Introduction Cerebral small-vessel disease is common in neurologically asymptomatic individuals with type 1 diabetes. The retinal vasculature is thought to mirror the brain’s vasculature, but data on this association are limited in type 1 diabetes. Our aim was to study associations between diabetic retinopathy severity and cerebral small-vessel disease in type 1 diabetes. Research design and methods For this cross-sectional study, we enrolled 189 participants with type 1 diabetes (median age 40 (33–45) years; 53% female; diabetes duration 21.6 (18.2–30.7) years) and 29 healthy age-matched and sex-matched controls as part of the Finnish Diabetic Nephropathy Study. Participants underwent a clinical investigation, brain MRI, and fundus imaging. Signs of cerebral small-vessel disease in brain MRIs were analyzed in relation to diabetic retinopathy severity (Early Treatment Diabetic Retinopathy Study (ETDRS) score). Results In type 1 diabetes, participants with cerebral small-vessel disease had higher ETDRS scores (35 (20–61) vs 20 (20–35), p=0.022) and a higher prevalence of proliferative diabetic retinopathy than those without cerebral small-vessel disease (25% vs 9%, p=0.002). In adjusted analysis, proliferative diabetic retinopathy was associated with cerebral small-vessel disease (OR 2.57 (95% CI 1.04 to 6.35)). Median ETDRS score (35 (20–65) vs 20 (20–35), p=0.024) and proliferative diabetic retinopathy prevalence were higher (29% vs 13%, p=0.002) in participants with versus without cerebral microbleeds. ETDRS scores increased by number of cerebral microbleeds (p=0.001), both ETDRS score (OR 1.05 (95% CI 1.02 to 1.09)) and proliferative diabetic retinopathy (8.52 (95% CI 1.91 to 37.94)) were associated with >2 cerebral microbleeds in separate multivariable analysis. We observed no association with white matter hyperintensities or lacunar infarcts. Conclusions Presence of cerebral small-vessel disease on brain MRI, particularly cerebral microbleeds, is associated with the severity of diabetic retinopathy. Data are available upon reasonable request. The data that support the findings are available from the corresponding author upon reasonable request.

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脑小血管疾病与 1 型糖尿病患者糖尿病视网膜病变的严重程度相关

简介 脑小血管疾病在无神经症状的 1 型糖尿病患者中很常见。视网膜脉管系统被认为反映了大脑的脉管系统，但关于这种关联的数据仅限于 1 型糖尿病。我们的目的是研究糖尿病视网膜病变严重程度与 1 型糖尿病脑小血管疾病之间的关联。研究设计和方法 在这项横断面研究中，我们招募了 189 名 1 型糖尿病参与者（中位年龄为 40 (33-45) 岁；53% 为女性；糖尿病病程为 21.6 (18.2-30.7) 岁）和 29 名年龄匹配的健康受试者和性别匹配的对照作为芬兰糖尿病肾病研究的一部分。参与者接受了临床调查、脑部 MRI 和眼底成像。分析了脑 MRI 中脑小血管疾病的迹象与糖尿病视网膜病变严重程度的关系（早期治疗糖尿病视网膜病变研究 (ETDRS) 评分）。结果 在 1 型糖尿病中，与没有脑小血管疾病的参与者相比，患有脑小血管疾病的参与者具有更高的 ETDRS 评分（35（20-61）比 20（20-35），p=0.022）和增殖性糖尿病视网膜病变的患病率更高。血管疾病（25% 对 9%，p=0.002）。在校正分析中，增殖性糖尿病视网膜病变与脑小血管疾病相关（OR 2.57（95% CI 1.04 至 6.35））。有脑微出血的参与者与无脑微出血的参与者的中位 ETDRS 评分（35（20-65）比 20（20-35），p=0.024）和增殖性糖尿病视网膜病变患病率更高（29% 对 13%，p=0.002）。ETDRS 评分随脑微出血次数增加 (p=0.001)，在单独的多变量分析中，ETDRS 评分（OR 1.05（95% CI 1.02 至 1.09））和增殖性糖尿病视网膜病变（8.52（95% CI 1.91 至 37.94））均与 >2 次脑微出血相关。我们观察到与白质高信号或腔隙性梗塞无关。结论 脑部 MRI 显示的脑小血管病变，尤其是脑微出血，与糖尿病视网膜病变的严重程度相关。可应合理要求提供数据。应合理要求，通讯作者可提供支持研究结果的数据。我们观察到与白质高信号或腔隙性梗塞无关。结论 脑部 MRI 显示的脑小血管病变，尤其是脑微出血，与糖尿病视网膜病变的严重程度相关。可应合理要求提供数据。相应作者可根据合理要求提供支持研究结果的数据。我们观察到与白质高信号或腔隙性梗塞无关。结论 脑部 MRI 显示的脑小血管病变，尤其是脑微出血，与糖尿病视网膜病变的严重程度相关。可应合理要求提供数据。相应作者可根据合理要求提供支持研究结果的数据。