An opening-day session at the 83rd Scientific Sessions will feature a series of oral abstract presentations highlighting a variety of factors and their potential associations with diabetic retinopathy (DR). Retinopathy Risk—Other Diseases, Devices, Disparities will be held on Friday, June 23, at 5:30 p.m. PT in Room 28 of the San Diego Convention Center.

This session also will be available via livestream for registered meeting participants.

Laura Bovee, MD, MS, Fellow in the Department of Metabolism, Endocrinology and Nutrition at the University of Washington School of Medicine, will discuss ongoing research exploring the association of diabetic retinopathy with A1C and glucose management indicator (GMI) discordance.

“It is well established that increased A1C is associated with increased hemoglobin glycation. Glycation is also one of the pathophysiologic mechanisms for the development of microvascular complications,” Dr. Bovee said. “What’s exciting is that we now have continuous glucose monitoring (CGM) data, which provides us with a more complete picture of individuals’ glucose profiles. This allows us to compare A1C values with GMI data as a marker of glycation status.”

In a retrospective pilot study, Dr. Bovee and colleagues looked at the glycation ratio in people who had increased A1C compared to GMI, or positive discordance. Approximately 16.2% of the participants had positive discordance with A1C levels higher than expected based on their GMI.

“When we looked at that group compared with other participants, we saw an increased association with both retinopathy and nephropathy. We’ve now modeled that and will show that it is a continuous nonlinear function,” Dr. Bovee said. “While it’s too soon for us to say that this will be clinically useful, we will evaluate further and see if it applies in other cohorts.”

Ward Fickweiler, MD, Clinical Fellow in Ophthalmology at the Joslin Diabetes Center and Harvard Medical School, will discuss research exploring the relationship between the presence of age-related macular degeneration (AMD) and DR severity.

“Although AMD and DR are distinct entities, they share clinical features and are thought to share common pathways,” Dr. Fickweiler said. “To date, however, most studies focus on only one of these conditions and generally exclude the other. Thus, our understanding of how these diseases interact in combination is incomplete at best.”

In an analysis of a large group of people mostly with type 1 diabetes from the Joslin 50-Year Medalist Study, composed of individuals who have had insulin-dependent diabetes for 50 years or longer and some with type 2 diabetes, the presence of AMD was associated with less severe DR, and DR progression was less frequent in eyes with AMD compared to eyes without AMD at baseline, he said.

Additionally, the study found that milder DR at baseline was associated with increased risk of AMD and that the presence of AMD was associated with older age, increased diabetes duration, less severe DR, and the absence of neuropathy.

“In contrast, younger age and the presence of neuropathy were associated with the presence of advanced DR. Higher vitreous retinol binding protein 3 (RBP3) to vascular endothelial growth factor (VEGF) ratios, biochemical markers of DR, were associated with AMD and less severe DR,” Dr. Fickweiler said. “These findings suggest that DR and AMD may relate to discordant metabolic pathways underlying their development or worsening and indicate that the pathogenesis of early DR is likely due to aging factors.”

He said detailed studies from eyes with DR and AMD are needed to identify differential pathogenic pathways for DR and AMD and to provide new therapeutic targets for these common sight-threatening diseases.

DR is one of the most common diabetes-related eye conditions, along with diabetic macular edema (DME), cataracts, glaucoma, and vision loss. The American Diabetes Association^® (ADA) has launched a multi-year initiative to increase awareness about diabetes and eye health, Focus on Diabetes, to promote early detection, timely treatment, and appropriate follow-up care for these conditions.

Masahiko Yamamoto, MD, PhD, Assistant Professor in the Department of Hematology, Endocrinology and Metabolism at Niigata University of Medicine in Japan, will describe research into the association of prior cerebrovascular disease with severe diabetic retinopathy and diabetic macular edema (DME) in type 2 diabetes.

“Although it is well known that diabetic retinopathy and DME are risk factors for incident cerebrovascular disease, whether the cerebrovascular disease history could be a predictor of severe DR or DME remains unknown among people with type 2 diabetes,” Dr. Yamamoto said.

Dr. Yamamoto and his colleagues longitudinally examined the role of prior cerebrovascular disease in the incidence of severe diabetic eye diseases among Japanese patients with type 2 diabetes from a national health insurance claim database.

“We showed that prior cerebrovascular disease was associated with a 63% increase in severe diabetic eye diseases,” he said. “Prior cerebrovascular disease was positively associated with incident treatment-required diabetic eye diseases in analysis of the study population. It contributed to preventing severe visual impairment and further deterioration of the quality of life after cerebrovascular disease.”

Anum Zehra, BA, Pediatric Diabetes Research Assistant at The Johns Hopkins University School of Medicine, will talk about research on autonomous artificial intelligence (AI) diabetic eye exams to mitigate disparities in screening completion. Investigators compared diabetic retinopathy screening completion rates between white and non-white youth with type 1 diabetes and type 2 diabetes before and after the implementation of point-of-care (POC) autonomous AI screening.

“Diabetic retinopathy is a serious complication of diabetes, yet few diabetic youths undergo DR screening. And of those who are screened, racial and ethnic minority youth are even less likely to complete DR screening,” Zehra said.

After the implementation of POC autonomous AI screening, the screening rates were 99% regardless of race or ethnicity, she said.

“We believe that artificial intelligence can help improve health care access and mitigate disparities between racial and ethnic groups,” she said. “In the future, this can help maximize the impact of health care technology by ensuring that it benefits as many patients as possible, regardless of their racial or ethnic background.”