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Risk of diabetic retinopathy according to subtype of type 2 diabetes

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posted on 2024-03-18, 16:59 authored by Frederik N. Pedersen, Lonny Stokholm, Nis Andersen, Jens Andresen, Toke Bek, Javad Hajari, Steffen Heegaard, Kurt Højlund, Ryo Kawasaki, Caroline S. Laugesen, Sören Möller, Katja Schielke, Jens Steen Nielsen, Jacob V. Stidsen, Reimar W. Thomsen, Benjamin Thinggaard, Jakob Grauslund

Type 2 diabetes is a heterogeneous disease that can be subdivided based on beta-cell function and insulin sensitivity. We aimed to investigate the presence, incidence and progression of diabetic retinopathy (DR) according to subtypes of type 2 diabetes. In a national cohort, we identified three subtypes of type 2 diabetes which included classical, hyperinsulinemic and insulinopenic type 2 diabetes based on HOMA2 measurements. From the Danish Registry of Diabetic Retinopathy (DiaBase) we extracted information on level of DR. We used several national health registries to link information on comorbidity, medications and laboratory tests. We found individuals with hyperinsulinemic type 2 diabetes were less likely to have DR at entry date compared to classical type 2 diabetes, whereas individuals with insulinopenic type 2 diabetes were more likely to have DR. In multivariable Cox regression analysis, individuals with hyperinsulinemic type 2 diabetes had a decreased risk of both incidence and progression of DR compared to classical type 2 diabetes. We did not find any clear difference in risk of incident or progression of DR in individuals with insulinopenic compared to classical type 2 diabetes. These findings indicate that subcategorization of type 2 diabetes is important in evaluating the future risk of DR.

Funding

This work was supported by VELUX FONDEN (grant 00028744) and Synoptik Fonden. The DD2 study was supported by the Danish Agency for Science and Higher Education (grant nos. 09-067009 and 09-075724), the Danish Health and Medicines Authority, the Danish Diabetes Association, Region of Southern Denmark, and the Novo Nordisk Fonden (NNF17SA0030364).

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