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Diabetic retinopathy in newly diagnosed subjects with type 2 diabetes mellitus: contribution of β-Cell function

Roy Chowdhury, Sharmistha, Thomas, Rebecca Louise, Dunseath, Gareth John, Peter, Rajesh, Rees, Dafydd Aled, North, Rachel Valerie, Luzio, Stephen Denis and Owens, David Raymond 2016. Diabetic retinopathy in newly diagnosed subjects with type 2 diabetes mellitus: contribution of β-Cell function. Journal of Clinical Endocrinology & Metabolism 101 (2) , pp. 572-580. 10.1210/jc.2015-2203

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Abstract

Purpose: The association of hyperglycemia and diabetic retinopathy (DR) in established type 2 diabetes mellitus (T2DM) subjects is well accepted. However, the association between β-cell responsiveness and insulin sensitivity leading to fasting and postprandial hyperglycemia with DR in newly diagnosed treatment-naïve T2DM subjects remain unreported. Methods: A total of 544 newly diagnosed treatment-naïve T2DM subjects were screened for DR (digital photography) and underwent a standardized meal tolerance test. Serial plasma glucose and insulin levels were measured, and fasting (M0) and postprandial β-cell responsiveness calculated Calculating Pancreatic Response Program along with homeostasis model assessment-β cell function (HOMA-B) and HOMA-Insulin Sensitivity. A subgroup of 201 subjects also underwent a frequently sampled IV glucose tolerance test and the acute insulin response to glucose, insulin sensitivity, and glucose effectiveness (SG) estimated (MINMOD model). Results: A total of 16.5% (90) subjects had DR at diagnosis. Subjects with DR had significantly reduced M0, HOMA-B and SG leading to higher fasting and postprandial (2 hour) glucose and significantly lower fasting and postprandial (2 hour) insulin. Factors independently associated with DR in multivariate logistic regression analysis were M0, HOMA-B, and SG with fasting and postprandial (2 hour) glucose and insulin. There was no statistical difference in glycated hemoglobin, systolic blood pressure, acute insulin response to glucose, and insulin sensitivity between those with or without DR. Principal Conclusions: In this cohort of newly diagnosed T2DM subjects, DR is associated with reduced β-cell responsiveness, resulting from β-cell failure rather than insulin resistance, leading to fasting and postprandial hyperglycemia and hypoinsulinemia

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Optometry and Vision Sciences
Subjects: R Medicine > R Medicine (General)
Publisher: The Endocrine Society
ISSN: 0021-972X
Date of Acceptance: 3 December 2015
Last Modified: 28 Jun 2019 03:29
URI: http://orca.cf.ac.uk/id/eprint/86694

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