Multimodal testing reveals subclinical neurovascular dysfunction in prediabetes, challenging the diagnostic threshold of diabetes
Authors' conclusion
The glucose threshold for the diagnosis of diabetes is based on emergent retinopathy on fundus examination. We show that both abnormal retinal neurovascular structure (OCT-A) and function (ERG) may precede retinopathy in prediabetes, which require confirmation in larger, adequately powered studies.
Study context
- Population
- Participants with normoglycaemia, prediabetes or T2D assessed by optical coherence tomography angiography (OCT-A), handheld electroretinography (ERG), corneal confocal microscopy (CCM) and electrochemical skin conductance (ESC)
- Participants
- 75 participants
- Exposure
- Prediabetes vs normoglycaemia
- Normoglycaemian = 20reference
- Prediabetesn = 29
- T2Dn = 26
- Outcome
- Early small nerve fibre and retinal neurovascular pathology in prediabetes, by novel non-invasive technologies
Methodological detailsexploratory
- Exploratory
Main finding
As reported in the abstract
Retinal neurovascular measures (handheld ERG, OCT-A), prediabetes vs normoglycaemia
Estimate (95% CI)
Normoglycaemiavs Prediabetes
difference in mean peak ERG amplitude, low retinal illuminance (16-Td·s) 4.05 μV(0.96–7.13)
Normoglycaemiavs Prediabetes
difference in mean peak ERG amplitude, high retinal illuminance (32-Td·s) 5.20 μV(1.54–8.86)
Estimate (95% CI)
Normoglycaemiavs Prediabetes
difference in OCT-A parafoveal vessel density, superficial retinal layer 0.051 pixels/mm²(0.005–0.095)
Normoglycaemiavs Prediabetes
difference in OCT-A parafoveal vessel density, deep retinal layer 0.048 pixels/mm²(0.003–0.093)
Observational data: associations, not effects.
Further findings
Correlations with HbA1c
- Peak ERG amplitude at 32-Td·s
- r = −0.256, p = 0.028
- Implicit time at 32-Td·s
- r = 0.422, p < 0.001
- Implicit time at 16-Td·s
- r = 0.327, p = 0.005
- OCT parafoveal vessel density, superficial layer
- r = −0.238, p = 0.049
- OCT parafoveal vessel density, deep layer
- r = −0.3, p = 0.017
- Corneal nerve fibre length (CNFL)
- r = −0.293, p = 0.017
- ESC-hands
- r = −0.244, p = 0.035
HOMA-IR as predictor of corneal nerve measures
- CNFD
- β = −0.94, 95% CI −1.66 to −0.21, p = 0.012
- CNBD
- β = −5.02, 95% CI −10.01 to −0.05, p = 0.048
Original publication
Multimodal testing reveals subclinical neurovascular dysfunction in prediabetes, challenging the diagnostic threshold of diabetes. Diabet Med. Published 12 September 2022. doi:10.
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