Meta Analysis Of The Relationship Between Glucose Variability And Type 2 Diabetic Retinopathy

Objective:Glucose variability(GV)has been proved to be closely related to macrovascular complications of type 2 diabetes,but its relationship with microvascular lesions of type 2 diabetes is still unclear.The purpose of this study was to compare the difference of glucose variability between people with type 2 diabetic retinopathy and those without retinopathy in order to explore the relationship between glucose variability and type 2 diabetic retinopathy.Methods:1.Search strategy:Pubmed,Cochrane Library,Embase,Web of science,China National Knowledge Infrastructure,Wanfang,VIP database,China Biomedical Databases were searched.2.Selection criteria:Studies was included to compare the glucose variability of patients with type 2 diabetic retinopathy and those without retinopathy,and the data of glucose variability should be represented by （?）(mean)and SD(standard deviation),or （?） and SD can be obtained by calculation.3.Data extraction and analysis:RevMan5.3 software and STATA12.0software was used for the Meta analysis.Fixed effect model was used when I~2<50%,and random effect model was used when I~2≥50%to calculate the total weighted mean difference(WMD)and 95%confidence interval(CI).Results:In the seventeen included studies,mean amplitude of glycemic excursion(MAGE)were significantly higher in the diabetic retinopathy(DR)group than in the non-diabetic retinopathy(NDR)group(WMD and 95%CI were 2.12[1.66,2.58],P<0.00001).In the subgroup of HbA1c<7%,MAGE of the DR group was significantly higher than that of the NDR group(WMD and95%CI were 2.12[1.62,2.63],P<0.00001);In the subgroup without restricted HbA1c range,MAGE of the DR group was significantly higher than that of the NDR group(WMD and 95%ci were 2.14[1.56,2.71],P<0.00001).In the northern of China,MAGE were significantly higher in the DR group than in the NDR group(WMD and 95%CI were 1.96[1.78,2.14],P<0.00001);In the southern of China,MAGE were significantly higher in the DR group than in the NDR group(WMD及95%CI为2.13[1.26,3.01],P<0.00001).The MAGE of the DR group examined by fundus photography was significantly higher than that of the NDR group(WMD and 95%CI were 2.28[1.05,3.50],P<0.0003).MAGE of the DR group examined by Fundus fluorography was significantly higher than that of the NDR group(WMD and 95%CI were2.34[1.86,2.81],P<0.00001);MAGE of the DR group examined by Fundus photography combined with fundus fluorography was significantly higher than that of the NDR group(WMD and 95%CI were 2.34[1.87,1.67],P<0.00001).In the nine included studies,compared with the proliferative diabetic retinopathy(PDR)group,MAGE was significantly lower than that in the non-proliferative diabetic retinopathy(NPDR)group(WMD and 95%CI were-1.09[-1.42,-0.77],P<0.00001).Compared with the NDR group,MAGE were significantly higher in the NPDR group(WMD and 95%CI were 1.52[1.25,1.79],P<0.00001).In the three included studies reported MODD values,MODD of the DR group were higher than that in the NDR group(WMD and 95%ci were 0.89[0.21,1.57],P=0.01).Conclusion:The inter-and intra-day glucose variability in diabetic retinopathy group was higher than that in diabetic non-retinopathy group.From diabetic non-retinopathy group to non-proliferative retinopathy group and then proliferative retinopathy group,the glucose variability presented a gradually increasing trend.Glucose variability may play an important role in the occurrence and progression of diabetic retinopathy,and reducing glucose variability as much as possible may become an important means to control the occurrence and development of diabetic retinopathy.