Abstract
INTRODUCTION: Diabetic retinopathy (DR) is the most important risk factor causing blindness in diabetic individuals, and its risk progresses with increased disease duration. Epicardial fat thickness (EFT) is an emerging indicator of inflammation and metabolic derangement and has been proposed as a potential biomarker linked to the severity of DR. This study aims to assess the prevalence of DR, identify risk factors associated with DR, and evaluate the predictive role of EFT in detecting DR in subjects with type 2 diabetes mellitus (T2DM).
METHODS: A cross-sectional observational study was conducted at LLRM Medical College, Meerut, from 2023 to 2024. The participants included 130 T2DM patients who were assessed clinically, radiologically, and biochemically. Demographic data, duration of diabetes, body mass index (BMI), HbA1c levels, and EFT were measured. The severity of DR was determined based on ophthalmic examination. Data were analyzed using Kruskal-Wallis and Chi-squared tests.
RESULTS: In this study of 130 patients with T2DM, 64.61% (n = 84) had DR, including 33.84% (n = 44) with nonproliferative DR (NPDR) and 30.76% (n = 40) with proliferative DR (PDR), while 35.38% (n = 46) had no DR. Patients in the PDR group were older on average (60.5 ± 13.9 years), but age differences were not statistically significant (p = 0.154). The duration of diabetes was significantly longer in PDR patients (9.0 ± 3.01 years) compared with NPDR and non-DR groups (p < 0.001). BMI increased with DR severity, reaching 28.49 ± 2.07 kg/m2 in the PDR group, in which 20% were obese and 72.5% were overweight. A higher waist-hip ratio (WHR) was significantly associated with more severe DR in males (p < 0.001) but not in females (p = 0.099). HbA1c levels increased with disease severity, from 6.1 ± 0.71% in non-DR to 8.6 ± 1.97% in PDR patients (p < 0.001). Similarly, EFT increased from 3.9 ± 0.47 mm in non-DR to 7.9 ± 1.09 mm in PDR (p < 0.001), suggesting EFT as a potential biomarker for DR severity. These findings highlight strong links between DR severity, poor glycemic control, obesity measures, and longer diabetes duration.
CONCLUSION: These findings suggest that in type 2 diabetes mellitus patients, EFT can serve as a significant marker for the severity of DR. It can be used as a noninvasive investigation to predict PDR. When considered alongside established risk factors such as BMI, HbA1c levels, and diabetes duration, EFT could enhance early identification of patients at risk, potentially helping to prevent advancement to the more severe proliferative stage (PDR). However, larger and more extensive studies are required to confirm these observations and strengthen their clinical relevance.