Correlation Of Diabetic Retinopathy Severity With Myocardial Remodeling And Quality Of Life In Type II Diabetes Mellitus Patients

Abstract

Background: Type II diabetes mellitus (T2DM) is associated with microvascular complications like diabetic retinopathy (DR) and macrovascular complications such as myocardial remodeling, both of which impair quality of life (QoL). This study explores the relationship between DR severity, cardiac structural changes, and QoL in T2DM patients to guide integrated care.

Methods: A cross-sectional study was conducted at R. L. Jalappa Hospital, Kolar, involving 97 T2DM patients with over 5 years of disease duration and no prior cardiac history. Assessments included visual acuity (Snellen chart), slit-lamp biomicroscopy, posterior segment evaluation (indirect ophthalmoscopy, +90D biomicroscopy), echocardiography, and electrocardiography (ECG). DR was graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. QoL was evaluated with the using Cardiomyopathy Questionnaire (Kansas city)- KCCQ-12. Data were analyzed using SPSS, employing descriptive statistics and logistic regression (p<0.05).

Results: DR severity correlated with increased left ventricular end-diastolic diameter (LVDD) (47.3±6.5 mm in proliferative DR [PDR] vs. 42.5±4.2 mm in normal fundus, p=0.01), left ventricular systolic diameter (LVDS) (33.2±5.7 mm vs. 28.3±3.8 mm, p=0.02), and reduced left ventricular ejection fraction (LVEF) (43.5±8.9% vs. 55.2±6.1%, p<0.001). ECG abnormalities were prevalent in 90% of PDR patients (p<0.001). Severe DR was associated with elevated systolic blood pressure (135.4±18.6 mmHg vs. 124.3±12.8 mmHg, p=0.03), poor glycemic control (HbA1c 10.8±2.5% vs. 8.1±1.6%, p<0.001), and nephropathy markers (serum creatinine 2.4±1.5 mg/dL vs. 1.2±0.6 mg/dL, p<0.01). QoL declined significantly with DR progression (p=0.04), driven by cardiac symptoms and psychological distress. Diabetes duration >10 years was linked to severe DR, cardiac remodelling, and renal impairment (p<0.001).

Conclusion: Progressive DR is associated with myocardial remodelling, increased cardiovascular risk, and reduced QoL in T2DM patients. Severe DR serves as a marker for cardiac dysfunction, necessitating integrated ophthalmic and cardiovascular screening. Early glycemic control and multidisciplinary care are critical to mitigate complications and enhance QoL.