Health care institution.

Substudy 1 included 4,454 patients with T2DM. In Substudy 2, 33 patients with T2DM and dementia (male, n = 15; M age = 78.7 yr) were compared with 67 matched control participants (male, n = 36; M age = 76.6 yr).

Patients with and without dementia were assessed with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) and the Revised Self-Report Assessment of Functional Visual Performance (R-SRAFVP).

Substudy 1 showed a borderline significant association between proliferative diabetic retinopathy and dementia. In Substudy 2, functional vision, particularly in the overall scales and three subscales of the R-SRAFVP and four subscales of the NEI-VFQ 25, declined significantly among patients with T2DM and dementia, but no significant differences were found in VA.

The findings illustrate the complex relationships among T2DM, dementia, VRQoL, and vision-dependent ADL and suggest that occupational therapists who care for patients with T2DM and dementia should pay close attention to patients' functional vision. Plain-Language Summary: Complications of Type 2 diabetes mellitus (T2DM) that lead to vision loss may increase the risk of dementia. People with T2DM and dementia show a significant decline in functional vision. This study investigated the relationship between diabetes-related eye problems and dementia as well as the impact of dementia on vision-related quality of life and activities of daily living for patients with T2DM. The study demonstrates the complex relationships among dementia, T2DM, eye conditions, and vision-related function. The results highlight the importance of a functional vision assessment for patients with T2DM and dementia. Occupational therapists who care for patients with T2DM and dementia should pay close attention to patients' functional vision, which will guide them in assessment and intervention planning.

BackgroundDiabetic retinopathy (DR), the primary retinal vascular consequence of diabetes mellitus (DM) among people of working age worldwide, is the primary cause of vision impairment and blindness. Despite increasing understanding of the prevalence of DM as a significant public health concern in China, the world's most populous developing nation, there is much to discover about the epidemiology of DR.ObjectiveThis work uses a systematic review and meta-analysis to determine the total prevalence of diabetic retinopathy (DR) in China.MethodsUsing common keywords, we looked up published research on the prevalence of DR in diabetic patients using Google Scholar, PubMed, and Scopus from their founding until 2023. Using random effects models, pooled estimates of DR prevalence and the associated 95% confidence intervals (CI) were computed. Fifteen articles covering 4837 patients with different forms of diabetes were analyzed. The Egger tests refuted the publication bias assumption for the prevalence of DR (P = 0.825, P = 0.057, respectively). Significant heterogeneity was seen in the prevalence of DR (P < 0.01, I2 = 92% and τ2 = 0.0082), PDR (P < 0.01, I2 = 97% and τ2 = 0.0072), and NPDR (P < 0.01, I2 = 84% and τ2 = 0.0039), according to the results of I2 and τ2 statistics.ResultsThe combined prevalence of PDR was 24% (95% CI: 19-28), NPDR was 31% (95% CI: 27-35), and DR was 55% (95% CI: 63-71).Conclusions: In summary, DR's prevalence appears slightly higher than that of other studies, with a greater incidence of NPDR. This study emphasises the need for DR screening and treatment in individuals with diabetes.

The primary ocular effect of diabetes is diabetic retinopathy (DR), which is associated with diabetic microangiopathy. Diabetic macular edema (DME) can cause vision loss for people with DR. For this reason, deciding on the appropriate treatment and follow-up has a critical role in terms of curing the disease. Current artificial intelligence (AI) approaches focus on OCT images and may ignore clinical, laboratory, and demographic information obtained by the specialist. This study presents a novel deep learning (DL) framework for evaluating the visual outcome of the TREX anti-VEGF intravitreal injection regimen. DL models are trained to extract deep features from OCT and ILM topographic images and the obtained deep features are combined with patients' demographic, clinical, and laboratory findings to predict the direction of the treatment process. When the ResNet-18 network is used, the proposed DL framework is able to predict the prognosis status of patients with the highest accuracy.

Diabetic retinopathy (DR), the leading cause of vision loss in elderly individuals, coupled with limited treatment options, has prompted efforts to identify modifiable risk factors associated with DR. The purpose of this study was to explore the associations between the "weekend warrior" (WW) physical activity (PA) pattern and DR risk in U.S. adults and to examine how Hb levels mediate this relationship. Cross-sectional study data were obtained from nationally representative NHANES data from 2007 to 2018. The PA pattern was categorized as inactive, insufficiently active, WW, or regularly active (RA). The study ultimately included 6145 U.S. adults, including 1043 participants with DR and 5102 participants with DM but not DR. Multivariate logistic regression modelling indicated that both the WW (OR = 0.631, 95% CI = 0.487-0.818, P < 0.001) and RA (OR = 0.738, 95% CI = 0.574-0.959, P = 0.018) PA patterns were significant protective factors against DR compared with the inactive PA pattern. Moreover, compared to the RA and insufficiently active PA patterns, WW did not show a significant association with DR, whereas the inactive PA pattern (OR = 1.355, 95% CI = 1.054-1.742, P = 0.018) was a risk factor. Mediation analysis revealed a significant partial mediation effect of Hb level on the association between PA pattern and DR risk, with a mediation ratio of 5.95%. Our study revealed that the WW and RA PA patterns are protective factors against DR and that Hb levels mediate this association. In comparison, the WW PA pattern is the most cost effective for DR prevention.

While many eye disorders are linked through defects in vascularization and optic nerve degeneration, genetic correlation studies have yielded variable results despite shared features. For example, glaucoma and myopia both share optic neuropathy as a feature, but genetic correlation studies demonstrated minimal overlap. By leveraging electronic health record (EHR) resources that contain genetic variables such as genetically predicted gene expression (GPGE), researchers have the potential to improve the identification of shared genetic drivers of disease by incorporating knowledge of shared features to identify disease-causing mechanisms. In this study, we examined shared genetic architecture across eye diseases. Our gene-based approach used transcriptome-wide association methods to identify shared transcriptomic profiles across eye diseases within BioVU, Vanderbilt University Medical Center's (VUMC's) EHR-linked biobank. Our phenome-based approach leveraged phenome-wide association studies (PheWASs) to identify eye disease comorbidities. Using the beta estimates from the significantly associated comorbidities, we constructed a phenotypic risk score (PheRS) representing a weighted sum of an individual's eye disease comorbidities. This PheRS is predictive of eye disease status and associated with the altered GPGE of significant genes in an independent population. The implementation of both gene- and phenome-based approaches can expand genetic associations and shed greater insight into the underlying mechanisms of shared genetic architecture across eye diseases.

The mounting burden of type 2 diabetes is a major concern in healthcare systems worldwide. The purpose of this study is to investigate Burden of type 2 diabetes and its relationship with human development index in Asian countries.

All accessible data from the 2019 Global Burden of Disease study were used to estimate the diabetes mellitus type 2 prevalence, mortality and disability-adjusted life years and diabetes mellitus type 2 in Asia from 1990 to 2019. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs) and attributable risk.

The results indicated that the human development index (HID) was positively and significantly correlated with the incidence of type 2 diabetes in men (r = 0.481, P < 0.05) and women (r = 0.414, P < 0.05, but the correlation between death and the HDI was not significant in men and women (P > 0.05). The highest share of DALY risk factors in men (12093.2 per 100000) and in women (7122.4 per 100000) was related to behavioral factors. According to the results, air pollution, high fasting plasma glucose, and dietary risks are the main risk factors associated with the burden of type 2 diabetes in women and men, respectively.

Given that the burden of type 2 diabetes is escalating in Asia and the burden of disease can be largely controlled by managing its risk factors, the disease management program in different countries, especially in countries with high prevalence and high burden could be reduced by making policies.

Considering the uncertain relationship between high-density lipoprotein cholesterol (HDL-C) and uric acid (UA) with diabetic retinopathy (DR),this study investigates the link between Uric Acid to High-Density Lipoprotein Cholesterol (UHR) and DR in T2DM patients, evaluating its potential for DR diagnosis and early prediction.

This retrospective study analyzed 1450 type 2 diabetes patients, divided into NDR and DR groups by retinal exams. We gathered demographic and clinical data, calculated UHR, and explored its correlation with DR development.

Individuals diagnosed with diabetic retinopathy (DR) exhibited a markedly elevated uric acid to high-density lipoprotein cholesterol (UHR) ratio when contrasted with those without DR (NDR), achieving statistical significance with a P-value below 0.001. The Mantel-Haenszel chi-square test for linear association validated a pronounced positive correlation between the UHR ratio and the incidence of DR (P<0.001). Binary logistic regression analysis revealed that age, glycated hemoglobin (HbA1c), uric acid (UA), high-density lipoprotein cholesterol (HDL-C), and the UHR ratio were all independent risk factors for the development of DR in patients with type 2 diabetes. Furthermore, the receiver operating characteristic (ROC) curve analysis indicated that the UHR ratio was the most precise predictor for diagnosing DR, with an area under the ROC curve (AUC) of 78.4%, a sensitivity of 87%, and a specificity of 60.6%.

Our research has found that the UHR ratio is an independent risk factor for diabetic retinopathy (DR) in patients with type 2 diabetes and can serve as a readily available indicator that takes into account both metabolic status and inflammatory status for the early detection of DR.

The aim of this study was to reveal the biological functionalities associated with endoplasmic reticulum stress (ERS)-related genes (ERSGs) in the context of diabetic retinopathy (DR).

Differentially expressed genes (DEGs) within the DR group and the Control group were identified and then integrated with ERSGs. Gene Ontology (GO) and Gene Set Enrichment Analysis (GSEA) methodologies were used to investigate potential biological mechanisms. A diagnostic model for ERS and a nomogram were formulated based on biomarkers selected through the Least Absolute Shrinkage and Selection Operator method. The diagnostic efficacy of this model was thoroughly evaluated. ERS-associated subtypes were identified, and the Single-Sample GSEA (ssGSEA) and CIBERSORT algorithms were used to assess immune infiltration.

We identified 10 ERS-related DEGs (ERSRDEGs) within the DR Group. Subsequently, a diagnostic model was constructed based on 5 ERS genes, namely CCND1, IGFBP2, TLR4, TXNIP, and VIM. The validation analysis demonstrated the commendable diagnostic performance of the model. Analysis of the ssGSEA immune characteristics revealed a positive correlation in the DR group between myeloid-derived suppressor cells (MDSC), regulatory T cells (Tregs), and CCND1 TXNIP. Furthermore, a significant negative correlation was observed between central memory CD4 T cells and CCND1. In the context of CIBERSORT, the results indicated a positive correlation between macrophages and IGFBP2, as well as Tregs and IGFBP2 in the DR group. Notably, a conspicuous negative correlation was identified between resting mast cells and IGFBP2.

The present study provides novel diagnostic biomarkers for DR from an ERS perspective.

To investigate the perspectives of people accessing a general medical practitioner (GP)-optometry model of collaborative care that was established to increase access to diabetes eye care.

Qualitative study of patient barriers and facilitators to accessing primary diabetes eye care located in a metropolitan area in Australia. One-on-one interviews were recorded, transcribed and thematically analysed using a determinant framework on patient-centred access to health care.

Twenty-four people with type 2 diabetes, including 15 males and 9 females, who accessed the service between September 2021 and June 2022 agreed to participate. Mean (SD) age of the participants was 52 (12) years and 50% had been diagnosed with diabetes for <2 years. Facilitators to accessing diabetes eye care included a referral from a GP or GP nurse, fee-free consultations, availability of after-hours appointments and short waiting times. Barriers to access included perceived out-of-pocket costs, competing responsibilities and lack of awareness of diabetic retinopathy screening recommendations.

Considering diabetic retinopathy may present asymptomatically, primary health practitioners (optometrists and GPs) are well positioned to raise patient awareness of the importance of routine eye examinations. In Australia, access to routine screening could be facilitated by fee-free eye checks and personalised text message reminders implemented at a health system level.

Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes mellitus. VEGF plays a pivotal role in the pathogenesis of DR. To characterize the VEGF-related genes in DR patients, the RNAseq dataset of DR and normal control were downloaded from the GEO database and analyzed using R package limma. The differentially expressed VEGFGs between DR and NC were identified, and their expression levels were verified through qRT-PCR and Western blotting. Enrichment analyses were performed to understand the key functions and involved pathways of DE-VEGFGs. A two-sample MR analysis was carried out to study the causal link between prostate cancer and DR. Next, we built a nomogram model to predict the risk of DR using the expression level of DE-VEGFGs. Additionally, we estimated the immune cell infiltration between clusters and calculated the correlation between DE-VEGFGs expression and immune cell infiltration in DR. The DGIdb database was used to identify potential target drug for DE-VEGFGs. Finally, we constructed a ceRNA regulation network with predictions from miRNA-mRNA interaction databases and miRNA-lncRNA interaction database. We identified six DE-VEGFGs that are involved in the regulation of the VEGF pathway. The two-sample MR analysis revealed a positive correlation between prostate cancer and the risk of DR. The nomogram which uses the DE-VEGFGs expression to predict the DR risk shows good performance based on the calibration curve and AUC value. Monocytes and T cells CD4 memory activated show different expression between DR and NC; meanwhile, these cell types were correlated with DE-VEGFGs. The drug-gene interaction network provides candidates for DR treatment, and the ceRNA regulation network suggests a potential biomarker for DR. Our study identified dysregulated VEGF-related genes in DR and emphasized their significance in the pathogenesis of DR. Additionally, our findings offer insights into their potential clinical predictive value, immune implications, targeting drug candidates, and regulatory network dynamics.

To investigate the non-linear relationship between diabetes mellitus (DM) duration and the development of diabetic retinopathy (DR). By investigating the association between these variables, our goal is to contribute to the existing knowledge regarding the impact of DM duration on the development and severity of DR. A retrospective cross-sectional study was conducted on 420 patients in the Department of Endocrinology at Guangdong Provincial People's Hospital, who had undergone ophthalmic consultations from December 2017 to November 2018. The analysis of DM duration and DR utilized a generalized additive model to identify both linear and non-linear connections. The threshold effect was determined using a two-piece regression model. The study included a total of 420 patients, with a mean age of 58.7 years. Of these, 56.9% (239/420) were male. The prevalence of DR was 38.33% (161/420). After adjusting for confounding factors, a nonlinear relationship between DM duration and DR was observed, with a turning point at 8 years. On the left side of the turning point, the prevalence increased by 24% per 1-year increase in DM duration (OR: 1.24; 95% CI: 1.11-1.38; P<0.0001). However, no statistically significant differences were found on the right side of the turning point (OR: 1.02; 95% CI: 0.97-1.08; P = 0.4987). Our study identified a non-linear relationship between DM duration and DR in patients. When the DM duration is less than 8 years, a positive correlation exists between DM duration and DR. However, once the DM duration exceeds 8 years, the effect reaches saturation, and no significant correlation is observed.

Diabetic retinopathy (DR) is one of the leading causes of blindness among diabetic patients, particularly in areas with an increase in diabetes epidemics, such as Saudi Arabia. Notwithstanding the significant public health implications, data on the prevalence and risk factors of DR in Saudi Arabia are few and scattered, limited to certain geographic areas. Our study objective is to conduct a systematic review of the literature and a meta-analysis of the prevalence and predictors for DR in Saudi Arabia, within both type 1 and type 2 diabetes.

A systematic review and meta-analysis were constructed according to PRISMA guidelines. We searched PubMed, Embase, Web of Science, and Google Scholar electronic databases for studies published from 2000-2023. Any study related to the prevalence of diabetic retinopathy in T1DM or T2DM among adult patients aged ≥18 years that was conducted in Saudi Arabia was included. Pooling prevalence estimates were calculated using a random-effects model, and heterogeneity across the studies was tested by the I2 statistic and Cochran's Q test.

A total of 11 studies published between 2006 and 2019 met the inclusion criteria, with sample sizes ranging from 99 to over 50,000 participants. The overall pooled prevalence of DR was estimated to be 31% (95% CI: 24-39%), with substantial heterogeneity observed across studies (I2 = 99%). Prevalence estimates ranged from 16.7% to 69.8% and were influenced by variables such as study design, duration of diabetes, and glycemic control. Among individuals with type 2 diabetes, the pooled prevalence was 24% (95% CI: 20-28%). Poor glycemic control and longer diabetes duration were consistently identified as significant predictors of DR, while other factors, such as obesity and hypertension, were also associated with an increased risk of DR.

The high prevalence of DR in Saudi Arabia highlights the critical need for focused public health initiatives, especially among those with type 2 diabetes. To minimize the effects of DR, early intervention, routine DR screening programs, and optimal diabetes control are essential. The increasing prevalence of DR in Saudi Arabia requires careful consideration of healthcare policy and resource allocation, which is made possible by our results.

In recent years, artificial intelligence (AI), especially deep learning models, has increasingly been integrated into diagnosing and treating diabetic retinopathy (DR). From delving into the singular realm of ocular fundus photography to the gradual development of proteomics and other molecular approaches, from machine learning (ML) to deep learning (DL), the journey has seen a transition from a binary diagnosis of "presence or absence" to the capability of discerning the progression and severity of DR based on images from various stages of the disease course. Since the FDA approval of IDx-DR in 2018, a plethora of AI models has mushroomed, gradually gaining recognition through a myriad of clinical trials and validations. AI has greatly improved early DR detection, and we're nearing the use of AI in telemedicine to tackle medical resource shortages and health inequities in various areas. This comprehensive review meticulously analyzes the literature and clinical trials of recent years, highlighting key AI models for DR diagnosis and treatment, including their theoretical bases, features, applicability, and addressing current challenges like bias, transparency, and ethics. It also presents a prospective outlook on the future development in this domain.

Primary diabetes care and diabetic retinopathy (DR) screening persist as major public health challenges due to a shortage of trained primary care physicians (PCPs), particularly in low-resource settings. Here, to bridge the gaps, we developed an integrated image-language system (DeepDR-LLM), combining a large language model (LLM module) and image-based deep learning (DeepDR-Transformer), to provide individualized diabetes management recommendations to PCPs. In a retrospective evaluation, the LLM module demonstrated comparable performance to PCPs and endocrinology residents when tested in English and outperformed PCPs and had comparable performance to endocrinology residents in Chinese. For identifying referable DR, the average PCP's accuracy was 81.0% unassisted and 92.3% assisted by DeepDR-Transformer. Furthermore, we performed a single-center real-world prospective study, deploying DeepDR-LLM. We compared diabetes management adherence of patients under the unassisted PCP arm (n = 397) with those under the PCP+DeepDR-LLM arm (n = 372). Patients with newly diagnosed diabetes in the PCP+DeepDR-LLM arm showed better self-management behaviors throughout follow-up (P < 0.05). For patients with referral DR, those in the PCP+DeepDR-LLM arm were more likely to adhere to DR referrals (P < 0.01). Additionally, DeepDR-LLM deployment improved the quality and empathy level of management recommendations. Given its multifaceted performance, DeepDR-LLM holds promise as a digital solution for enhancing primary diabetes care and DR screening.

Introduction: To explore the effect of cigarette smoking on the risk for developing diabetic macular edema (DME) among patients with diabetes. Methods: This retrospective exactly-matched cohort study used claims data for patients from all 50 states in the United States from 2010 through 2020. Patients with an initial diagnosis of diabetes were stratified into 3 cohorts as follows: active smokers, never smokers, and former smokers. After exact matching based on demographics and comorbidities, Kaplan-Meier survival functions for the 3 cohorts were compared using pairwise log-rank tests. Results: After matching, there were 42 298 patients in each cohort. Over 6 years of follow-up, the cumulative risk for DME was significantly higher among never smokers (1.18%) than among active smokers (0.88%) and former smokers (0.90%) (both P < .001). Conclusions: Among patients with diabetes, smoking may decrease the risk for developing DME. Although the harms of smoking far outweigh any potential protective benefits, further investigation into the mechanisms behind these findings has potential to uncover new therapeutic targets.

Type 2 diabetes mellitus (T2DM) represents one of the most impacting health issues of the modern era, as it is associated with an extensive range of comorbidities. Diabetic retinopathy (DR) is one the utmost severe diabetes complications as it is one of the major causes of vision loss among these patients. Our present research aims to evaluate the most frequent risk factors related to the occurrence of DR in T2DM patients.

This study consisted of a research group of 302 participants, priorly diagnosed with T2DM, that were evaluated for the most important risk factors related to the occurrence of DR.

Patients had a median age of 64 years, 48% of them being women, with a 12-year median duration of DM and presenting a deficient glycaemic control echoed by a median HbA1C value of 7.5%. From the total number of participants, the total prevalence of DR in different stages of severity was 34.8% with a 95% CI. Statistically significant values were found regarding DM duration (p = 0.007), HbA1c > 7.2% (p = 0.001) and patients aged over 67 years (p = 0.0035), all these parameters being directly linked to DR.

Older patients with T2DM that have a longer disease duration and simultaneous comorbidities present a higher risk of DR development, consequently a stringent management of these pathologies is needed.

Although risk factors linked to diabetic retinopathy (DR) among patients with Type 2 diabetes mellitus (T2DM) have been extensively studied globally, the specific determinants of these factors in relation to DR in Palestine are presently not well understood.

This retrospective cross-sectional study included patients who underwent DR screening with a fundus camera (VersaCam a). The study included patients aged ≥18 with T2DM, excluding those with other types of diabetes or a history of malignancies. Univariable and multivariable logistic regressions were used to identify factors associated with DR.

A total of 1163 patients with T2DM were included in this study. Of these, 211 (18.1%) patients were classified in the DR group, 761 (65.4%) in the no DR group and 191 (16.4%) were ungradable. Among the included patients, 434 (37.3%) were male. A secondary level of education or higher and a BMI ≥30 kg/m2, compared with <25 kg/m2, were independently and inversely associated with DR, with odds ratios (ORs) of 0.46 (p < 0.001) and 0.58 (p = 0.046), respectively. A 5-year increase in the duration of T2DM correlated with 45% higher odds of having DR (p < 0.001). Patients with DR were more likely to have HbA1c >7%, be physically inactive and use insulin, with ORs of 1.63 (p = 0.02), 2.05 (p < 0.001) and 1.53 (p = 0.03), respectively. Age, gender, occupational status, hypertension and hyperlipidaemia were not independent predictors of DR (p < 0.05).

Longer duration of T2DM, HbA1c >7%, physical inactivity and insulin use were all independently associated with the presence of DR. Furthermore, a secondary or higher educational level and obesity demonstrated independent and inverse associations with the development of DR.

Diabetic retinopathy (DR) is an eye disease that causes blindness and vision loss in diabetic. Risk factors for DR include high blood glucose levels and some environmental factors. The pathogenesis is based on inflammation caused by interferon and other nuclear proteins. This review article provides an overview of DR and discusses the role of nuclear proteins in the pathogenesis of the disease. Some core proteins such as MAPK, transcription co-factors, transcription co-activators, and others are part of this review. In addition, some current advanced treatment resulting from the role of nuclear proteins will be analyzes, including epigenetic modifications, the use of methylation, acetylation, and histone modifications. Stem cell technology and the use of nanobiotechnology are proposed as promising approaches for a more effective treatment of DR.

Qi-Ju-Di-Huang-Pill (QJDH pill) is a Chinese decoction. Although it is commonly used to treat eye conditions, such as diabetic retinopathy (DR), its exact mechanism of action is unknown.

To investigate the specific mechanism by which QJDH pill slows the progression of diabetic retinopathy (DR) based on animal and cellular experiments.

The major components of QJDH pill were characterized by ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLCMS/MS). C57BL/6J mice were randomly divided into five groups as follows: normal group (control group), model group (STZ group), low-dosage QJDH pill group (QJDH-L group), medium-dosage QJDH pill group (QJDH-M group) and high-dosage QJDH pill group (QJDH-H group). Changes in water intake, urination, food intake, and body mass were monitored weekly, while changes in blood glucose were monitored monthly. Fluorescein fundus angiography (FFA), optical coherence tomography angiography (OCTA), and optical coherence tomography (OCT) were utilized to analyze the changes in fundus imaging indications. Hematoxylin & eosin (H&E) and transmission electron microscopy (TEM) were employed to examine histopathologic and ultrastructural changes in retina. The levels of interleukin-6 (IL-6), interleukin-17 (IL-17), tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF) in peripheral blood were detected using Enzyme-linked immunosorbent assay (ELISA). The mouse retina apoptotic cells were labeled with green fluorescence via terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (Tunel). The protein levels of Bcl-2-Associated X (Bax), B cell lymphoma 2 (Bcl-2), Caspase-3, PI3K, phosphorylated PI3K (p-PI3K), protein kinase B (AKT) and phosphorylated AKT (p-AKT) were quantified by Western blot (WB). The retinal pigment epithelium (RPE) cells were cultured and classified into five groups as follows: normal glucose group (NG group), high glucose group (HG group), high glucose + QJDH pill group (HG + QJDH group), high glucose + inhibitor group (HG + LY294002 group), and high glucose + inhibitor + QJDH pill group (HG + LY294002 + QJDH group). Cell viability and apoptosis were detected via Cell Counting Kit-8 (CCK8) and then analyzed by flow cytometry.

In vivo experiments revealed that the QJDH pill effectively reduced blood glucose, symptoms of increased water intake, elevated urination, increased food intake and decreased body mass in DR mice. QJDH pill also slowed the development of a series of fundus imaging signs, such as retinal microangiomas, tortuous dilatation of blood vessels, decreased vascular density, and thinning of retinal thickness, downregulated IL-6, IL-17, TNF-α, and VEGF levels in peripheral blood, and inhibited retinal cell apoptosis by activating the PI3K/AKT signaling pathway. Moreover, in vitro experiments showed that high glucose environment inhibited RPE cell viability and activated RPE cell apoptosis pathway. In contrast, lyophilized powder of QJDH pill increased RPE cell viability, protected RPE cells from high glucose-induced damage, and decreased apoptosis of RPE cells by activating the pi3k pathway.

QJDH pill induces hypoglycemic, anti-inflammatory effects, anti-VEGF and anti-retinal cell apoptosis by activating PI3K/AKT signaling pathway, and thus can protect the retina and slow the DR progression.

Diabetic retinopathy (DR) is a severe ocular complication of diabetes that can lead to vision damage and even blindness. Currently, traditional deep convolutional neural networks (CNNs) used for DR grading tasks face two primary challenges: (1) insensitivity to minority classes due to imbalanced data distribution, and (2) neglecting the relationship between the left and right eyes by utilizing the fundus image of only one eye for training without differentiating between them. To tackle these challenges, we proposed the DRGCNN (DR Grading CNN) model. To solve the problem caused by imbalanced data distribution, our model adopts a more balanced strategy by allocating an equal number of channels to feature maps representing various DR categories. Furthermore, we introduce a CAM-EfficientNetV2-M encoder dedicated to encoding input retinal fundus images for feature vector generation. The number of parameters of our encoder is 52.88 M, which is less than RegNet_y_16gf (80.57 M) and EfficientNetB7 (63.79 M), but the corresponding kappa value is higher. Additionally, in order to take advantage of the binocular relationship, we input fundus retinal images from both eyes of the patient into the network for features fusion during the training phase. We achieved a kappa value of 86.62% on the EyePACS dataset and 86.16% on the Messidor-2 dataset. Experimental results on these representative datasets for diabetic retinopathy (DR) demonstrate the exceptional performance of our DRGCNN model, establishing it as a highly competitive intelligent classification model in the field of DR. The code is available for use at https://github.com/Fat-Hai/DRGCNN.

This is a systematic review of 25 publications on the topics of the prevalence and cost of diabetic retinopathy (DR) in Trinidad and Tobago, the cost of traditional methods of screening for DR, and the use and cost of artificial intelligence (AI) in screening for DR. Analysis of these publications was used to identify and make estimates for how resources allocated to ophthalmology in public health systems in Trinidad and Tobago can be more efficiently utilized by employing AI in diagnosing treatable DR. DR screening was found to be an effective method of detecting the disease. Screening was found to be a universally cost-effective method of disease prevention and for altering the natural history of the disease in the spectrum of low-middle to high-income economies, such as Rwanda, Thailand, China, South Korea, and Singapore. AI and deep learning systems were found to be clinically superior to, or as effective as, human graders in areas where they were deployed, indicating that the systems are clinically safe. They have been shown to improve access to diabetic retinal screening, improve compliance with screening appointments, and prove to be cost-effective, especially in rural areas. Trinidad and Tobago, which is estimated to be disproportionately more affected by the burden of DR when projected out to the mid-21st century, stands to save as much as US$60 million annually from the implementation of an AI-based system to screen for DR versus conventional manual grading.

This study aimed to investigate and compare the efficacy and safety of retinal laser photocoagulation (PRP) alone, PRP with aflibercept 3+PRN, and PRP with aflibercept 5+PRN in patients with both high-risk proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME).

Overall, 170 patients with high-risk PDR and DME (170 eyes from 170 patients) who visited our ophthalmology clinic from December 2018 to December 2020 were divided into the PRP (n=58), aflibercept 5+PRN with PRP (n=53), and aflibercept 3+PRN with PRP (n= 59) groups. General information, such as age, sex, and eye category, was obtained. Moreover, best-corrected visual acuity (BCVA), baseline central macular foveal thickness (CFT), microaneurysm (MA), area of neovascularization (NV), area of hard exudate (HE), and cytokine levels in atrial fluid before and after treatment, were assessed. The χ2 test was used for comparison between groups for statistical data. Analysis of variance was used for the statistical description of measurement data, independent samples were analyzed using Student's t-test, and Student-Newman-Keuls test was used for group comparisons. Differences were considered statistically significant at P < 0.05.

After treatment, no significant improvement in the BCVA (logMAR) of patients in the PRP group was observed. The BCVA (log MAR) decreased from 0.72 ± 0.17 and 0.74 ± 0.17 to 0.50 ± 0.13 and 0.53 ± 0.17 in PRP with aflibercept 5+PRN and PRP with aflibercept 3+PRN groups, respectively, with a statistically significant difference compared to those in the PRP group (P<0.05 in all cases). However, no statistically significant difference was observed between the combined treatment groups (P>0.05). The CFT in the PRP-only group decreased slightly from 361.80 ± 36.70 μm to 353.86 ± 40.88 μm, with no statistically significant difference (P>0.05), whereas the CFT in the aflibercept 5+PRN with PRP and aflibercept 3+PRN with PRP groups decreased from 356.57 ± 37.57 μm and 358.17 ± 44.66 μm to 284.87 ± 31.52 μm and 303.19 ± 37.00 μm, respectively, with statistically significant differences before and after treatment (P<0.05 for both groups). Statistically significant differences were observed in CFT between the three groups after treatment (P<0.05 in all cases). The number of MA (pcs) in the PRP, aflibercept 5+PRN with PRP, and aflibercept 3+PRN with PRP groups decreased from 118.34 ± 27.96, 118.60 ± 33.34, and 116.59 ± 28.95 to 92.95 ± 29.04, 44.60 ± 20.73, and 54.26 ± 25.43, respectively. The two-way comparison of the three groups revealed statistically significant differences in MA (P<0.05 in all cases). In the three groups, NV decreased from 1.00 ± 0.21 mm², 1.01 ± 0.18 mm², and 0.98 ± 0.20 mm² before treatment to 0.49 ± 0.17 mm², 0.31 ± 0.16 mm², and 0.38 ± 0.14 mm², respectively, with statistically significant differences (P<0.05 in all cases). After 12 months of treatment, 13, 18, and 18 patients had reduced HE area in the PRP-only, aflibercept 5+PRN with PRP, and aflibercept 3+PRN with PRP groups, respectively, with statistically significant differences (P<0.05 in all cases). After 12 months of treatment, vascular endothelial growth factor, monocyte chemoattractant protein-1, and glial fibrilliary acidic protein levels (pg/mL) in the aqueous humor decreased in both combined treatment groups compared with that at baseline, with statistically significant differences; however, no significant difference was observed between the two combined treatment groups (P>0.05).

Aflibercept 5+PRN combined with PRP was safe and effective in treating patients with high-risk PDR and DME, and was more effective than PRP-only and aflibercept 3+PRN with PRP in improving CFT and MA.

To assess the correlation among cognitive impairment (CI) and the degree of diabetic retinopathy (DR).

The current analytic cross-sectional study has been carried out on two hundred ten individuals having diabetes mellitus type 2. Individuals were split into 7 groups in order of severity of DR in the worse eye with 30 cases in each group. Cognition function has been determined utilizing mini-mental state examination (MMSE) and montreal cognitive assessment (MoCA) tests.

Comparing the severity of CI using both MMSE and MoCA tests, statistically substantial differences have been discovered among individuals without DR, those having non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) (p < 0.001). The greatest percentage of severe and moderate CI was seen in the PDR group. Regarding the severity of CI, there has been a statistically substantial difference among NPDR and PDR groups, as well as among no-DR and PDR groups (p < 0.001). Moreover, the severity of CI in the MMSE and MoCA tests had a negative connection with the grades of DR (r = - 0.522, P < 0.001 and r = - 0.540, P < 0.001, respectively).

We discovered a negative connection between the grades of DR and the severity of CI that persisted as a significant finding, showing that patients with more severe DR tended to have higher levels of CI. These results might offer retinal examination or retinal photography as a promising strategy for mass screening of CI in diabetic patients, especially if it is combined with artificial intelligence and telemedicine.

Intravitreal injection is widely employed for the treatment of retinal diseases. However, it suffers from various drawbacks, including ocular trauma, risk of infection, and poor patient compliance due to frequent administrations. Due to the presence of barriers such as the cornea, it has been a challenge to develop efficient noninvasive ophthalmic eye drops that can reach the retina. Framework nucleic acids (FNAs), known for their excellent biocompatibility and precise, controllable shape and size, have been extensively utilized in drug delivery application. Here, we report the development of size- and shape-resolved fluorescent DNA frameworks for noninvasive retinal administration. Results show that tetrahedral DNA nanostructures (TDNs) with an edge length of 20 bp can reach the retina within 6 h with the highest efficiency. Moreover, this delivery method exhibits excellent biocompatibility. Our findings provide an approach for the development of localized treatment strategies for retinal diseases using FNA-based nanocarriers.

Type 2 diabetes mellitus (T2D) is commonly associated with an increasing complexity of multimorbidity. While some progress has been made in identifying genetic and non-genetic risk factors for T2D, understanding the longitudinal clinical history of individuals before/after T2D diagnosis may provide additional insights.

In this study, we utilised longitudinal data from the DARE (Diabetes Alliance for Research in England) study to examine the trajectory of clinical conditions in individuals with and without T2D. Data from 1932 individuals (T2D n = 1196 vs. matched non-T2D controls n = 736) were extracted and subjected to trajectory analysis over a period of up to 50 years (25 years pre-diagnosis/25 years post-diagnosis). We also analysed the cumulative proportion of people with diagnosed coronary artery disease (CAD) in their general practice (GP) record with an analysis of lower respiratory tract infection (RTI) as a comparator group.

The mean age of diagnosis of T2D was 52.6 (95% confidence interval 52.0-53.4) years. In the years leading up to T2D diagnosis, individuals who eventually received a T2D diagnosis consistently exhibited a considerable increase in several clinical phenotypes. Additionally, immediately prior to T2D diagnosis, a significantly greater prevalence of hypertension (35%)/RTI (34%)/heart conditions (17%)/eye, nose, throat infection (19%) and asthma (12%) were observed. The corresponding trajectory of each of these conditions was much less dramatic in the matched controls. Post-T2D diagnosis, proportions of T2D individuals exhibiting hypertension/chronic kidney disease/retinopathy/infections climbed rapidly before plateauing. At the last follow-up by quintile of disadvantage, the proportion (%) of people with diagnosed CAD was 6.4% for quintile 1 (least disadvantaged) and 11% for quintile 5 (F = 3.4, p = 0.01 for the difference between quintiles).

These findings provide novel insights into the onset/natural progression of T2D, suggesting an early phase of inflammation-related disease activity before any clinical diagnosis of T2D is made. Measures that reduce social inequality have the potential in the longer term to reduce the social gradient in health outcomes reported here.

To assess the 1-year efficacy, durability, and safety of faricimab in patients with diabetic macular edema from Asian and non-Asian countries.

Global, multicenter, randomized, double-masked, active comparator-controlled, phase III trials.

Subgroup analysis of patients from Asian (N=144) and non-Asian (N=1747) countries randomized to faricimab 6.0 mg every 8 weeks (Q8W), faricimab per personalized treatment interval (PTI), or aflibercept 2.0 mg Q8W in the YOSEMITE/RHINE (NCT03622580/NCT03622593) trials. Primary endpoint: best-corrected visual acuity (BCVA) changes from baseline at 1 year, averaged over weeks 48, 52, and 56.

Mean BCVA change from baseline at 1 year in the Asian country subgroup was similar between arms: faricimab Q8W (n=50), +10.9 (95% CI: 8.6-13.2); faricimab PTI (n=48) +10.0 (7.7-12.4) letters; aflibercept Q8W (n=46) +9.0 (6.6-11.4) letters. BCVA gains in the non-Asian country subgroup (n=582, 584, 581) were +11.3 (10.5-12.1), +11.2 (10.5-12.0), and +10.7 (9.9-11.5) letters, respectively. At 1 year, 49% of Asian country patients in the faricimab PTI arm achieved Q16W dosing (vs. 52% non-Asian) and 78% achieved ≥Q12W dosing (vs. 72% non-Asian). Anatomic improvementswere generally greater with faricimab versus aflibercept and similar between the Asian and non-Asian country subgroups. Faricimab was well tolerated, with no new safety signals.

Vision, durability, anatomic, and safety outcomes were generally similar between the Asian and non-Asian country subgroups, suggesting that global YOSEMITE/RHINE results may be generalized to the Asian population. These data support the benefit-risk profile of faricimab for treating Asian patients with diabetic macular edema.

Diabetic retinopathy (DR) is the leading cause of vision impairment in the global working-age population. In China, with one-third of the world's diabetes population estimated at 141 million, the blindness prevalence due to DR has increased significantly. The country's geographic variations in socioeconomic status have led to prominent disparities in DR prevalence, screening and management. Reported risk factors for DR in China include the classic ones, such as long diabetes duration, hyperglycaemia, hypertension and rural habitats. There is no national-level DR screening programme in China, but significant pilot efforts are underway for screening innovations. Novel agents with longer durations, noninvasive delivery or multi-target are undergoing clinical trials in China. Although optimised medical insurance policies have enhanced accessibility for expensive therapies like anti-VEGF drugs, further efforts in DR prevention and management in China are required to establish nationwide cost-effective screening programmes, including telemedicine and AI-based solutions, and to improve insurance coverage for related out-of-pocket expenses.

Diabetic retinopathy (DR) is a common complication of diabetes. Approximately 20% of DR patients have diabetic macular edema (DME) characterized by fluid leakage into the retina. There is a genetic component to DR and DME risk, but few replicable loci. Because not all DR cases have DME, we focused on DME to increase power, and conducted a multi-ancestry GWAS to assess DME risk in a total of 1,502 DME patients and 5,603 non-DME controls in discovery and replication datasets. Two loci reached GWAS significance (p<5x10-8). The strongest association was rs2239785, (K150E) in APOL1. The second finding was rs10402468, which co-localized to PLVAP and ANKLE1 in vascular / endothelium tissues. We conducted multiple sensitivity analyses to establish that the associations were specific to DME status and did not reflect diabetes status or other diabetic complications. Here we report two novel loci for risk of DME which replicated in multiple clinical trial and biobank derived datasets. One of these loci, containing the gene APOL1, is a risk factor in African American DME and DKD patients, indicating that this locus plays a broader role in diabetic complications for multiple ancestries. Trial Registration: NCT00473330, NCT00473382, NCT03622580, NCT03622593, NCT04108156.

To validate the potential application of THEIA™ as clinical decision making assistant in a national screening program.

A total of 900 patients were recruited from either an urban large eye hospital, or a semi-rural optometrist led screening provider, as they were attending their appointment as part of New Zealand Diabetic Eye Screening Programme. The de-identified images were independently graded by three senior specialists, and final results were aggregated using New Zealand grading scheme, which was then converted to referable/non-referable and Healthy/mild/more than mild/sight threatening categories.

THEIA™ managed to grade all images obtained during the study. Comparing the adjudicated images from the specialist grading team, "ground truth", with the grading by the AI platform in detecting "sight threatening" disease, at the patient level THEIA™ achieved 100% imageability, 100% [98.49-100.00%] sensitivity and [97.02-99.16%] specificity, and negative predictive value of 100%. In other words, THEIA™ did not miss any patients with "more than mild" or "sight threatening" disease. The level of agreement between the clinicians and the aggregated results was (k value: 0.9881, 0.9557, and 0.9175), and the level of agreement between THEIA™ and the aggregated labels was (k value: 0.9515).

This multi-centre prospective trial showed that THEIA™ did not miss referable disease when screening for diabetic retinopathy and maculopathy. It also had a very high level of granularity in reporting the disease level. As THEIA™ has been tested on a variety of cameras, operating in a range of clinics (rural/urban, ophthalmologist-led\optometrist-led), we believe that it will be a suitable addition to a public diabetic screening program.

Effects of type 2 diabetes on achromatic and chromatic contrast sensitivity (CS) are still controversial. In this study, we aimed to investigate CS in patients without diabetic retinopathy (no-DR) and in those with non-proliferative DR (NPDR) and proliferative DR (PDR) using psychophysical methods with transient and sustained achromatic stimuli and color patches. Achromatic CS was measured with the pulsed pedestal (PP) paradigm (7, 12, and 19 cd/m²) and pedestal-△-pedestal (P-△-P) paradigm (11.4, 18, and 28.5 cd/m²). A chromatic discrimination paradigm that assesses protan, deutan, and tritan color vision was adopted. Forty-two patients (no-DR n = 24, NPDR n = 12, PDR = 6; male n = 22, mean age = 58.1 y/o) and 38 controls (male n = 18, mean age = 53.4 y/o) participated. In patients, mean thresholds were higher than in controls and linear trends were significant in most conditions. For the PP paradigm, differences were significant in the PDR and NPDR groups in the 7 and 12 cd/m² condition. For the P-△-P paradigm, differences were only significant in the PDR group in the 11 cd/m² condition. Chromatic contrast loss was significant in the PDR group along the protan, deutan and tritan axes. The results suggest independent involvements of achromatic and chromatic CS in diabetic patients.

To quantitatively analyze and compare the differences in retinal neurovascular units (NVUs) between healthy individuals and patients with type 2 diabetes mellitus (DM) by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) techniques and to determine the value of this technique for the early diagnosis of retinal neurovascular damage in patients with diabetes mellitus without retinopathy (NDR).

This observational case‒control study was conducted from July 1, 2022, to November 30, 2022, at the outpatient ophthalmology clinic of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. All subjects underwent baseline data entry and mean thickness of the peripapillary retinal nerve fiber layer (pRNFL), the thickness of each retinal layer in the macula 3 × 3 mm, and vascular density (VD) examination.

The study included 35 healthy individuals and 48 patients with DM. The retinal VD as well as partial pRNFL, macular nerve fiber layer (NFL), and macular ganglion cell layer (GCL) thickness in DM patients exhibited significantly lower VD in the DM group than in the control group (p < 0.05). Age and disease duration of DM patients showed a negative trend with pRNFL thickness, macular NFL thickness, macular GCL thickness, and VD. However, a positive trend was observed between DM duration and partial inner nuclear layer (INL) thickness. Moreover, there was a positive correlation between macular NFL and GCL thickness and VD for the most part, while a negative correlation was shown between INL temporal thickness and DVC-VD. pRNFL-TI and GCL-superior thickness were screened as two variables in the analysis of the predictors of retinal damage in DM according to the presence or absence of DM. The AUCs were 0.765 and 0.673, respectively. By combining the two indicators for diagnosis, the model predicted prognosis with an AUC of 0.831. In the analysis of retinal damage indicators associated with the duration of DM, after regression logistic analysis according to the duration of DM within 5 years and more than 5 years, the model incorporated two indicators, DVC-VD and pRNFL-N thickness, and the AUCs were 0.764 and 0.852, respectively. Combining the two indicators for diagnosis, the AUC reached 0.925.

Retinal NVU may have been compromised in patients with DM without retinopathy. Basic clinical information and rapid noninvasive OCT and OCTA techniques are useful for the quantitative assessment of retinal NVU prognosis in patients with DM without retinopathy.

Diabetic retinopathy causes progressive and irreversible damage to the retina through activation of inflammatory processes, overproduction of oxidative species, and glial reactivity, leading to changes in neuronal function and finally ischemia, edema, and hemorrhages. Current treatments are invasive and mostly applied at advanced stages, stressing the need for alternatives. To this end, we tested two unconventional and potentially complementary non-invasive treatment options: Photobiomodulation, the stimulation with near-infrared light, has shown promising results in ameliorating retinal pathologies and insults in several studies but remains controversial. Boldine, on the other hand, is a potent natural antioxidant and potentially useful to prevent free radical-induced oxidative stress. To establish a baseline, we first evaluated the effects of diabetic conditions on the retina with immunofluorescence, histological, and ultrastructural analysis in two diabetes model systems, obese LepR^db/db mice and organotypic retinal explants, and then tested the potential benefits of photobiomodulation and boldine treatment in vitro on retinal explants subjected to high glucose concentrations, mimicking diabetic conditions. Our results suggest that the principal subcellular structures affected by these conditions were mitochondria in the inner segment of photoreceptors, which displayed morphological changes in both model systems. In retinal explants, lactate metabolism, assayed as an indicator of mitochondrial function, was altered, and decreased photoreceptor viability was observed, presumably as a consequence of increased oxidative-nitrosative stress. The latter was reduced by boldine treatment in vitro, while photobiomodulation improved mitochondrial metabolism but was insufficient to prevent retinal structural damage caused by high glucose. These results warrant further research into alternative and complementary treatment options for diabetic retinopathy.

the most important way to control diabetes is to follow a preventive lifestyle and if a diabetic individual follows a preventive lifestyle which he or she has accepted. The main objective of the current study is to compare the factors affecting the lifestyle in patients suffering from Type II diabetes and the healthy individuals in Kermanshah City.

this study is based on a case-control design where using simple random sampling, 110 patients suffering from type II diabetes are selected as the case group and 111 healthy subjects among the companions of other patients are selected as the control group from the Center for Diabetics in Kermanshah City. The average age of the participants is 48.8±11.0. The questionnaires used for collecting the data included the following: the demographic information questionnaire and the lifestyle questionnaire which covers diet, physical activity, coping with stress, and smoking. Software applications including STSTA14 and SPSS23 were used for performing statistical computations and logistic regression or linear regression tests were used for analyzing the collected data.

in the subscales of diet, physical activity, spiritual growth, and stress management, there was a significant difference between the diabetic and healthy groups in a wat that the average score for these subscales was higher in the healthy individuals. While the average score for "health responsibility" was higher in the diabetic group compared to the healthy subjects, the difference was not significant (P<0.232). Moreover, there was a significant statistical relationship between the two groups, i.e. the diabetic and healthy groups, and the variables of age, education level, and occupation (P > 0.05).

healthy lifestyle including proper diet and athletic activity is effective in preventing type II diabetes. Accordingly, implementing policies in the urban transportation system such as providing a special lane for bikers in the cities, increasing the tax for harmful foods, considering subsidies for healthy food products, and self-care of individuals can be effective.

'Glucolipotoxicity' and 'insulin resistance' are claimed to drive type 2 diabetes (T2D) and the non-glycemic diseases of the metabolic syndrome (MetS) (obesity, dyslipidemia, hypertension). In line with that, glycemic and/or insulin control are considered to be primary goal in treating T2D/MetS. However, recent standard-of-care (SOC) treatments of T2D, initially designed to control T2D hyperglycemia, appear now to alleviate the cardio-renal and non-glycemic diseases of T2D/MetS independently of glucose lowering and insulin resistance, and in non-T2D patients altogether, calling for an alternative unifying pathophysiology/treatment paradigm for T2D/MetS. This opinion article proposes to replace the current 'glucolipotoxic/insulin-resistance' paradigm of T2D/MetS with an 'mammalian target of rapamycin complex 1 (mTORC1) syndrome' (TorS) paradigm, implying an exhaustive cohesive disease entity driven by an upstream hyperactive mTORC1, and which includes diabetic hyperglycemia, diabetic dyslipidemia, hypertension, diabetic macrovascular and microvascular disease, non-alcoholic fatty liver disease, some cancers, neurodegeneration, polycystic ovary syndrome (PCOS), psoriasis, and others. The TorS paradigm may account for the insulin-resistant glycemic context of TorS, combined with response to insulin of the non-glycemic diseases of TorS. The TorS paradigm may account for the efficacy of current antidiabetic SOC treatments in diabetic and nondiabetic patients. Most importantly, the TorS paradigm may generate novel treatments for TorS.

An increasing number of patients suffering from diabetes require regular ophthalmological check-ups to diagnose and/or treat potential diabetic retinal disease. Some countries have already implemented systematic fundus assessments including artificial intelligence-based programs in order to detect sight-threatening retinopathy. The aim of this study was to improve the detection of diabetic fundus changes in Germany without examination by a doctor and to create an easy access to ophthalmological examinations.

In this prospective monocentric study 93 patients in need for a routine check-up for diabetic retinopathy were included. The study participants took up an offer of an examination (visual examination, non-mydriatic camera-based fundus examination) without doctor-patient contact. Patient satisfaction with the organization and examinations was assessed using a questionnaire.

The mean age was 53.5 years (SD 13.6 years, 49.5% female) and 17 eyes (18.3%) showed a diabetic retinopathy which was detected using a camera-based examination. Within the small sample, no patient had to repeat the examination due to poor image quality. All categories of the questionnaire showed a good to very good satisfaction, indicating a high acceptance of the other examination form that took place at the ophthalmologist's premises.

In our study in an ophthalmological practice a high level of acceptance among the patients interested in the screening for diabetic retinopathy without any direct patient-doctor contact was achieved. Our study shows a very good acceptance and feasibility. Future use of artificial intelligence in clinical practice may help to be able to screen many more patients as in this study imaging quality was very good.

The purpose of this case report is to describe a case of vitreous hemorrhage in a patient with a history of diabetic retinopathy and receiving dulaglutide for the management of type 2 diabetes mellitus (T2DM).

A 64-year-old African American male with a past medical history of T2DM and severe diabetic retinopathy for 4 years was restarted on dulaglutide 1.5 mg weekly after being off therapy for 3 months. Baseline laboratory test results included hemoglobin A1c (HbA1c) of 8.8% and random blood glucose (BG) of 280 mg/dL. In addition, the patient had an average fasting BG of 150 mg/dL. In absence of intolerance, the dulaglutide dose was gradually maximized to 4.5 mg weekly and HbA1c decreased to 7.3% and random BG to 121 mg/dL at week 12 since reinitiation. At week 17 of therapy, the patient presented to the emergency department with a 1-day history of vision loss in the left eye and was diagnosed as having vitreous hemorrhage. The etiology for vitreous hemorrhage is unclear and may be a spontaneous episode. In discussion with the patient and the ophthalmologist, dulaglutide was restarted at 1.5 mg once weekly. After 4 weeks of reinitiation, the patient denied any recurrent symptoms of vitreous hemorrhage or worsening diabetic retinopathy. The most recent ophthalmology evaluation indicated no change in diabetic retinopathy.

This case report adds to the limited body of evidence available for the incidence of vitreous hemorrhage in the setting of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) therapy and pre-existing diabetic retinopathy. The case report illustrates that a history of diabetic retinopathy should not automatically preclude the use of GLP-1 RAs.

The purpose of this study was to investigate the change in macular choroidal thickness and choriocapillaris vessel density in type 2 diabetic (T2D) with high myopia.

This cross-sectional study recruited a total of 182 patients (182 eyes) in the Affiliated Hospital of Chengde Medical University between January 2018 and December 2021, including myopia + diabetes patients (40 eyes), T2D patients without myopia patients (47 eyes), myopia patients (45 eyes), and healthy volunteers (50 eyes). The choroidal thickness and choriocapillaris vessel density of macular were measured in all subjects by optical coherence tomography and optical coherence tomography angiography.

The choroidal thicknesses in myopic, diabetes, myopia + diabetes groups were statistically significantly lower than those in control group (p < 0.001). Further pairwise comparisons showed that the choroidal thicknesses in myopia + diabetes group were statistically significantly lower than those in diabetes group (p < 0.001). The choriocapillaris vessel densities in diabetes, myopia + diabetes groups were statistically significantly lower than those in control group (p < 0.001). Interestingly, there were no significant differences in choriocapillaris vessel density between myopia group and control group (p > 0.05). Further pairwise comparisons showed that the choriocapillaris thicknesses in myopia + diabetes group were statistically significantly lower than those in myopia group (p < 0.001), while no statistically significant differences were found between diabetes group and myopia + diabetes group (p > 0.05).

The choroidal thickness of the patients with high myopia and diabetes (without diabetic retinopathy [DR]) was significantly lower than that of normal people and diabetic patients, but the choriocapillaris vessel density was not significantly different from that of normal people, which may be one of the protective mechanisms of high myopia against DR.

Diabetic retinopathy (DR) is a common microvascular complication of diabetes and the leading cause of blindness at working age. DR is considered to be a chronic low-grade inflammatory subclinical disease, and its pathogenesis is related to genetic and environmental factors. Interleukin (IL)-1 is an important inflammatory cytokine. An association between DR and the rs16944 (IL-1B-511) T>C gene polymorphism has not been reported. The aim of this study was to investigate the association between the rs16944 T>C gene polymorphism and DR in the Han population in southwest China. Participants in this study were 272 patients with DR, 274 patients with type 2 diabetes mellitus (T2DM), and 335 healthy controls (NC). The polymerase chain reaction-restriction fragment length polymorphism method was used to detect the rs16944 T>C genotype of participants. The distribution frequencies of the rs16944 T>C genotype and allele were significantly different among the three groups (p < .05). The distribution frequency of TT, CT, CC genotype (χ² = 9.893, p = .007; χ² = 6.567, p = .037) and each allele (χ² = 5.585, p = .018; χ² = 9.187, p = .002) in the DR group was significantly different from the NC and T2DM groups, respectively. Logistic regression analysis showed that the TT + CT genotype was a risk factor for DR, with an odds ratio of 1.731 (95% confidence interval 1.140-2.627, p = .01). The rs16944 T>C gene polymorphism may be associated with DR, and the TT+CT genotype may increase the risk of DR.