Commentary on “Prevalence, incidence, and risk factors of diabetic retinopathy and macular edema in patients with early and late-onset type 2 diabetes mellitus”
Fatemeh Rasulpur, Mohammad Ranaee, Mohammad Barary, Sahar Sadr Moharerpour, Soheil Ebrahimpour
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Although the study provides valuable population-based data, several methodological issues limit the strength and generalizability of the conclusions.</p><p>First, the analytic model omitted widely available laboratory indicators of systemic inflammation and oxidative stress that are mechanistically linked to DR progression. Composite indices derived from full blood counts (neutrophil-to-lymphocyte, platelet-to-lymphocyte, monocyte-to-lymphocyte ratios; systemic immune-inflammation, inflammatory response, and aggregate systemic inflammation indices) as well as cytokines (interleukin-1β, -6, -8; tumor necrosis factor-α), micronutrients (vitamins C, E, D, B12; zinc), mean platelet volume, and erythrocyte sedimentation rate have each shown predictive value across DR stages<span><sup>2</sup></span>. Their inclusion would have enabled adjustment for subclinical inflammatory burden and reinforced causal inference.</p><p>Second, key diabetes-related comorbidities, such as neuropathy, peripheral arterial disease, psychological disorders, and diabetic foot disease, were not systematically documented. These conditions share pathogenic pathways with DR and can alter retinal micro-circulation, potentially confounding associations between age at diagnosis and ocular outcomes.</p><p>Third, medication exposure was insufficiently characterized. Interferons, corticosteroids, and other immuno-modulators influence retinal vascular permeability and may precipitate or ameliorate DR<span><sup>3, 4</sup></span>. Detailed pharmacotherapy histories, including cumulative dose and treatment duration, are therefore essential covariates.</p><p>Fourth, sociodemographic variables such as ethnicity, educational attainment, and socioeconomic status were reported only in aggregate, precluding stratified analyses. Social determinants shape health-care access, metabolic control, and diet quality; their exclusion hampers external validity, particularly beyond Han Chinese urban populations.</p><p>Finally, operational definitions for insulin resistance, nutritional status, and body composition were not provided, despite their recognized roles in DR pathogenesis. Incorporating standardized metrics such as the homeostasis model assessment of insulin resistance, body-mass index, or dual-energy X-ray absorptiometry would strengthen etiologic insights.</p><p>In summary, Tsui <i>et al</i>. furnish important evidence that EOD confers heightened retinopathy risk; however, the omission of inflammatory biomarkers, comorbidities, medication profiles, and social determinants may have introduced residual confounding. Future prospective studies integrating multidimensional laboratory, clinical, and sociodemographic data are warranted to delineate modifiable pathways that underlie the disproportionate retinal burden borne by individuals with EOD type 2 diabetes mellitus.</p><p>The authors received no specific funding for this work.</p><p>Fatemeh Rasulpur: investigation, writing – original draft preparation. Mohammad Ranaee: investigation, writing – original draft preparation. Mohammad Barary: investigation, writing – original draft preparation, Writing – review and editing. Sahar Sadr Moharerpour: investigation, writing – original draft preparation, supervision. Soheil Ebrahimpour: investigation, supervision, writing – original draft preparation. All authors contributed significantly to the work and approved the final version of the manuscript. Their contributions align with the latest guidelines of the International Committee of Medical Journal Editors.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 8","pages":"1566-1567"},"PeriodicalIF":3.0000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70076","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Diabetes Investigation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jdi.70076","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
Dear Editor,
Epidemiological comparisons of diabetic retinopathy (DR) and diabetic macular edema (DME) between early-onset (EOD) and late-onset (LOD) type 2 diabetes mellitus constitute a growing research priority because global trends toward earlier type 2 diabetes mellitus diagnosis increase lifetime risk of micro-vascular sequelae. Tsui et al.1 recently reported higher DR prevalence and incidence in urban southern Chinese adults with EOD relative to LOD and identified glycemic control and diabetes duration as dominant risk factors. Although the study provides valuable population-based data, several methodological issues limit the strength and generalizability of the conclusions.
First, the analytic model omitted widely available laboratory indicators of systemic inflammation and oxidative stress that are mechanistically linked to DR progression. Composite indices derived from full blood counts (neutrophil-to-lymphocyte, platelet-to-lymphocyte, monocyte-to-lymphocyte ratios; systemic immune-inflammation, inflammatory response, and aggregate systemic inflammation indices) as well as cytokines (interleukin-1β, -6, -8; tumor necrosis factor-α), micronutrients (vitamins C, E, D, B12; zinc), mean platelet volume, and erythrocyte sedimentation rate have each shown predictive value across DR stages2. Their inclusion would have enabled adjustment for subclinical inflammatory burden and reinforced causal inference.
Second, key diabetes-related comorbidities, such as neuropathy, peripheral arterial disease, psychological disorders, and diabetic foot disease, were not systematically documented. These conditions share pathogenic pathways with DR and can alter retinal micro-circulation, potentially confounding associations between age at diagnosis and ocular outcomes.
Third, medication exposure was insufficiently characterized. Interferons, corticosteroids, and other immuno-modulators influence retinal vascular permeability and may precipitate or ameliorate DR3, 4. Detailed pharmacotherapy histories, including cumulative dose and treatment duration, are therefore essential covariates.
Fourth, sociodemographic variables such as ethnicity, educational attainment, and socioeconomic status were reported only in aggregate, precluding stratified analyses. Social determinants shape health-care access, metabolic control, and diet quality; their exclusion hampers external validity, particularly beyond Han Chinese urban populations.
Finally, operational definitions for insulin resistance, nutritional status, and body composition were not provided, despite their recognized roles in DR pathogenesis. Incorporating standardized metrics such as the homeostasis model assessment of insulin resistance, body-mass index, or dual-energy X-ray absorptiometry would strengthen etiologic insights.
In summary, Tsui et al. furnish important evidence that EOD confers heightened retinopathy risk; however, the omission of inflammatory biomarkers, comorbidities, medication profiles, and social determinants may have introduced residual confounding. Future prospective studies integrating multidimensional laboratory, clinical, and sociodemographic data are warranted to delineate modifiable pathways that underlie the disproportionate retinal burden borne by individuals with EOD type 2 diabetes mellitus.
The authors received no specific funding for this work.
Fatemeh Rasulpur: investigation, writing – original draft preparation. Mohammad Ranaee: investigation, writing – original draft preparation. Mohammad Barary: investigation, writing – original draft preparation, Writing – review and editing. Sahar Sadr Moharerpour: investigation, writing – original draft preparation, supervision. Soheil Ebrahimpour: investigation, supervision, writing – original draft preparation. All authors contributed significantly to the work and approved the final version of the manuscript. Their contributions align with the latest guidelines of the International Committee of Medical Journal Editors.
期刊介绍:
Journal of Diabetes Investigation is your core diabetes journal from Asia; the official journal of the Asian Association for the Study of Diabetes (AASD). The journal publishes original research, country reports, commentaries, reviews, mini-reviews, case reports, letters, as well as editorials and news. Embracing clinical and experimental research in diabetes and related areas, the Journal of Diabetes Investigation includes aspects of prevention, treatment, as well as molecular aspects and pathophysiology. Translational research focused on the exchange of ideas between clinicians and researchers is also welcome. Journal of Diabetes Investigation is indexed by Science Citation Index Expanded (SCIE).