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Synergistic interaction between prolonged increased glycemic exposure and mildly increased urinary albumin excretion on diabetic retinopathy.

Abstract The association of mild increase in urinary albumin excretion with diabetic retinopathy (DR) in clinical studies is controversial. The aim of this study is to clarify the interaction between increased glycemic exposure and mild increase in urinary albumin excretion on risk of DR.Data were collected from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2012. Overall, data from 953 participants without microalbuminuria (477 men and 476 women) were assessed. Logistic regression analysis was constructed to evaluate the association between DR and related clinical parameters, including urinary albumin-creatinine ratio (UACR, mg/g creatinine). The biological interaction of glycemic status and UACR on DR was evaluated by 3 indices: RERI, the relative excess risk due to the interaction; AP, the attributable proportion due to the interaction; and S, the additive interaction index of synergy.We found that UACR, glycated hemoglobin (HbA1c), and diabetic duration were deeply associated with increased risk of DR (UACR, odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.02-1.07; HbA1c, OR = 1.16, 95% CI = 1.04-1.30; diabetic duration, OR = 1.06, 95% CI = 1.04-1.07). Furthermore, our interaction analysis demonstrated that synergistic interaction between HbA1c and UACR on development of DR was prominent in participants with diabetic duration of ≥10 years (adjusted RERI = 0.92, 95% CI = 0.10-1.74; adjusted AP = 0.29, 95% CI = -0.82-1.41; adjusted S = 1.76, 95% CI = 1.27-2.25), but not subjects with shorter diabetic duration.These findings imply that there is the interaction between prolonged hyperglycemic exposure and increased urinary albumin excretion may exert additive synergistic effect on vascular endothelial dysfunction in the eye, even before the appearance of overt diabetic nephropathy.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29504969
OWN - NLM
STAT- MEDLINE
DCOM- 20180315
LR  - 20180315
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 3
DP  - 2018 Jan
TI  - Synergistic interaction between prolonged increased glycemic exposure and mildly 
      increased urinary albumin excretion on diabetic retinopathy.
PG  - e9351
LID - 10.1097/MD.0000000000009351 [doi]
AB  - The association of mild increase in urinary albumin excretion with diabetic
      retinopathy (DR) in clinical studies is controversial. The aim of this study is
      to clarify the interaction between increased glycemic exposure and mild increase 
      in urinary albumin excretion on risk of DR.Data were collected from the National 
      Health and Nutrition Examination Survey (NHANES) from 2005 to 2012. Overall, data
      from 953 participants without microalbuminuria (477 men and 476 women) were
      assessed. Logistic regression analysis was constructed to evaluate the
      association between DR and related clinical parameters, including urinary
      albumin-creatinine ratio (UACR, mg/g creatinine). The biological interaction of
      glycemic status and UACR on DR was evaluated by 3 indices: RERI, the relative
      excess risk due to the interaction; AP, the attributable proportion due to the
      interaction; and S, the additive interaction index of synergy.We found that UACR,
      glycated hemoglobin (HbA1c), and diabetic duration were deeply associated with
      increased risk of DR (UACR, odds ratio [OR] = 1.04, 95% confidence interval [CI] 
      = 1.02-1.07; HbA1c, OR = 1.16, 95% CI = 1.04-1.30; diabetic duration, OR = 1.06, 
      95% CI = 1.04-1.07). Furthermore, our interaction analysis demonstrated that
      synergistic interaction between HbA1c and UACR on development of DR was prominent
      in participants with diabetic duration of >/=10 years (adjusted RERI = 0.92, 95% 
      CI = 0.10-1.74; adjusted AP = 0.29, 95% CI = -0.82-1.41; adjusted S = 1.76, 95%
      CI = 1.27-2.25), but not subjects with shorter diabetic duration.These findings
      imply that there is the interaction between prolonged hyperglycemic exposure and 
      increased urinary albumin excretion may exert additive synergistic effect on
      vascular endothelial dysfunction in the eye, even before the appearance of overt 
      diabetic nephropathy.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Moon, Shinje
AU  - Moon S
AD  - Department of Internal Medicine, Hallym University College of Medicine.
FAU - Yoo, Hyung-Joon
AU  - Yoo HJ
AD  - Department of Internal Medicine, Hallym University College of Medicine.
FAU - Ahn, You-Hern
AU  - Ahn YH
AD  - Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
      Republic of Korea.
FAU - Kim, Gheun-Ho
AU  - Kim GH
AD  - Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
      Republic of Korea.
FAU - Yu, Jae Myung
AU  - Yu JM
AD  - Department of Internal Medicine, Hallym University College of Medicine.
FAU - Park, Joon-Sung
AU  - Park JS
AD  - Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
      Republic of Korea.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Blood Glucose)
SB  - AIM
SB  - IM
MH  - Aged
MH  - Albuminuria/*blood/*urine
MH  - Blood Glucose/*analysis
MH  - Cross-Sectional Studies
MH  - Diabetic Retinopathy/*blood/*urine
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Time Factors
PMC - PMC5779738
EDAT- 2018/03/06 06:00
MHDA- 2018/03/16 06:00
CRDT- 2018/03/06 06:00
PHST- 2018/03/06 06:00 [entrez]
PHST- 2018/03/06 06:00 [pubmed]
PHST- 2018/03/16 06:00 [medline]
AID - 10.1097/MD.0000000000009351 [doi]
AID - 00005792-201801190-00003 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Jan;97(3):e9351. doi: 10.1097/MD.0000000000009351.