Skip to main content
Log in

Link between retinopathy and nephropathy caused by complications of diabetes mellitus type 2

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

While the correlation and chronology of appearance of diabetic nephropathy and retinopathy is well known in diabetes mellitus (DM) type 1 patients, in DM type 2 this correlation is less clear. A retrospective study including 917 patients with type 2 diabetes. Diabetic retinopathy (DR) was diagnosed based on fundus photographs taken with a non-mydriatic camera. Diabetic nephropathy (DN) was diagnosed based on urinary albumin concentration in a morning urine sample. Statistical analysis was performed with a seemingly unrelated regression (SUR) model. Our SUR model is statistically significant: the test for “model versus saturated” is 2.20 and its significance level is 0.8205. The model revealed that creatinine and glomerular filtration rate (GFR) have strong influence on albuminuria, while body mass index (BMI) and HbA1c have less significant impact. DR is affected positively by diabetes duration, insulin treatment, glucose levels, and HbA1c, and it is affected negatively by GFR, triglyceride levels, and BMI. The association between DR and DN was statistically significant and had a unidirectional correlation, which can be explained by chronological order; that is, DN precedes DR. The present study indicates that the level of renal impairment is proportional to the level of damage to the eye. Furthermore, such an association has a chronological aspect; the renal injury precedes retinal damage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Colagiuri S, Borch-Johnsen K, Glumer C, Vistisen D (2005) There really is an epidemic of type 2 diabetes. Diabetologia 48:1459–1463

    Article  CAS  PubMed  Google Scholar 

  2. Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes. Diabetes Care 27:1047–1053

    Article  PubMed  Google Scholar 

  3. Avisar R, Friling R, Snir M, Avisar I, Weinberger D (2006) Estimation of prevalence and incidence rates and causes of blindness in Israel, 1998–2003. IMAJ 8:880–881

    PubMed  Google Scholar 

  4. Remuzzi G, Schieppati A, Ruggenenti P (2002) Nephropathy in patients with type 2 diabetes. N Engl J Med 346:1145–1151

    Article  PubMed  Google Scholar 

  5. American Diabetes Association (2012) Standards of medical care in diabetes-2012. Diabetes Care 35(Suppl 1):S11–S63

    Google Scholar 

  6. Romero-Aroca P, Mendez-Marin I, Baget-Bernaldiz M, Fernandez-Ballart J, Santos-Blanco E (2010) Review of the relationship between renal and retinal microangiopathy in diabetes mellitus patients. Curr Diabetes Rev 6:88–101

    Article  CAS  PubMed  Google Scholar 

  7. Rani PK, Raman R, Gupta A, Pal SS, Kulothungan V, Sharma T (2011) Albuminuria and diabetic retinopathy in Type 2 diabetes mellitus Sankara Nethralaya diabetic retinopathy epidemiology and molecular genetic study. Diabetol Metab Syndr 3:9

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Savage S, Estacio RO, Jeffers B, Schrier RW (1996) Urinary albumin excretion as a predictor of diabetic retinopathy, neuropathy, and cardiovascular disease in NIDDM. Diabetes Care 19(11):1243–1248

    Article  CAS  PubMed  Google Scholar 

  9. Looker HC, Krakoff J, Knowler WC, Bennett PH, Klein R, Hanson RL (2003) Longitudinal studies of incidence and progression of diabetic retinopathy assessed by retinal photography in Pima Indians. Diabetes Care 26(2):320–326

    Article  PubMed  Google Scholar 

  10. Kim HK, Kim CH, Kim SW, Park JY, Hong SK, Yoon YH et al (1998) Development and Progression of diabetic retinopathy in Koreans with NIDDM. Diabetes Care 21:134–138

    Article  CAS  PubMed  Google Scholar 

  11. Entacio RO, McFarling E, Biggerstaff S, Jeffers BW, Johnson D, Schrier RW (1998) Overt albuminuria predicts diabetic retinopathy in Hispanics with NIDDM. Am J Kidney Dis 31(6):947–953

    Article  Google Scholar 

  12. Erasmus RT, Oyeyinka G, Arije A (1992) Microalbuminuria in non-insulin-dependent (type 2) nigerian diabetics: relation to glycaemic control, blood pressure and retinopathy. Postgrad Med J 68:638–642

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Israeli Central Bureau of Statistics: population and demography, 64th Independence day report (2012). http://www1.cbs.gov.il/reader/newhodaot/hodaa_template.html?hodaa=201211106

  14. The seventh report of the joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC 7) of the U.S. Department of Health & Human Services. http://www.nhlbi.nih.gov/guidelines/hypertension/

  15. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130:461–470

    Article  CAS  PubMed  Google Scholar 

  16. Gansevoort RT, Verhave JC, Hillege HL, Burgerhof JGM, Bakker SJL, Zeeuw D et al (2005) The validity of screening based on spot morning urine samples to detect subjects with microalbuminuria in the general population. Kidney Int Suppl 94:S28–S35

    Article  PubMed  Google Scholar 

  17. Massin P, Erginay A, Ben Mehidi A, Vicaut E, Quentel G, Victor Z et al (2003) Evaluation of a new non-mydriatic digital camera for detection of diabetic retinopathy. Diabet Med 20:635–641

    Article  CAS  PubMed  Google Scholar 

  18. Murgatroyd H, Ellingford A, Cox A, Binnie M, Ellis JD, MacEwen CJ et al (2004) Effect of mydriasis and different field strategies on digital image screening of diabetic eye disease. Br J Ophthalmol 88:920–924

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Aptel F, Denis P, Rouberol F, Thivolet C (2008) Screening of diabetic retinopathy: effect of field number and mydriasis on sensitivity and specificity of digital fundus photography. Diabetes Metab 34:290–293

    Article  CAS  PubMed  Google Scholar 

  20. Zellner A (1962) An efficient method of estimating seemingly unrelated regressions and tests for aggregation bias. J Am Stat Assoc 57:348–368

    Article  Google Scholar 

  21. Cameron AC, Trivedi PK (2010) Microeconometrics using stata. Stata Press, College Station

    Google Scholar 

  22. Dall TM, Zhang Y, Chen YJ, Quick WW, Yang WG, Fogli J (2010) The economic burden of diabetes. Health Affairs (Millwood) 29(2):297–303

    Article  Google Scholar 

  23. Chodick G, Porath A, Alapi H, Sella T, Flash S, Wood F et al (2010) The direct medical cost of cardiovascular diseases, hypertension, diabetes, cancer, pregnancy and female infertility in a large HMO in Israel. Health Policy 95:271–276

    Article  PubMed  Google Scholar 

  24. Wilf-Miron R, Peled R, Yaari E, Shem-Tov O, Weinner VA, Porath A et al (2010) Disparities in diabetes care: role of the patient’s socio-demographic characteristics. BMC Public Health 10:729

    Article  PubMed Central  PubMed  Google Scholar 

  25. Chorny A, Lifshits T, Kratz A, Levy J, Golfarb D, Zlotnik A et al (2011) Prevalence and risk factors for diabetic retinopathy in type 2 diabetes patients in Jewish and Bedouin populations in southern Israel. Harefuah 150:906–910

    PubMed  Google Scholar 

  26. Abou-Rbiah Y, Weitzman S (2002) Diabetes among Bedouins in the Negev: the transition from a rare to a highly prevalent condition. IMAJ 4(9):687–689

    PubMed  Google Scholar 

  27. Tamir O, Peleg R, Dreiher J, Abu-Hammad T et al (2007) Cardiovascular risk factors in the bedouin population: management and compliance. IMAJ 9(9):652–655

    PubMed  Google Scholar 

  28. Israeli Central Bureau of statistics: characterization and classification of local authorities by the socio-economic level of the population 2006 http://www1.cbs.gov.il/www/publications/local_authorities06/local_authorities_e.htm

  29. Nicklett EJ (2011) Socioeconomic status and race/ethnicity independently predict health decline among older diabetics. BMC Public Health 11:684

    Article  PubMed Central  PubMed  Google Scholar 

  30. Król E, Rutkowski B, Czarniak P, Kraszewska E, Lizakowski S, Szubert R et al (2009) Early detection of chronic kidney disease: results of the Pol Nef Study. Am J Nephrol 29:264–273

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jaime Levy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kotlarsky, P., Bolotin, A., Dorfman, K. et al. Link between retinopathy and nephropathy caused by complications of diabetes mellitus type 2. Int Ophthalmol 35, 59–66 (2015). https://doi.org/10.1007/s10792-014-0018-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-014-0018-6

Keywords

Navigation