Risk Factors for Diabetic Retinopathy in Chinese Patients with Different Diabetes Duration: Association of C-Peptide and BUN/Cr Ratio with Type 2 Diabetic Retinopathy

Jianting Li; Zhenhua Dong; Xiaoli Wang; Xin Wang; Lulu Wang; Shuguang Pang

doi:10.2147/IJGM.S420983

Risk Factors for Diabetic Retinopathy in Chinese Patients with Different Diabetes Duration: Association of C-Peptide and BUN/Cr Ratio with Type 2 Diabetic Retinopathy

Int J Gen Med. 2023 Sep 6:16:4027-4037. doi: 10.2147/IJGM.S420983. eCollection 2023.

Authors

Jianting Li^{1

2}, Zhenhua Dong², Xiaoli Wang², Xin Wang², Lulu Wang², Shuguang Pang^{1

2

3}

Affiliations

¹ Department of Endocrinology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250013, People's Republic of China.
² Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People's Republic of China.
³ Department of Clinical Medicine, Weifang Medical College, Weifang Medical College, Weifang, People's Republic of China.

Abstract

Background and aim: Controlling the risk factors was the most effective strategy to prevent diabetic retinopathy (DR). This study aimed to recognize the risk factors of DR, and explores whether the effect of those factors is modified by diabetes mellitus (DM) duration.

Methods: A total of 1058 DM patients with information about DR assessment were included. DR was measured by a complete ophthalmic examination and was classified as having one or more distinct microaneurysms in the eyes. Data from the lab and clinical factors were gathered. Multivariate logistic analysis was used to examine the risk factors, and the best-fitting model was selected by a backward stepwise based on A1C.

Results: In the current study, 274 (25.9%) patients developed DR. In the entire subjects, baseline age, the level of C-peptide, and urinary creatinine were all presented as protective effects of DR, whose odds ratios (ORs) and 95% confidence intervals (CIs) were 0.79 (0.62, 0.99), 0.75 (0.61, 0.91), and 0.70 (0.52, 0.93), respectively. Conversely, systolic pressure (SBP), urinary albumin, and BUN/Cr ratio were the important risk factors for DR with ORs (95% CIs) 1.21 (1.01, 1.46), 1.55 (1.30, 1.84), and 1.33 (1.11, 1.59), respectively. In stratification analysis, females with higher SBP would be more likely to develop DR in the short-duration group, while C-peptide and urinary creatinine showed protective effects in the long-duration group. BUN/Cr ratio all presented as a risk factor, with ORs 1.38 (p = 0.041) and 1.33 (p = 0.014) in short- and long-duration groups, respectively.

Conclusion: Although renal functions presented a significant association with DR in all DM patients, the risk factors of DR varied widely in different disease-duration subjects. Target strategies to prevent DR should be put forward individually, considering the patient's DM duration. Improving the BUN/Cr ratio may be beneficial to delaying DR.

Keywords: BUN/Cr ratio; C-peptide; clinical factors; diabetic retinopathy; risk factors analyses.

Grants and funding

The financial support for this study was provided by the Shandong Province Key R&D Plan (Grant No. 2016GSF201019), Jinan Science and Technology Innovation Program of Clinical Medicine (Grant No. 201705072), Latitudinal project of Shandong University (Grant No. 6020320001), Shandong Province Postdoctoral Innovation Program (Grant No. SDCX-ZG-202202004), and Academic promotion program of Shandong First Medical University (Grant No. 2019QL025).