Endocrine Abstracts

JOINT3673

Prolonged hyperglycemia results in the formation and accumulation of complex and heterogeneous groups of compounds - advanced glycation end-products (AGEs) that increase oxidative stress and induce inflammatory reaction, which exacerbate the occurrence and progression of diabetic complications. The project “Integrated model for personalized diabetic retinopathy screening and monitoring using risk-stratification and automated AI-based fundus image analysis – PerDiRe” involved data on type 1 diabetes (T1D) and type 2 diabetes (T2D) patients from four countries - Latvia, Lithuania, Estonia, and Norway, on two consecutive annual visits. The project was funded by EEA-RESEARCH-60 grant. The objective of this substudy was to assess the relationship between AGE levels and diabetic retinopathy (DR) course in patients with diabetes across all four countries.

Methods: 410 patients with diabetes attended the initial visit, and 226 patients returned for the 1st year follow-up. At both visits, the patients with diabetes underwent full ophthalmological and diabetes-specific clinical examinations. The patients were stratified according to the DR status as follows: no retinopathy, non-proliferative (simple) retinopathy, proliferative retinopathy, and diabetic macular edema. AGEs were measured non-invasively using an AGE Reader device (DiagnOptics Technologies B. V., SN 00010604, Netherlands). AGE z-scores were calculated with the formula: AGE z-score=AGE mean-(0. 024*age, years+0. 83).

Results: During the initial visit, 47. 3% (n = 194) of the patients had some form of DR. By the second visit, 52. 2% (n = 118) presented with DR (P=0. 23). 9. 3% of the study subjects experienced progression to a more severe stage of DR (P<0. 05). A significant change in DR severity from first to second visit was found only within the T2D group (P < 0. 05). During both visits, T2D patients had significantly higher median AGE values and z-scores, compared to T1D (P < 0. 001). Patients with T1D exhibited a statistically significant increase in median AGE values and z- scores at the second visit compared to the first one (P < 0. 05 for both measures). Conversely, patients with T2D showed no significant change in either AGE values or AGEs z-scores between the two visits. In both groups combined, marginal means of AGE values and z-scores increased significantly with progression of DR stages during both visits (general linear models’ P < 0. 001).

Conclusions: The results indicate a notable change in the distribution of DR stages between the first and second visits, especially in T2D. AGE levels were significantly higher in T2D patients and were directly related to more advanced stages of DR.