Health Science Reviews

by Mqiniseli Dlamini

Diabetes is a global health concern, impacting more than 537 million adults globally, with adverse micro- and macrovascular complications as a vascular disease. In a recent meta-analysis led by Z. Wang and titled “Diabetic Retinopathy (DR) as a Potential Predictor of Stroke in Diabetes Mellitus Patients,” the primary objective was to elucidate a critical connection between diabetic retinopathy, a prevalent cause of blindness affecting approximately one-third of individuals with diabetes, and stroke, which ranks as the second leading cause of mortality among diabetic patients on a global scale. The frequency of stroke is known to be two to four times higher in people with diabetes than those without the condition, underscoring the importance of predicting and managing risk factors from a diabetic perspective.

This study sought to explore whether the presence of diabetic retinopathy could serve as an early indicator or predictor of the risk of stroke in individuals with diabetes mellitus, a condition with substantial healthcare implications. Understanding this link has the potential to improve both preventive and clinical management strategies for diabetic patients to mitigate the risk of stroke and its associated complications.

Researchers conducted a comprehensive search in electronic databases, seeking studies that explored the relationship between stroke and diabetic retinopathy. The research studies were divided into two groups, one focused on odds ratios and the other on hazard ratios, to thoroughly examine the relationship between DR and strokes. Additionally, a supplementary analysis was carried out on the ACCORD Eye study, which involved 3,472 patients who underwent baseline and year 4 eye examinations. This approach ensured a comprehensive and rigorous assessment of the link between DR and the risk of stroke. The primary outcome was stroke, including ischemic and haemorrhagic events. Covariates were selected through stepwise selection, and sensitivity analyses considered various DR severity levels.

Out of 20 papers reviewed, including 48 967 patients, they discovered a distinct connection between DR and strokes, indicating that the microvascular abnormalities associated with DR have substantial implications for cerebrovascular health. Notably, individuals with DR were found to have a 62% higher risk of experiencing a stroke compared to their diabetic counterparts without DR. To put it differently, having DR was linked to a 1.62 times higher likelihood of experiencing a stroke. This discovery highlights the significance of acknowledging the increased likelihood of stroke in individuals with diabetic retinopathy, especially among patients diagnosed with type 2 diabetes and those exhibiting more advanced stages of diabetic retinopathy. In cases of severe diabetic retinopathy, the risk of stroke is notably amplified. This emphasizes the need for vigilant monitoring and tailored interventions in these high-risk populations to prevent cerebrovascular complications.

References

Wang, Zicheng, Dan Cao, Xuenan Zhuang, Jie Yao, Ruoyu Chen, Yesheng Chen, Kangyan Zheng, and Liang Zhang. 2022. “Diabetic Retinopathy May Be a Predictor of Stroke in Patients With
Diabetes Mellitus.” Journal of the Endocrine Society 6 (8).

Wong, Ka-Ho, Katherine Hu, Cecilia Petersoon, Nazanin Sheibani, Georgios Tsivgoulis, Jennifer J Majersik, and Adam H de Havenon. 2020. “Diabetic Retinopathy and Risk of Stroke: A Secondary Analysis of the ACCORD Eye Study.” Stroke 51 (12): 3733-3736.