BACKGROUND

Diabetic retinopathy (DR) remains to be the leading cause of blindness worldwide. Traditionally, risk factors such as diabetes duration, HbA1c levels, hypertension and dyslipidemia have been closely linked to the development of this condition. However, recent research suggests that these factors account for only a portion of DR cases. Emerging studies highlight additional potential risk factors including diabetic nephropathy, insulin use, and body mass index -though data on these factors remain limited and at times contradictory. While there have been a few local studies exploring some of these variables, none have comprehensively examined how these factors collectively influence the occurrence and severity of diabetic retinopathy. This study aims to asses both the factors associated with presence and occurrence of diabetic retinopathy.

METHODOLOGY

This analytical cross-sectional study included patients with diabetes (n=201, aged 18 years and older) who underwent fundus photography at The Medical City Ortigas between January 1, 2022, and December 31, 2022. Data collection involved a thorough review of patient records, which provided demographic information and details on potential risk factors. The presence and severity of diabetic retinopathy (DR) were assessed based on fundus photography results, as interpreted by ophthalmologists. To evaluate the statistical significance of the association between risk factors and DR status, logistic regression analysis was done

RESULTS

Duration of diabetes (odds ratio [OR] 1.07; 95% CI, 1.01-1.13 per year increase), HBA1c (OR 1.4; 95% CI, 1.1-1.86),
fasting blood sugar (OR 1.4; 95% CI, 0.977-0.998), hypercholesterolemia (OR 5.02; 95% CI 1.67-16.44) and presence of
nephropathy (OR 3.39; 95% CI 1.49-8) were correlated with diabetic retinopathy.

CONCLUSION

The presence of diabetic retinopathy was significantly associated with several clinical factors. Each additional year of diabetes mellitus duration was associated with a 1.07-fold increase in the likelihood of DR. Additionally, each 1% increase in HbA1c was linked to a 1.40-fold increase in DR risk. The presence of diabetic nephropathy and hypercholesterolemia were also strong predictors, associated with a 3.39-fold and 5-fold increase in the likelihood of DR, respectively. Glycemic control, dyslipidemia and nephropathy appear to be associated with more severe forms of diabetic retinopathy. Clinicians handling diabetes patients with this patient profile should be wary of this diabetes complication.

Human ; Male ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Diabetic Retinopathy ; Hospitals ; Risk ; Risk Factors ; Tertiary Care Centers

OBJECTIVES

In Asia, younger individuals (below age 45) are diagnosed to have type 2 diabetes with increased rates of obesity defined by lower BMI yet with greater visceral adiposity (waist circumference and waisthip ratios). The prevalence data on type 1 diabetes is not well established, considered to be low, but is seen to be increasing as well. This changing phenotype therefore, presents a clinical dilemma in terms of correctly classifying diabetes and deciding on the consequent appropriate treatment. Distinguishing type 1 from type 2 diabetes has become more difficult with type 2 diabetes dramatically increasing in young adults and children. This study aims to define the characteristics of diabetes among young adults in the Philippines to provide a basis for appropriate management amidst changes in diabetes phenotypes seen globally.

METHODS

In this cross-sectional analytic study, we characterized the demographic, metabolic, and autoimmune features of diabetes among young adult Filipinos aged 18 to 45 years old consulting at a tertiary referral center in Manila, Philippines. Baseline serum A1c, FBS, 75-g oral glucose tolerance test, insulin, serum C-peptide, insulin autoantibodies, leptin, adiponectin, lipid profile, and thyroid function tests were obtained from the participants and analyzed. The homeostasis model assessment (HOMA) was used to estimate the insulin sensitivity.

RESULTS

A total of 348 patients with diabetes were included, with females comprising two-thirds of the participants. The mean age at diagnosis of diabetes was 35.9±7.22 years. The mean BMI was 28.12 kg/m2, with median waist to hip ratio (WHR) of 0·93. Metabolic syndrome was found in 60% of participants and 67.82% were obese by body mass index. The mean A1c was 9.07±2.52%. Good glucose control (A1c less than 7.0%) was seen in 23% of participants  while nearly half (48%) had HbA1c which was >9.0%. The median levels of fasting insulin and C-peptide were 12.62 (range 1.33–90.42) mIU/L and 0.78 ng/mL (range 0–16.2), respectively. 

Included participants were diagnosed with diabetes within a year and as such, majority did not have any micro- or macrovascular complications. The most common diabetes complication was sensory neuropathy detected by monofilament testing, which was found in 28% of participants, followed by non-proliferative diabetic retinopathy in 13%. A history of previous diabetic ketoacidosis was found in 10 patients (2.87%). Glutamic acid decarboxylase (GAD) and insulin auto-antibodies were found in 3.2% and 19.3% of participants, respectively. Approximately half (51.73%) of the participants were insulin resistant by HOMA-IR.

CONCLUSION

In contrast with Caucasians and other Asians, diabetes among young Filipino adults is associated with lower BMI but with a similarly high visceral adiposity as shown by an elevated WHR. Metabolic syndrome with insulin resistance as defined by a variety of indices is predominant. Type 1 diabetes with autoantibodies occur in only a small fraction of this population. Data derived from this work can provide a framework for cluster analysis towards personalized management specific to this population.

Human ; Acids ; Adiponectin ; Adiposity ; Adult ; Aged ; Antibodies ; Asia ; Asian ; Asian Continental Ancestry Group ; Autoantibodies ; Body Mass Index ; C-peptide ; Carboxy-lyases ; Child ; Cluster Analysis ; Demography ; Diabetes Complications ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Diabetic Retinopathy ; Diagnosis ; Fasting ; Female ; Glucose ; Glucose Tolerance Test ; Glutamate Decarboxylase ; Glutamic Acid ; Insulin ; Insulin Resistance ; Ketosis ; Leptin ; Lipids ; Metabolic Syndrome ; Obesity ; Patients ; Peptides ; Phenotype ; Philippines ; Population ; Prevalence ; Serum ; Therapeutics ; Thyroid Gland ; Thyroid Function Tests ; Young Adult

Simiao Yong'an Decoction is derived from the New Compilation of Proved Prescriptions(Yan Fang Xin Bian). This formula has the effects of clearing heat and detoxifying as well as activating blood and relieving pain. It is mainly used to treat gangrene caused by excessive heat toxin and with the clinical manifestations including dark red and slightly swollen limbs, scorching skin, ulceration and odor, severe pain, occasional fever, thirst, red tongue, and rapid pulse. Nowadays, Simiao Yong'an Decoction is mostly used in the treatment of thromboangitis obliterans, ulcers in arteriosclerosis obliterans of lower limbs, stent restenosis after angioplasty of lower limbs, ecthyma, deep venous thrombosis, diabetic arteriosclerosis obliterans of lower limbs, diabetic foot ulcer, acute knee arthritis, varicose veins of lower limbs, coronary heart disease, post percutaneous coronary intervention(PCI), sepsis, gout, tumor, chronic tonsillitis in children, and other diseases. It has been identified that diabetic foot with infection, sepsis, arteriosclerosis obliterans, and thromboangitis obliterans belong to the category of gangrene in traditional Chinese medicine(TCM), and Simiao Yong'an Decoction is an ancient specialized prescription for treating this disease. The diseases that can be treated by Simiao Yong'an Decoction include arteriosclerosis obliterans, thromboangitis obliterans, diabetic foot, and ecthyma. The symptoms that can be treated by Simiao Yong'an Decoction include dark red, blackened, slightly swollen, burning, ulceration, and odor in the fingers and toes, and toes falling off, hands and feet decaying and collapsing, severe and unbearable pain in some cases. Furthermore, this formula is effective for skin ulceration spreading, pus dripping, swollen and proliferating lymph nodes. These symptoms are always accompanied by dry mouth, thirst, irritability, yellow urine, and dry stool. The TCM symptoms include red tongue, thin and white tongue coating, and wiry and rapid pulse. In the case with the complication of refractory hypotension, large dosage of Astragali Radix is used to replenish Qi, reinforce healthy Qi, and expressing toxin, which can often achieve blood pressure-elevating and anti-inflammatory effects. Simiao Yong'an Decoction is often combined with Simiao Pills and Guizhi Fuling Pills. High-dose medication is the key to the effectiveness of this formula. Integrated traditional Chinese and western medicine plays an important role in the treatment of diabetic foot with infection, sepsis, septic shock, arteriosclerosis obliterans, and thromboangitis obliterans.
Humans ; Diabetic Foot/physiopathology* ; Drugs, Chinese Herbal/administration & dosage* ; Arteriosclerosis Obliterans/physiopathology* ; Sepsis/physiopathology* ; Critical Care ; Male ; Infections/physiopathology*

Ginsenoside Rg_2(GRg2) is a triterpenoid compound found in Panax notoginseng. This study explored its effects and mechanisms on diabetic retinopathy and angiogenesis. The study employed endothelial cell models induced by glucose or vascular endothelial growth factor(VEGF), the chorioallantoic membrane(CAM) model, the oxygen-induced retinopathy(OIR) mouse model, and the db/db mouse model to evaluate the therapeutic effects of GRg2 on diabetic retinopathy and angiogenesis. Transwell assays and endothelial tube formation experiments were conducted to assess cell migration and tube formation, while vascular area measurements were applied to detect angiogenesis. The impact of GRg2 on the retinal structure and function of db/db mice was evaluated through retinal thickness and electroretinogram(ERG) analyses. The study investigated the mechanisms of GRg2 by analyzing the activation of Yes-associated protein(YAP) and Toll-like receptors(TLRs) pathways. The results indicated that GRg2 significantly reduced cell migration numbers and tube formation lengths in vitro. In the CAM model, GRg2 exhibited a dose-dependent decrease in the vascular area ratio. In the OIR model, GRg2 notably decreased the avascular and neovascular areas, ameliorating retinal structural disarray. In the db/db mouse model, GRg2 increased the total retinal thickness and enhanced the amplitudes of the a-wave, b-wave, and oscillatory potentials(OPs) in the ERG, improving retinal structural disarray. Transcriptomic analysis revealed that the TLR signaling pathway was significantly down-regulated following YAP knockdown, with PCR results consistent with the transcriptome sequencing findings. Concurrently, GRg2 downregulated the expression of Toll-like receptor 4(TLR4), TNF receptor-associated factor 6(TRAF6), and nuclear factor-kappaB(NF-κB) proteins in high-glucose-induced endothelial cells. Collectively, GRg2 inhibits cell migration and tube formation and significantly reduces angiogenesis in CAM and OIR models, improving retinal structure and function in db/db mice, with its pharmacological mechanism likely involving the down-regulation of YAP expression.
Animals ; Ginsenosides/pharmacology* ; Diabetic Retinopathy/physiopathology* ; Mice ; YAP-Signaling Proteins ; Humans ; Male ; Signal Transduction/drug effects* ; Cell Movement/drug effects* ; Adaptor Proteins, Signal Transducing/genetics* ; Mice, Inbred C57BL ; Neovascularization, Pathologic/metabolism* ; Drugs, Chinese Herbal/administration & dosage* ; Panax notoginseng/chemistry* ; Endothelial Cells/metabolism* ; Transcription Factors/genetics* ; Angiogenesis

Diabetic retinopathy is a common blinding complication in diabetic patients. Compared with conventional fundus color photography, fundus fluorescein angiography can dynamically display retinal vessel permeability changes, offering unique advantages in detecting early small lesions such as microaneurysms. However, existing intelligent diagnostic research on diabetic retinopathy images primarily focuses on fundus color photography, with relatively insufficient research on complex lesion recognition in fluorescein angiography images. This study proposed an adaptive multi-label classification model (D-LAM) to improve the recognition accuracy of small lesions by constructing a category-adaptive mapping module, a label-specific decoding module, and an innovative loss function. Experimental results on a self-built dataset demonstrated that the model achieved a mean average precision of 96.27%, a category F1-score of 91.21%, and an overall F1-score of 94.58%, with particularly outstanding performance in recognizing small lesions such as microaneurysms (AP = 1.00), significantly outperforming existing methods. The research provides reliable technical support for clinical diagnosis of diabetic retinopathy based on fluorescein angiography.
Diabetic Retinopathy/diagnostic imaging* ; Humans ; Fluorescein Angiography ; Microaneurysm/diagnostic imaging* ; Retinal Vessels ; Algorithms

BACKGROUND

Type 2 diabetes is the most common type of diabetes in the Philippines. Diabetic foot complications represent a prevalent and significant chronic concern for individuals with type 2 diabetes. This poses an immediate community health concern, as diabetic complications may threaten an individual's well-being.

OBJECTIVE

This study intends to cross-culturally adapt the Diabetic Foot Knowledge Subscale (DFKS) and Foot Self-Care Behavior Scale (FSCBS) questionnaires into the Filipino language as an assessment tool among Filipinos with diabetes.

METHODS

The study employed a psychometric research design, where it entailed Phase A and Phase B. Phase A involved the forward translation of the DFKS and FSCBS questionnaires, followed by the synthesis of the translations and backward translation. Subsequently, an expert committee reviewed the translations and concluded the final version. The final translated versions of the questionnaires ensured that it can be understood by an individual who has a Grade 6 level of reading proficiency. Phase B entailed the validity testing with the evaluation of the expert committee, and reliability testing of the said questionnaires with a sample size of 30 participants. A wash-out period of 24 hours was given for the test-retest reliability, followed by data analysis. The validity and reliability of the questionnaires were measured using the item and scale content validity indices and the internal consistency and test-retest reliability, respectively, to ensure their accuracy and appropriateness. The content validity of the questionnaires was evaluated individually by the experts using a Likert scale from 1-4, with 4 being the highest meaning the item was very relevant and succinct. Scores per item were between 3 and 4, which indicate that the translated version of the items were relevant and succinct or were relevant but needed minor revisions.

RESULTS

The validity scores for the translated DFKS and FSCBS questionnaires were obtained using the Scale Content Validity Index (S-CVI) with a score of 0.96 and 0.92, respectively. Moreover, all items in the questionnaires obtained an Item Content Validity Index (I-CVI) of 0.88-1.00. The DFKS also has an acceptable internal consistency with a Cronbach’s alpha of 0.72, while the FSCBS has a good internal consistency with a Cronbach’s alpha of 0.85. The test-retest reliability shows an acceptable Spearman’s correlation at 0.76 for the DFKS and a strong positive Pearson correlation coefficient at 0.73 for the FSCBS.

CONCLUSION

The validity of the two questionnaires was acceptable and the test-retest reliability showed a strong positive correlation among the items thereby making the cross-cultural adaptation of the questionnaires successful. The Filipino versions of the DFKS and FSCBS questionnaires accurately measure the knowledge and behavior of individuals with type 2 diabetes, respectively.

Human ; Diabetes Mellitus, Type 2 ; Diabetic Foot ; Public Health ; Cross-cultural Comparison

Diabetic retinopathy, a prevalent and vision-threatening microvascular complication of diabetes mellitus, is the leading cause of blindness among middle-aged and elderly individuals. Natural diterpenoids isolated from Siegesbeckia pubescens demonstrate potent anti-inflammatory properties. This study aimed to identify novel bioactive diterpenoids from S. pubescens and investigate their effects on oxidative stress and inflammatory responses in diabetic retinopathy, both in vitro and in vivo. Three new ent-pimarane-type diterpenoids (1-3) and six known compounds (4-9) were isolated from the aerial parts of S. pubescens. Their structures were elucidated through spectroscopic data interpretation, and absolute configurations were determined by comparing calculated and experimental electronic circular dichroism (ECD) spectra. Among these compounds, 14β,16-epoxy-ent-3β,15α,19-trihydroxypimar-7-ene (5) exhibited the most potent protective effect against high glucose and interleukin-1β (IL-1β)-stimulated human retinal endothelial cells. Mechanistically, compound 5 promoted endothelial cell survival while ameliorating oxidative stress and inflammatory response in diabetic retinopathy, both in vivo and in vitro. These findings not only suggest that diterpenoids such as compound 5 are important anti-inflammatory constituents in S. pubescens, but also indicate that compound 5 may serve as a lead compound for preventing or treating vascular complications associated with diabetic retinopathy.
Diabetic Retinopathy/metabolism* ; Humans ; Oxidative Stress/drug effects* ; Animals ; Diterpenes, Kaurane/administration & dosage* ; Asteraceae/chemistry* ; Male ; Endothelial Cells/drug effects* ; Abietanes/administration & dosage* ; Molecular Structure ; Mice ; Anti-Inflammatory Agents/chemistry* ; Plant Extracts/chemistry* ; Mice, Inbred C57BL

OBJECTIVE: To establish and validate a novel diabetic retinopathy (DR) risk-prediction model using a whole-exome sequencing (WES)-based machine learning (ML) method. METHODS: WES was performed to identify potential single nucleotide polymorphism (SNP) or mutation sites in a DR pedigree comprising 10 members. A prediction model was established and validated in a cohort of 420 type 2 diabetic patients based on both genetic and demographic features. The contribution of each feature was assessed using Shapley Additive explanation analysis. The efficacies of the models with and without SNP were compared. RESULTS: WES revealed that seven SNPs/mutations ( rs116911833 in TRIM7, 1997T>C in LRBA, 1643T>C in PRMT10, rs117858678 in C9orf152, rs201922794 in CLDN25, rs146694895 in SH3GLB2, and rs201407189 in FANCC) were associated with DR. Notably, the model including rs146694895 and rs201407189 achieved better performance in predicting DR (accuracy: 80.2%; sensitivity: 83.3%; specificity: 76.7%; area under the receiver operating characteristic curve [AUC]: 80.0%) than the model without these SNPs (accuracy: 79.4%; sensitivity: 80.3%; specificity: 78.3%; AUC: 79.3%). CONCLUSION Novel SNP sites associated with DR were identified in the DR pedigree. Inclusion of rs146694895 and rs201407189 significantly enhanced the performance of the ML-based DR prediction model.
Diabetic Retinopathy/diagnosis* ; Humans ; Machine Learning ; Male ; Female ; Polymorphism, Single Nucleotide ; Middle Aged ; Exome Sequencing ; Aged ; Adult ; Pedigree ; Diabetes Mellitus, Type 2/complications* ; Genetic Predisposition to Disease ; Mutation

OBJECTIVE

To compare the frequency and severity of color vision defects between diabetes mellitus (DM) patients without retinopathy and those with mild non-proliferative diabetic retinopathy (NPDR), and to evaluate the relationship between these color vision defects and capillary blood glucose (CBG) levels.

METHODS

This was a cross-sectional, hospital-based study conducted over a seven-month period at the Ophthalmology Outpatient Department of Cardinal Santos Medical Center. Thirty-five (35) DM patients (70 eyes) aged 50 to 75 years with best-corrected visual acuity of ≥20/50 and no more than mild NPDR were included. Patients with moderate or severe NPDR, macular edema, optic nerve pathology, or significant cataracts were excluded. All participants underwent visual acuity testing, fundus examination, and color vision assessment using the Ishihara pseudoisochromatic plates and Farnsworth D-15 tests conducted under standardized lighting conditions. CBG was measured using the finger-prick method. Main outcome measures included the proportion and type of color vision defects, their association with DR classification, and CBG levels. Statistical analyses included descriptive statistics, the Fisher exact test, the Mann-Whitney U test for the Farnsworth D-15 Color Confusion Index (CCI), and Spearman correlation between CBG and CCI.

RESULTS

Tritan-type defects were the most common, accounting for 36.2%. Color vision defects were observed in 91.3% (64 eyes) of patients with no DR, while defects were seen in all eyes (100%) with mild NPDR (5 eyes). However, this difference was not statistically significant (p = 1.000). There was no significant correlation between CBG levels and color vision scores. Mean CCI scores were similar between groups (p = 0.394), indicating no substantial difference in defect severity.

CONCLUSIONS

Color vision defects may be more prevalent in early NPDR compared to no DR, but this difference was not significant in this sample. No correlation was found between CBG levels and color vision performance. Color vision testing may serve as a useful adjunctive screening tool for early diabetic retinal changes; however, further studies with larger sample sizes are necessary.

Human ; Color Vision Defects ; Diabetic Retinopathy

This case study describes Mrs. CS, a 57-year-old grandmother with a 3-year history of Type 2 Diabetes Mellitus (T2DM), who came from a diabetic family and presented with blurry vision and fatigue. She was also diagnosed as hypertensive last year. She reported discontinuing all prescribed medications for five months, relying instead on decoctions of the Philippine serpentina plant (Andrographis paniculata) and the insulin plant (Chamaecostus cuspidatus) for blood pressure and glycemic control due to budget constraints. An HbA1c test revealed hyperglycemia (7.5%). This case highlights the critical public health challenge of medication non-adherence in T2DM patients, particularly those influenced by traditional herbal remedies. It emphasizes the significant risks of relying on unproven therapies, the resulting poor glycemic control, and the potential for severe microvascular complications like diabetic retinopathy. The report emphasizes the urgent need for comprehensive patient and family education regarding evidence-based T2DM management, the dangers of unsupervised medication cessation, and the importance of professional medical consultation to integrate any complementary therapies safely.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Diabetes Mellitus, Type 2 ; Andrographis Paniculata ; Diabetic Retinopathy