Commentary on “Prevalence, incidence, and risk factors of diabetic retinopathy and macular edema in patients with early and late-onset type 2 diabetes mellitus”

IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
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. 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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. 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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.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.

对“早发性和晚发性2型糖尿病患者糖尿病视网膜病变和黄斑水肿的患病率、发病率及危险因素”的评论。
尊敬的编辑,早发性(EOD)和晚发性(LOD) 2型糖尿病之间的糖尿病视网膜病变(DR)和糖尿病黄斑水肿(DME)的流行病学比较日益成为研究的重点,因为早期2型糖尿病诊断的全球趋势增加了微血管后遗症的终生风险。Tsui等人1最近报道了中国南方城市成年EOD患者DR患病率和发病率高于LOD患者,并确定血糖控制和糖尿病病程是主要危险因素。尽管该研究提供了有价值的基于人群的数据,但几个方法问题限制了结论的强度和普遍性。首先,分析模型忽略了与DR进展机制相关的广泛可用的全身性炎症和氧化应激的实验室指标。由全血细胞计数得出的综合指数(中性粒细胞与淋巴细胞、血小板与淋巴细胞、单核细胞与淋巴细胞比率;全身免疫-炎症、炎症反应和全身炎症综合指数)以及细胞因子(白细胞介素-1β, -6, -8;肿瘤坏死因子-α)、微量营养素(维生素C、E、D、B12;锌)、平均血小板体积和红细胞沉降率在DR分期中均显示出预测价值2。他们的纳入将有助于调整亚临床炎症负担,并加强因果推理。其次,关键的糖尿病相关合并症,如神经病变、外周动脉疾病、心理障碍和糖尿病足病,没有系统的记录。这些疾病与DR有共同的致病途径,可改变视网膜微循环,可能混淆诊断年龄与眼部预后之间的关联。第三,药物暴露特征不充分。干扰素、皮质类固醇和其他免疫调节剂会影响视网膜血管通透性,并可能导致或改善dr3,4。详细的药物治疗史,包括累积剂量和治疗时间,因此是必要的协变量。第四,社会人口变量,如种族、受教育程度和社会经济地位,仅在总体上进行了报道,排除了分层分析。社会决定因素影响卫生保健获取、代谢控制和饮食质量;对他们的排斥阻碍了外部有效性,特别是在汉族城市人口之外。最后,尽管胰岛素抵抗、营养状况和身体成分在DR发病机制中发挥了公认的作用,但没有提供它们的操作定义。结合标准化的指标,如胰岛素抵抗的稳态模型评估、体重指数或双能x线吸收仪,将加强病因学的认识。总之,Tsui等人提供了重要的证据,证明EOD会增加视网膜病变的风险;然而,炎症生物标志物、合并症、药物概况和社会决定因素的遗漏可能引入了残留的混淆。未来的前瞻性研究将整合多方面的实验室、临床和社会人口学数据,以确定EOD 2型糖尿病患者视网膜负担过重的可改变途径。作者没有得到这项工作的特别资助。Fatemeh Rasulpur:调查,写作-原稿准备。Mohammad Ranaee:调查,写作-原稿准备。Mohammad Barary:调查,写作-原稿准备,写作-审查和编辑。萨哈尔·萨德尔·莫哈勒普尔:调查、撰写——原稿准备、监督。Soheil Ebrahimpour:调查,监督,写作-原稿准备。所有作者都对这项工作做出了重大贡献,并批准了手稿的最终版本。他们的贡献符合国际医学期刊编辑委员会的最新指导方针。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Diabetes Investigation
Journal of Diabetes Investigation ENDOCRINOLOGY & METABOLISM-
CiteScore
6.50
自引率
9.40%
发文量
218
审稿时长
6-12 weeks
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).
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