RISK FACTORS ASSOCIATED WITH THE PROGRESSION OF DIABETIC RETINOPATHY IN ADULT PATIENTS

Abstract

To determine the predictive ability of conventional glycemic measurements and combined inflammatory-thrombotic and protein-based biomarkers in 24-month diabetic retinopathy progression in individuals with type 2 diabetes mellitus. The study was a prospective longitudinal cohort study that recruited 340 patients with type 2 diabetes mellitus who were followed over a period of 24 months. The blood tests at baseline were hemoglobin A1c, diabetes duration, cumulative glycemic index, which is the product of diabetes duration and mean hemoglobin A1c, high-sensitivity C-reactive protein, platelet count, inflammatory-thrombotic score, which is the product of high-sensitivity C-reactive protein and platelet count, albumin-to-glob The main outcome was the progression of diabetic retinopathy, which was at least a two-step increase on the International Clinical Diabetic Retinopathy Severity Scale or proliferative diabetic retinopathy. The Akaike Information Criterion, Bayesian Information Criterion, C-index, net reclassification improvement, integrated discrimination improvement, and calibration models were used to compare nine nested Cox proportional hazards and Fine-Gray competing risk models. During a period of 24 months, 86 of the patients who constituted a quarter of the cohort developed diabetic retinopathy. A baseline glycemic-only model had a C-index of 0.684, whereas the cumulative glycemic index model had a greater discrimination of 0.723, which had a significant decrease in the Akaike Information Criterion. The inflammatory-thrombotic score on its own gave a C-index of 0.741, and the albumin-to-globulin ratio produced a significant net reclassification of 18.4 percent. The cumulative glycemic index, inflammatory-thrombotic score, albumin-to-globulin ratio, systolic blood pressure and fibrinogen each had a hazard ratio of 1.483, 1.562, 0.713, and 1.160, respectively, and the cross-validated C-index was 0.758 with an excellent cal The rate of progression in patients in the highest risk tertile was 42.8 percent as compared to 8.2 percent in the lowest tertile. The albumin-to-globulin ratio and inflammatory-thrombotic score are both important incremental prognostic factors in relation to the conventional glycemic measures when used as predictors of diabetic retinopathy progression. Diabetic retinopathy risk stratification should include routine measurement of high-sensitivity C-reactive protein, platelet count, and serum protein fractions to identify patients at high risk who need more than glycemic control to achieve multi-target interventions.