Key result
In patients with type 1 diabetes and mild-to-moderate non-proliferative diabetic retinopathy, total macular volume significantly correlated with reduced recovery of low-frequency spectral power of heart rate variability after orthostatic load (r=0.58, p=0.002).
Why the study?
Does neuroretinal layer thickness correlate with cardiovascular autonomic neuropathy in patients with type 1 diabetes and NPDR?
Cross-Sectional (n=54)
No
Does neuroretinal layer thickness correlate with cardiovascular autonomic neuropathy in patients with type 1 diabetes and NPDR?
Effect estimate: r = 0.58
p-value: p=0.002
Inner retinal tissue loss correlates with diminished peripheral autonomic nerve function in patients with long-standing type 1 diabetes and mild-to-moderate NPDR, suggesting congruent early signs of retinal and systemic neuropathy.
Inner retinal thinning correlates with blunted autonomic recovery in mild-moderate NPDR; leaves open whether OCT measures predict systemic neuropathy progression.
PURPOSE: To evaluate the relationship of neuroretinal layer thickness with sensitive measures of cardiovascular autonomic neuropathy in diabetic patients with non-proliferative diabetic retinopathy (NPDR). METHODS: Twenty-seven eyes of 27 patients with type 1 diabetes presenting with mild-to-moderate NPDR were compared to 27 healthy control (HC) eyes matched for age and gender. The total macular volume (TMV) and the volumes of individual neurosensory layers in the macula were analysed from spectral domain optical coherence tomography using automated layer segmentation. Cardiovascular autonomic regulation was assessed by short-term power spectrum analysis of heart rate variability (HRV) before, during and after an orthostatic challenge. RESULTS: The patients had an age of 46 ± 12 years and diabetes since 28 ± 9 years. Diastolic and mean arterial pressure was lower in the patients compared to HCs. TMV (r = 0.58, p = 0.002), inner plexiform layer volume (IPLV; r = 0.39, p = 0.047) and inner nuclear layer volume (INLV; r = 0.60, p = 0.001) were associated with reduced recovery of low-frequency (LF) spectral power of HRV after orthostatic load in diabetic patients but not in HCs. The response of LF spectral power during the orthostatic manoeuvre was blunted in patients compared to HCs (p = 0.02). Diabetes duration was negatively associated with TMV and INLV, whereas IPLV was significantly reduced in eyes with moderate NPDR compared to HCs. CONCLUSION: The results indicate a correlation between inner retinal tissue loss and diminished autonomic regulation in type 1 diabetic patients with mild-to-moderate NPDR. The observed changes can be interpreted as congruent early signs of retinal and systemic neuropathy in diabetes.
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Pemp et al. (2018) conducted a cross-sectional in Type 1 diabetes with mild-to-moderate non-proliferative diabetic retinopathy (n=54). Type 1 diabetes with mild-to-moderate non-proliferative diabetic retinopathy vs. Healthy controls was evaluated on Correlation of total macular volume with reduced recovery of low-frequency spectral power of heart rate variability after orthostatic load (r = 0.58, p=0.002). In patients with type 1 diabetes and mild-to-moderate non-proliferative diabetic retinopathy, total macular volume significantly correlated with reduced recovery of low-frequency spectral power of heart rate variability after orthostatic load (r=0.58, p=0.002).
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