Progressive Retinal Vasodilation in Patients With Type 1 Diabetes: A Longitudinal Study of Retinal Vascular Geometry

Abstract

Purpose: Retinal vessels can be used to noninvasively monitor changes in microvasculature. These changes in retinal vascular geometry (RVG) may predict chronic diabetes complications. We evaluated longitudinal RVG changes in adolescents with type 1 diabetes.

Methods: We followed 102 adolescents (baseline: 47.1% male, mean [SD] age 14.4 [1.6] years, diabetes duration 7.2 [3.1] years, HbA1c 8.1% [1.3%] [65 (9.3) mmol/mol]) over three visits, with a mean follow-up of 2.6 years. Retinal vascular geometry was measured using a standardized computer-assisted protocol from retinal photographs at each visit. Multivariable linear mixed-models and logistic regression were used to examine predictors of RVG and diabetic retinopathy.

Results: During follow-up, mean arteriolar caliber, venular caliber, and venular tortuosity increased, from 156.0 (SD, 14.5) to 164.9 (14.0) μm, 215.9 (22.5) to 230.3 (20.6) μm, and 1.096 (0.014) to 1.099 (0.016), respectively (all P < 0.005). Other RVG measurements (fractal dimension, branching angle, length to diameter ratio) remained stable. Higher than baseline HbA1c and longer diabetes duration were associated with greater venular vasodilation. Retinopathy developed at any time-point in 24% of subjects, and the highest tertile arteriolar fractal dimension was associated with cumulative incidence of retinopathy (multivariable odds ratio 3.2, 95% confidence interval 1.0-9.6; P = 0.04).

Conclusions: Higher HbA1c and longer diabetes duration in early adolescence predicts greater venular vasodilation over time. Arteriolar fractal dimension predicts subsequent retinopathy development, suggesting value as a potential biomarker for diabetic complications.