Cerebral micro-angiopathy caused by diabetes can manifest itself as an impairment in cerebrovascular reactivity. Transcranial doppler ultrasound (TCD) is a cost-effective and non-invasive way to measure the cerebrovascular reactivity. This study aimed to assess the relationship between the grade of diabetic retinopathy and cerebrovascular reactivity changes as determined by TCD with breath-holding technique. A total of 43 diabetic patients with matched severity of diabetic retinopathy between their right and left eyes were included. Diabetic retinopathy was graded as mild, moderately severe, and severe in 27.9%, 34.9% and 37.2% of the patients, respectively. The grade of diabetic retinopathy was associated with the HbA1c level (p<0.049), microalbuminuria (p<0.024), and breath holding index (BHI) (p=0.001). In patients with severe diabetic retinopathy, the right-sided BHI was significantly lower as compared to those with mild or moderately severe retinopathy (p=0.001 and p=0.008, respectively). The left-sided BHI value in patients with severe diabetic retinopathy was significantly lower as compared to those with mild or moderately severe retinopathy (p=0.001 and p=0.012, respectively). In subjects with moderately severe diabetic retinopathy, both-sided BHI was significantly reduced compared to those with mild retinopathy (p=0.001). Results indicate that the grade of diabetic retinopathy is associated with alterations in cerebral vasomotor reactivity in patients with diabetes. The risk of cerebrovascular events is more pronounced in diabetic patients with high-grade retinopathy than in patients with low-grade retinopathy. The authors suggest that necessary precautions should be taken to protect these patients from cerebrovascular risk.
Relationship between diabetic retinopathy and cerebrovascular reactivity changes
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