Assessing association of serum vitamin D levels and diabetic retinopathy in Asian Indians with type 2 diabetes Open Access

Abstract

Background: Vitamin D deficiency (VDD) is a condition that has been associated with diabetic retinopathy (DR) in various populations, but has not been studied in Asian Indians.

Aim : To evaluate the association of serum 25-hydroxyvitamin D (25(OH)D) levels with presence and severity of DR among Asian Indians with type 2 diabetes.

Methods: We collected information on individuals with type 2 diabetes that received care at a tertiary diabetes centre in southern India, between 2012 and 2015. Patients were 18 years of age or older, underwent retinal examinations with DR grading, had serum 25(OH)D measurements, and were not taking vitamin D supplements. Relevant clinical and biochemical parameters were included in the assessment and VDD was diagnosed if 25(OH)D levels were <20ng/ml.

Results: Serum 25(OH)D levels were lower in patients with retinopathy compared to those without (11.9 ± 2.2ng/ml vs. 13.7 ± 2.1ng/ml, p<0.001). Stratifying patients by DR grade, reduced geometric means of 25(OH)D levels were associated with increased retinopathy severity: no DR (13.7 ± 2.1ng/ml), non-sight threatening DR (12.8 ± 2.1ng/ml), and sight threatening DR (11.1 ± 2.2ng/ml) (p<0.0001). After adjusting for six key covariates, VDD increased the odds of developing proliferative DR (OR 2.05; 95% CI 1.35-3.11; p=0.001).

Conclusion: In Asian Indians with type 2 diabetes, (1) lower serum 25(OH)D was associated with increased severity of DR and (2) the presence of VDD was associated with a two-fold increased risk for proliferative DR.

Table of Contents

INTRODUCTION............................................................................................................. 1

METHODS........................................................................................................................ 3

RESULTS........................................................................................................................... 6

DISCUSSION.................................................................................................................... 7

REFERENCES................................................................................................................. 10

TABLES AND FIGURE................................................................................................. 16

Table 1: Characteristics of study population ................................................................... 16

Table 2: Logistic regression models assessing relationship between vitamin D deficiency and diabetic retinopathy presence and severity... 17

Figure 1: Serum 25(OH)D levels in non-sight threatening and sight threatening retinopathy ... 18

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Ophthalmology Health Sciences, General
Keyword	serum vitamin D type 2 diabetes diabetic retinopathy vitamin D deficiency
Committee Chair / Thesis Advisor	Venkat Narayan, K.M., Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider University, college or educational institution (other than Emory)

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