Yin-He Chai1, Yong-Peng Zhang2, Yu-Shun Qiao1, Hong-Jian Gong1, Hui Xu1, Hai-Cheng She2, Ikramulhaq Patel1, Wei Liu1, Coen D A Stehouwer3, Jian-Bo Zhou4, Rafael Simó5. 1. From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China. 2. Beijing Tongren Eye Center (Y.P.Z., H.C.S.), Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China. 3. Department of Internal Medicine and CARIM School for Cardiovascular Diseases (C.D.A.S.), Maastricht University Medical Center, Maastricht, the Netherlands. 4. From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China. Electronic address: jbzhou@ccmu.edu.cn. 5. Department of Endocrinology and Nutrition (R.S.), Vall d'Hebron University Hospital, Autonomous University, Barcelona, Spain; Diabetes and Metabolism Research Unit (R.S.), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) (R.S.), Instituto de Salud Carlos III (ICSIII), Madrid, Spain.
Abstract
PURPOSE: To evaluate the association between diabetic retinopathy (DR) and cerebral disease or cognitive impairment. DESIGN: Systematic review and meta-analysis. METHOD: The hypothesis was formulated prior to data collection. Cross-sectional studies and cohort studies that assessed the association between any measure of DR and cerebral small vessel disease or any type of cognitive impairment in diabetic participants were included. The data were independently extracted by two investigators. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines RESULTS: A total of 27 studies were included. The combined odds ratio of 5 cross-sectional/cohort studies that reported that the associations between DR and cerebral structural changes was 1.75 (95% confidence interval [CI]: 1.36-2.25). The combined hazard ratio of 4 cohort studies that examined the association between DR and cognitive impairment events was 1.47 (95% CI: 1.22-1.78). The combined odds ratio of 14 cross-sectional/cohort studies that examined the association between DR and different cognitive impairment events was 1.43 (95% CI: 1.06-1.93). The overall coefficient (β) of 4 studies that examined the relationship between DR and specific cognitive performance was 0.09 (95% CI: 0.00-0.18). Considering the quality of the data, we have performed subgroup analysis in studies scored >7 and studies scored ≤7, respectively, according to the Newcastle-Ottawa scale. CONCLUSION: The present meta-analysis suggests that DR is associated with an increased risk of structural abnormalities in the brain and cognitive impairment. This association remained significant after adjusting for blood glucose, and the presence of hypertension, indicating that DR is an important danger signal for cerebral abnormalities.
PURPOSE: To evaluate the association between diabetic retinopathy (DR) and cerebral disease or cognitive impairment. DESIGN: Systematic review and meta-analysis. METHOD: The hypothesis was formulated prior to data collection. Cross-sectional studies and cohort studies that assessed the association between any measure of DR and cerebral small vessel disease or any type of cognitive impairment in diabetic participants were included. The data were independently extracted by two investigators. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines RESULTS: A total of 27 studies were included. The combined odds ratio of 5 cross-sectional/cohort studies that reported that the associations between DR and cerebral structural changes was 1.75 (95% confidence interval [CI]: 1.36-2.25). The combined hazard ratio of 4 cohort studies that examined the association between DR and cognitive impairment events was 1.47 (95% CI: 1.22-1.78). The combined odds ratio of 14 cross-sectional/cohort studies that examined the association between DR and different cognitive impairment events was 1.43 (95% CI: 1.06-1.93). The overall coefficient (β) of 4 studies that examined the relationship between DR and specific cognitive performance was 0.09 (95% CI: 0.00-0.18). Considering the quality of the data, we have performed subgroup analysis in studies scored >7 and studies scored ≤7, respectively, according to the Newcastle-Ottawa scale. CONCLUSION: The present meta-analysis suggests that DR is associated with an increased risk of structural abnormalities in the brain and cognitive impairment. This association remained significant after adjusting for blood glucose, and the presence of hypertension, indicating that DR is an important danger signal for cerebral abnormalities.