Resumen de Retinal Vascular Caliber as a Biomarker for Diabetes Microvascular Complications
M. Kamran Ikram, Carol Cheung, Mara Lorenzi, Ronald Klein, Teresa L.Z. Jones, Tien Yin Wong
Globally, the number of people with diabetes is expected to reach 552 million in 2030 (1). Both the macrovascular (coronary artery disease, peripheral artery disease, and stroke) and microvascular (retinopathy, nephropathy, and neuropathy) complications of diabetes are major causes of morbidity and mortality (2). In theory, the long preclinical phase should provide a window to apply interventions that preempt progression to clinical disease, but to date no strategy achieves this aim for diabetes complications. Intensive control of hyperglycemia and blood pressure implemented with the imperfect means available today delays the appearance and reduces the severity of most complications, but does not prevent their development (3). Drugs such as fenofibrate have reduced the risk of diabetic retinopathy (DR) progression in type 2 diabetic patients, and inhibitors of the renin-angiotensin system (e.g., enalapril, losartan) have reduced the risk of progression in type 1 diabetic patients, but have not reduced the risk of DR incidence. Thus, new approaches are required to derive further benefit from current interventions at an earlier stage of diabetes and to support the development of new interventions. One such approach is to identify biomarkers that will enable systematic patient surveillance and the identification of high-risk patients and also surrogate end points that will accelerate the discovery of new interventions.
The retinal vessels are early and prevalent targets of diabetic damage. They can be seen, measured, and tested by noninvasive means (4). Hence, investigators have attempted over the decades to identify early changes in the retinal vessels in diabetes and determine whether they could inform about the development of retinopathy and other complications. New measuring techniques have steadily come along, and others are in development. It seems timely to assess which concepts have emerged and which needs must be met toward fulfilling the expectation that retinal vessels may be able �
