Correlation And Diagnostic Value Of Lens Advanced Glycation End-products With Micro Vascular Complications Of Type 2 Diabetes

BackgroundIn patients with type 2 diabetes mellitus(T2DM),the accumulation of advanced glycation end products(AGEs)can be much higher than in the non-diabetic population due to the long-term increase in circulating glucose.AGEs have been shown to be strongly associated with diabetic microangiopathy,such as Diabetic Retinopathy(DR),Diabetic Peripheral Neuropathy(DPN),Diabetic Nephropathy(DN),and impairs pancreatic islet beta-cell function,leading to disease progression.ObjectiveTo apply advanced glycation end products scan instruments(AGEs-scan)to detect the accumulation level of advanced glycation end products in the lens and to assess the correlation and diagnostic value of intra-lens AGEs(%)(Lens AGEs(%))levels with microvascular complications(DR,DPN,DKD)in T2DM patients;to find an optimal Lens AGEs(%)cut-point value for early warning of T2DM microvascular complications,and to further investigate the concordance between the level of Lens AGEs(%)accumulation and the different diabetic microvascular complication stages.The aim is to accurately screen the risk of microvascular complications in T2DM and promote early detection,early intervention and early treatment.MethodThis is a single-center cross-sectional study that included a total of 313 patients with T2DM,including 105 patients with T2DM alone and 208 patients with T2DM microvascular complications,who were seen in the Department of Endocrinology,Qilu Hospital,Shandong University from March 2022 to March 2023.Clinical data were collected,and all patients underwent AGEs-scan examination.Baseline data of the study subjects were compared between two groups using independent sample T-test or Mann-Whitney U test according to the distribution,and between multiple groups using one-way ANOVA analysis or K independent sample test;Spearman rank correlation analysis was selected to assess the correlation between Lens AGEs(%)and other indexes in T2DM patients,and multi-factor Logistic regression was used to analyze the factors influencing Lens AGEs(%);ROC curves were plotted to clearly distinguish the cut-point values of parameters between patients with T2DM alone and those with T2DM with microvascular complications,and binary logistic regression was used to analyze the risk of disease in the positive group;ROC curves were plotted to clearly identify the respective cut-point values of DR,DPN,and DKD in the T2DM population,and the The indicators with statistically significant measures were analyzed by multi-factor logistic regression to screen out independent risk factors for DR,DPN,and DKD.p<0.05 or p<0.01 were considered statistically significant differences.Results1.The differences in gender composition ratio between the T2DM alone group and the T2DM with microvascular complications group were statistically significant(p<0.05);Lens AGEs(%),duration of diabetes,glycated hemoglobin,fasting glucose,urinary albumin creatinine ratio,and urea nitrogen were higher in the T2DM with microvascular complications group than in the T2DM alone group;C-peptide-corrected pancreatic β-cell function,albumin glomerular filtration rate,and fasting C-peptide were lower than those in the T2DM-only group,and the differences were statistically significant(p<0.05).2.The area under the curve(AUC)of Lens AGEs(%)for the diagnosis of T2DM microvascular complications was 0.78 {95%CI:(0.73,0.84)},optimal cut point value was 25.53,sensitivity:82.2%,specificity:66.7%,and Jorden index:48.9%;Lens AGEs(%)≥25.53 were defined as the positive group,and Lens AGEs(%)<25.53 were defined as the negative group.Lens AGEs(%)<25.53 were defined as the negative group,and the prevalence of microvascular complications in T2DM was significantly higher in the positive group than in the negative group;using binary logistic regression analysis,the risk of microvascular complications in the positive group was 8.16 times higher than that in the negative group after adjusting for confounding factors(p<0.001).3.The prevalence of DR in the positive group was 58.3%,significantly higher than that in the negative group(22.4%);the prevalence of DPN in the positive group was 70.9%,significantly higher than that in the negative group(20.6%);the prevalence of DKD in the positive group was 27.2%,significantly higher than that in the negative group(11.2%),all p<0.01.4.Lens AGEs(%),duration of diabetes,pulse,glycated hemoglobin,urinary albumin creatinine ratio,and urea nitrogen were higher in the DR group than in the NDR group,and fasting C-peptide,albumin,C-peptide-corrected islet β-cell function,and glomerular filtration rate were lower than in the NDR group,and the differences were statistically significant(p<0.05).5.The area under the curve(AUC)of Lens AGEs(%)for the diagnosis of DR was 0.75 {95%CI:(0.70,0.81)},the best cut point value was 31.69,sensitivity:59.0%,specificity:85.0%,and Jorden index:43.6%;the more severe the DR lesion,the more significantly the Lens AGEs(%)increased,and Logistic regression analysis showed that Lens AGEs(%)was an independent risk factor for DR(p<0.001).6.Lens AGEs(%),duration of diabetes,glycated hemoglobin,urinary albumin creatinine ratio,and urea nitrogen were higher in the DPN group than in the NDPN group,and fasting C-peptide,C-peptide-corrected islet β-cell function,and albumin were lower than in the NDPN group,with statistically significant differences(p<0.05).7.The area under the curve(AUC)of Lens AGEs(%)for the diagnosis of DPN was 0.76 {95%CI:(0.70,0.81)},the best cut point value was 25.53,sensitivity:86.9%,specificity:58.6%,and Jorden index:45.5%;the more severe the lesion of DPN,the more significantly its Lens AGEs(%)were elevated.Logistic regression analysis showed that Lens AGEs(%)was an independent risk factor for DPN(p<0.001).8.Lens AGEs(%),duration of diabetes mellitus,duration of hypertension,systolic blood pressure,pulse rate,glycated hemoglobin,total cholesterol,creatinine,urea nitrogen,and blood uric acid were higher in the DKD group than in the NDKD group,and height,ghrelin,albumin,and glomerular filtration rate were lower than in the NDKD group.9.The area under the curve(AUC)of Lens AGEs(%)for the diagnosis of DKD was 0.69 {95%CI:(0.61,0.76)},and the best cut point was 32.38,sensitivity:60.3%,specificity:73.9%,and Yordon index:34.2%;the more severe the lesion of DKD,the more significantly its Lens AGEs(%)were elevated,and logistic regression analysis showed that Lens AGEs(%)was an independent risk factor for DKD(p<0.05).10.Lens AGEs(%)were positively correlated with glycated hemoglobin,duration of diabetes,and total cholesterol(p<0.05),and negatively correlated with C-peptide-corrected islet β-cell function and fasting C-peptide values(p<0.05);logistic regression analysis showed that duration of diabetes,glycated hemoglobin,and total cholesterol were independent influences on Lens AGEs(%)(p<0.05).Conclusion1.Lens AGEs(%)correlated well with the risk of developing microvascular complications in T2DM,with an optimal cut-point value of 25.23 for diagnosing T2DM with microvascular complications and 31.68,25.23,and 32.38 for diagnosing DR,DPN,and DKD,respectively.2.Lens AGEs(%)were independent risk factors for the development of DR,DPN,and DKD,and the level of Lens AGEs(%)was positively correlated with the progression of DR,DPN,and DKD and may be involved in the development of DR,DPN,and DKD.3.Lens AGEs(%)may assist in the identification of microvascular complications of T2DM.