Response: Diabetic Retinopathy and Endothelial Dysfunction in Patients with Type 2 Diabetes Mellitus (Diabetes Metab J 2013;37:262-9)

Article information

Diabetes Metab J. 2013;37(5):393-394

Publication date (electronic) : 2013 October 17

doi : https://doi.org/10.4093/dmj.2013.37.5.393

Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.

Corresponding author: Yu-Bae Ahn. Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, 93 Jungbu-daero, Paldal-gu, Suwon 442-723, Korea. ybahn@catholic.ac.kr

We sincerely appreciate the interests and comments on our study, "Diabetic retinopathy and endothelial dysfunction in patients with type 2 diabetes mellitus" which was published in Diabetes & Metabolism Journal 2013;37:262-9.

We agreed with Dr. Son's perspective stating that the dysfunction of the vascular endothelium and chronic low grade inflammation are key features of the development of diabetic retinopathy. Previous studies reported the association between microangiopathy, endothelial dysfunction, and inflammation in type 2 diabetes. One prospective study showed that increased urinary albumin excretion, which is closely connected with retinopathy in patients with type 2 diabetes, endothelial dysfunction, and chronic inflammation, are interrelated processes [1]. In addition, van Hecke et al. [2] suggested inflammation and endothelial dysfunction (estimated by levels of molecular markers) are involved in the pathogenesis of retinopathy, and other experimental and clinical studies also have shown inflammation and endothelial dysfunction to be the pathogenic risk factors of diabetic retinopathy [2,3].

Furthermore, there are some evidences supporting the hypothesis that microvascular and macrovascular complications may have similar pathophysiological backgrounds. Microalbuminuria is well known as the risk of cardiovascular events, and its presence increases the incidence of cardiovascular events [4,5]. Diabetic retinopathy is also associated with intima media thickness and arterial stiffness [6] and predicts coronary heart disease events in patients with type 2 diabetes [7]. Endothelial dysfunction and inflammation can possibly serve as linkage mechanisms between microvascular and macrovascular complication; further prospective studies are needed to elucidate the pathogenic mechanisms.

Finally, your comments supported the conclusion of our study. We did not check inflammatory markers in this study, and we hope to publish another reliable prospective study to clarify the interrelationship between inflammation, endothelial dysfunction, and the development of diabetic retinopathy in the near future. Thank you for taking interest in this study and for your thoughtful comments.

Notes

No potential conflict of interest relevant to this article was reported.

References

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2. van Hecke MV, Dekker JM, Nijpels G, Moll AC, Heine RJ, Bouter LM, Polak BC, Stehouwer CD. Inflammation and endothelial dysfunction are associated with retinopathy: the Hoorn Study. Diabetologia 2005;48:1300–1306. 15918015.

3. Adamis AP. Is diabetic retinopathy an inflammatory disease? Br J Ophthalmol 2002;86:363–365. 11914197.

4. Slowik A, Turaj W, Iskra T, Strojny J, Szczudlik A. Microalbuminuria in nondiabetic patients with acute ischemic stroke: prevalence, clinical correlates, and prognostic significance. Cerebrovasc Dis 2002;14:15–21. 12097846.

5. Schrader J, Luders S, Kulschewski A, Hammersen F, Zuchner C, Venneklaas U, Schrandt G, Schnieders M, Rangoonwala B, Berger J, Dominiak P, Zidek W. MARPLE Study Group. Microalbuminuria and tubular proteinuria as risk predictors of cardiovascular morbidity and mortality in essential hypertension: final results of a prospective long-term study (MARPLE Study)^*. J Hypertens 2006;24:541–548. 16467658.

6. Rema M, Mohan V, Deepa R, Ravikumar R. Chennai Urban Rural Epidemiology Study-2. Association of carotid intima-media thickness and arterial stiffness with diabetic retinopathy: the Chennai Urban Rural Epidemiology Study (CURES-2). Diabetes Care 2004;27:1962–1967. 15277424.

7. Miettinen H, Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Retinopathy predicts coronary heart disease events in NIDDM patients. Diabetes Care 1996;19:1445–1448. 8941482.

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