Glycemic variability indices associated with diabetic retinopathy in patients with type 2 diabetes mellitus

Objective. To study short-term and long-term glycemic variability (GV) as factors associated with DR, its severity, and the progression of diabetic retinopathy in patients with type 2 diabetes mellitus. Materials and methods. A retrospective analysis was conducted of 593 patients with type 2 diabetes (419 women (70.66 %) and 174 men (29.32 %), disease duration 10 [6; 15] years) who underwent ophthalmological examination in the Laser Microsurgery Department of the City Clinical Hospital No. 10 for the period 2016-2023 was performed. DR was noted in 165 patients. The study included 428 patients without exudative-hemorrhagic manifestations. The dynamic of disease progression was monitored over a oneyear and three-year period. The GV SD, CV, MAGE, and TIR indices were calculated. Statistical data processing was performed using the Statistica 12 software package. Results. A GV SD threshold of 0.854 and MAGE 0.967 was established to detect the presence of DR. The SD and MAGE indices were statistically significantly higher in patients with DR (1.253 [0.707; 1.893] vs 0.707 [0.283; 1.414], p = 0.021 and 1.4 [0.9; 2.3] vs 0.9 [0.4; 1.833], p = 0.021). Progression of DR in the first year of observation was associated with higher rates of short-term GV SD (3.8 [2.68; 4.9] vs 1.15 [0.71; 1.4], p = 0.045); CV (41.3 [35.37; 47.1] vs 15.71 [8.14; 16.0], p = 0.045), MAGE (4.9 [2.87; 7.0] vs 1.3 [1.0; 2.0], p = 0.045). Progression of DR in the third year of observation was associated with higher rates of long-term GV SD HbA1c (3.418 [3.042; 5.219] vs 0.202 [0.0; 0.52], p = 0.052). Conclusion. VG was associated with the presence of DR and its progression, but cannot be used as a sole marker. Further research is needed to establish a comprehensive set of markers that is effective in assessing the risk of DR progression.