Estimated Resting Metabolic Rate and Body Composition Measures Are Strongly Associated With Diabetic Retinopathy in Indonesian Adults With Type 2 Diabetes.

To investigate the associations of estimated resting metabolic rate (RMR), body fat (BF), subcutaneous fat (SCF), visceral fat (VF), fat-free mass (FFM) percentage, BMI, and waist circumference (WC) with diabetic retinopathy (DR) in Indonesian adults with type 2 diabetes. This was a community-based cross-sectional study of 1,184 subjects with type 2 diabetes. DR was assessed from fundus photography and categorized as mild, moderate nonproliferative DR (NPDR), and vision-threatening DR (VTDR). RMR and body composition parameters were measured using automated body composition scan. Logistic regression with semipartial correlation analysis was used. DR and VTDR were present in 43.1 and 26.3% of participants, respectively. After adjustment for age, sex, diabetes duration, fasting glucose, systolic blood pressure, smoking, diabetic ulcer, and use of combined diabetes treatment, per SD increase in RMR (odds ratio [OR] 2.60 [95% CI 2.19-3.07]; P < 0.001) was associated with DR, while per SD increases in BF (0.66 [95% CI 0.56-0.78]; P < 0.001), FFM (0.69 [0.57-0.84]; P < 0.001), VF (0.77 [0.67-0.88]; P < 0.001), BMI (0.83 [0.73-0.94]; P = 0.004), and WC (0.81 [0.73-0.91]; P < 0.001) were inversely associated with presence of DR. Similar associations were found for VTDR. Among all variables, RMR had the largest contribution to the variance in the DR model (39%). In this study, RMR and body composition measures were strongly associated with and contributed considerably to the presence and severity of DR. These findings, if confirmed, suggest that RMR and body composition may be strong markers that represent actual metabolic state in the pathophysiology of DR.

Sasongko MB ，Widyaputri F ，Sulistyoningrum DC ，Wardhana FS ，Widayanti TW ，Supanji S ，Widyaningrum R ，Indrayanti SR ，Widhasari IA ，Agni AN ... -  《-》

Prevalence of Diabetic Retinopathy and Blindness in Indonesian Adults With Type 2 Diabetes.

To report the prevalence of diabetic retinopathy (DR) and DR-related blindness in an Indonesian population with type 2 diabetes. Design: Population-based cross-sectional study. Community health centers. We recruited 1184 people aged older than 30 years with type 2 diabetes residing in Jogjakarta, Indonesia. Multistage, clustered random sampling based on regencies and districts in Jogjakarta was used. Detailed interviews, general and eye examinations, and anthropometric measurement were performed. Disc- and macula-centered retinal photographs were taken to assess DR. The definition of DR followed a modified Airlie House classification system and was categorized into mild, moderate, and vision-threatening DR (VTDR). Prevalence and severity of DR. The median (range) age and diabetes duration of participants was 59 (52-65) and 4 (2-9) years. The prevalence of DR was 43.1% (95% confidence interval 39.6%-46.6%), with mild, moderate, and severe NPDR and PDR to be 9.41%, 7.46%, 11.1%, and 12.1%, respectively. The prevalence of VTDR was 26.3% (23.1%-29.5%). Longer diabetes duration, higher fasting glucose, presence of hypertension, and foot ulcers were associated with DR and VTDR. The prevalence of bilateral blindness was 4% and 7.7% in persons with DR and VTDR. This study reports a high prevalence of any DR and VTDR among Indonesian adults with type 2 diabetes in urban and rural areas: approximately 1 in 4 adults with diabetes had VTDR and 1 in 12 of those with VTDR was bilaterally blind, suggesting the need for appropriate screening and management of DR among the Indonesian population.

Sasongko MB ，Widyaputri F ，Agni AN ，Wardhana FS ，Kotha S ，Gupta P ，Widayanti TW ，Haryanto S ，Widyaningrum R ，Wong TY ，Kawasaki R ，Wang JJ ... -  《-》

Associations of Physical Activity and Sedentary Behaviour with Vision-Threatening Diabetic Retinopathy in Indonesian Population with Type 2 Diabetes Mellitus: Jogjakarta Eye Diabetic Study in the Community (JOGED.COM).

Dharmastuti DP ，Agni AN ，Widyaputri F ，Pawiroranu S ，Sofro ZM ，Wardhana FS ，Haryanto S ，Widayanti TW ，Kotha S ，Gupta P ，Sasongko MB ... -  《-》

Association of Time in Range, as Assessed by Continuous Glucose Monitoring, With Diabetic Retinopathy in Type 2 Diabetes.

Continuous glucose monitoring (CGM) has provided new measures of glycemic control that link to diabetes complications. This study investigated the association between the time in range (TIR) assessed by CGM and diabetic retinopathy (DR). A total of 3,262 patients with type 2 diabetes were recruited. TIR was defined as the percentage of time spent within the glucose range of 3.9-10.0 mmol/L during a 24-h period. Measures of glycemic variability (GV) were assessed as well. DR was determined by using fundus photography and graded as 1) non-DR; 2) mild nonproliferative DR (NPDR); 3) moderate NPDR; or 4) vision-threatening DR (VTDR). The overall prevalence of DR was 23.9% (mild NPDR 10.9%, moderate NPDR 6.1%, VTDR 6.9%). Patients with more advanced DR had significantly less TIR and higher measures of GV (all P for trend <0.01). The prevalence of DR on the basis of severity decreased with ascending TIR quartiles (all P for trend <0.001), and the severity of DR was inversely correlated with TIR quartiles (r = -0.147; P < 0.001). Multinomial logistic regression revealed significant associations between TIR and all stages of DR (mild NPDR, P = 0.018; moderate NPDR, P = 0.014; VTDR, P = 0.019) after controlling for age, sex, BMI, diabetes duration, blood pressure, lipid profile, and HbA1c. Further adjustment of GV metrics partially attenuated these associations, although the link between TIR and the presence of any DR remained significant. TIR assessed by CGM is associated with DR in type 2 diabetes.

Lu J ，Ma X ，Zhou J ，Zhang L ，Mo Y ，Ying L ，Lu W ，Zhu W ，Bao Y ，Vigersky RA ，Jia W ... -  《-》

Relationship between body fat and diabetic retinopathy in patients with type 2 diabetes: a nationwide survey in Korea.

Hwang IC ，Bae JH ，Kim JM 《-》