Type 2 diabetes and HbA1c are independently associated with wider retinal arterioles: the Maastricht study

Wenjie Li, Miranda T. Schram, Tos T.J.M. Berendschot, Carroll A.B. Webers, Abraham A. Kroon, Carla J.H. van der Kallen, Ronald M.A. Henry, Nicolaas C. Schaper, Fan Huang, Behdad Dashtbozorg, Tao Tan, Jiong Zhang, Samaneh Abbasi-Sureshjani, Bart M. ter Haar Romeny, Coen D.A. Stehouwer, Alfons J.H.M. Houben

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16 Citations (Scopus)


Aims/hypothesis: Retinal microvascular diameters are biomarkers of cardio-metabolic risk. However, the association of (pre)diabetes with retinal microvascular diameters remains unclear. We aimed to investigate the association of prediabetes (impaired fasting glucose or impaired glucose tolerance) and type 2 diabetes with retinal microvascular diameters in a predominantly white population. Methods: In a population-based cohort study with oversampling of type 2 diabetes (N = 2876; n = 1630 normal glucose metabolism [NGM], n = 433 prediabetes and n = 813 type 2 diabetes, 51.2% men, aged 59.8 ± 8.2 years; 98.6% white), we determined retinal microvascular diameters (measurement unit as measured by retinal health information and notification system [RHINO] software) and glucose metabolism status (using OGTT). Associations were assessed with multivariable regression analyses adjusted for age, sex, waist circumference, smoking, systolic blood pressure, lipid profile and the use of lipid-modifying and/or antihypertensive medication. Results: Multivariable regression analyses showed a significant association for type 2 diabetes but not for prediabetes with arteriolar width (vs NGM; prediabetes: β = 0.62 [95%CI −1.58, 2.83]; type 2 diabetes: 2.89 [0.69, 5.08]; measurement unit); however, there was a linear trend for the arteriolar width across glucose metabolism status (p for trend = 0.013). The association with wider venules was not statistically significant (prediabetes: 2.40 [−1.03, 5.84]; type 2 diabetes: 2.87 [−0.55, 6.29], p for trend = 0.083; measurement unit). Higher HbA1c levels were associated with wider retinal arterioles (standardised β = 0.043 [95% CI 0.00002, 0.085]; p = 0.050) but the association with wider venules did not reach statistical significance (0.037 [−0.006, 0.080]; p = 0.092) after adjustment for potential confounders. Conclusions/interpretation: Type 2 diabetes, higher levels of HbA1c and, possibly, prediabetes, are independently associated with wider retinal arterioles in a predominantly white population. These findings indicate that microvascular dysfunction is an early phenomenon in impaired glucose metabolism.

Original languageEnglish
Pages (from-to)1408-1417
Number of pages10
Issue number7
Publication statusPublished - 1 Jul 2020
Externally publishedYes


  • Clinical diabetes
  • Epidemiology
  • Human
  • Microvascular disease
  • Pathogenic mechanism
  • Pathophysiology/metabolism


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