Association between physical activity and severity of diabetic retinopathy in patients with diabetes mellitus
Researcher Bulletin of Medical Sciences,
Vol. 25 No. 1 (2020),
21 September 2020
,
Page e8
Abstract
Background: Diabetes mellitus (DM) and its related complications such as diabetic retinopathy (DR) are among considerably growing global concerns. Many efforts have been done toward a better understanding of the modifiable risk factors of DR, to stop progression as well as prevention of this complication. Physical activity (PA) is a known modifiable risk factor of DM but its effect on the severity of DR is not clearly understood. In this study, we aimed to evaluate the association between PA and severity of DR.
Materials and Methods: A case-control study was done comprising 232 patients with DM (type 1 or 2), 58 of whom were in control group with no sign of DR, while the others were divided into three subgroups each contained 58 individuals, according to the severity of DR. PA of patients was assessed by the International Physical Activity Questionnaire (IPAQ) short-version and total scores of PA were compared among different groups.
Result: Total PA scores in (metabolic equivalent [MET]-hour/week) in control group, in patients with mild to moderate non-proliferative diabetic retinopathy (NPDR), severe to very severe NPDR, and proliferative diabetic retinopathy were 24.6 ±28.3, 23.7 ±30.6, 17.1 ± 27.0, and 7.1 ±10.2, respectively. The lower the score of PA, the higher the stage of DR (r=-0.284, p<0.001). Low PA levels came with higher stages of DR (odds ratio [OR]=2.7, P=0.023) than moderate PA (OR=2.1, P=0.114). When adjusted for age, sex, duration of DM, and type of medication regimen, the association of DR severity with PA level was still statistically significant in mild PA group (P=0.049) and statistically insignificant in moderate PA group (P=0.132). Adjusting for hemoglobin A1c (HbA1c) and body mass index (BMI) showed no significant correlation between PA level and DR severity (OR=1.1 and P=0.794 in low PA group, OR=1.2 and P=0.670 in moderate PA group).
Conclusion: Low PA level can be identified as a risk factor for DR, but not a completely independent one. It is more likely that PA lowers the risk of DR progression through lowering BMI and achieving better glycemic control (HbA1c).
- Body mass index; Diabetic retinopathy; HbA1c; International physical activity questionnaire; Physical activity
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References
2. Klein BE. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic Epidemiol. 2007; 14:179-183.
3. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012; 35:556-564.
4. Amini M, Parvaresh E. Prevalence of macro-and microvascular complications among patients with type 2 diabetes in Iran: a systematic review. Diabetes research and clinical practice. 2009 Jan 1;83(1):18-25.
5. Wang W, Lo A. Diabetic retinopathy: pathophysiology and treatments. International journal of molecular sciences. 2018 Jun;19(6):1816.
6. Hordern MD, Dunstan DW, Prins JB, Baker MK, Singh MA, Coombes JS. Exercise prescription for patients with type 2 diabetes and pre-diabetes: a position statement from Exercise and Sport Science Australia. Journal of Science and Medicine in Sport. 2012 Jan 1;15(1):25-31.\
7. Dirani M, Crowston JG, van Wijngaarden P. Physical inactivity as a risk factor for diabetic retinopathy? A review. Clinical & experimental ophthalmology. 2014 Aug;42(6):574-81.
8. Wadén J, Forsblom C, Thorn LM, Saraheimo M, Rosengård-Bärlund M, Heikkilä O, Lakka TA, Tikkanen H, Groop PH. Physical activity and diabetes complications in patients with type 1 diabetes: The Finnish Diabetic Nephropathy (FinnDiane) Study. Diabetes care. 2008 Feb 1;31(2):230-2.
9. Makura CB, Nirantharakumar K, Girling AJ, Saravanan P, Narendran P. Effects of physical activity on the development and progression of microvascular complications in type 1 diabetes: retrospective analysis of the DCCT study. BMC endocrine disorders. 2013 Dec;13(1):37.
10. Global recommendations on physical activity for health. Switzerland: World Health Organisation, WHO2010.
11. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification: ETDRS report number 10. Ophthalmology. 1991 May 1;98(5):786-806.
12. Moghaddam MB, Aghdam FB, Jafarabadi MA, Allahverdipour H, Nikookheslat SD, Safarpour S. The Iranian Version of International Physical Activity Questionnaire (IPAQ) in Iran: content and construct validity, factor structure, internal consistency and stability. World applied sciences journal. 2012;18(8):1073-80.
13. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B. Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes care. 2010 Dec 1;33(12):e147-67.
14. Aiello LP, Wong J, Cavallerano JD, et al.Retinopathy. In: Ruderman N, Devlin JT, Schneider SH, Kriska A (eds) Handbook of exercise in diabetes, 2nd ed. Alexandria, VA: American Diabetes Association, 2002, pp.401–413.
15. Umpierre D, Ribeiro PA, Kramer CK, Leitão CB, Zucatti AT, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. Jama. 2011 May 4;305(17):1790-9.
16. Nordwall M, Abrahamsson M, Dhir M, Fredrikson M, Ludvigsson J, Arnqvist HJ. Impact of HbA1c, followed from onset of type 1 diabetes, on the development of severe retinopathy and nephropathy: the VISS Study (Vascular Diabetic Complications in Southeast Sweden). Diabetes care. 2015 Feb 1;38(2):308-15.
17. Cho NH, Kim TH, Woo SJ, Park KH, Lim S, Cho YM, Park KS, Jang HC, Choi SH. Optimal HbA1c cutoff for detecting diabetic retinopathy. Acta diabetologica. 2013 Dec 1;50(6):837-42.
18. LaPorte RE, Dorman JS, Tajima N, Cruickshanks KJ, Orchard TJ, Cavender DE, Becker DJ, Drash AL. Pittsburgh insulin-dependent diabetes mellitus morbidity and mortality study: physical activity and diabetic complications. Pediatrics. 1986 Dec 1;78(6):1027-33.
19. Kriska AM, LaPorte RE, Patrick SL, Kuller LH, Orchard TJ. The association of physical activity and diabetic complications in individuals with insulin-dependent diabetes mellitus: The Epidemiology of Diabetes Complications Study—VII. Journal of clinical epidemiology. 1991 Jan 1;44(11):1207-14.
20. Cruickshanks KJ, Moss SE, Klein R, Klein BE. Physical activity and the risk of progression of retinopathy or the development of proliferative retinopathy. Ophthalmology. 1995 Aug 1;102(8):1177-82.
21. Dharmastuti DP, Agni AN, Widyaputri F, Pawiroranu S, Sofro ZM, Wardhana FS, Haryanto S, Widayanti TW, Kotha S, Gupta P, Sasongko MB. Associations of physical activity and sedentary behaviour with vision-threatening diabetic retinopathy in Indonesian population with type 2 diabetes mellitus: Jogjakarta Eye Diabetic Study in the Community (JOGED. COM). Ophthalmic epidemiology. 2018 Mar 4;25(2):113-9.
22. Chen Y, Sloan FA, Yashkin AP. Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death. Journal of Diabetes and its Complications. 2015 Nov
23. Praidou A, Harris M, Niakas D, Labiris G. Physical activity and its correlation to diabetic retinopathy. Journal of Diabetes and its Complications. 2017 Feb 1;31(2):456-61.
24. Janevic MR, McLaughlin SJ, Connell CM. The association of diabetes complications with physical activity in a representative sample of older adults in the United States. Chronic illness. 2013 Dec;9(4):251-7.
25. Bener A, Al-Laftah F, Al-Hamaq AO, Daghash M, Abdullatef WK. A study of diabetes complications in an endogamous population: an emerging public health burden. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2014 Apr 1;8(2):108-14.
26. Cruickshanks KJ, Moss SE, Klein R, Klein BE. Physical activity and proliferative retinopathy in people diagnosed with diabetes before age 30 yr. Diabetes care. 1992 Oct 1;15(10):1267-72.
27. Loprinzi PD, Brodowicz GR, Sengupta S, Solomon SD, Ramulu PY. Accelerometer-assessed physical activity and diabetic retinopathy in the United States. JAMA ophthalmology. 2014 Aug 1;132(8):1017-9.
28. Schneider SH, Khachadurian AK, Amorosa LF, Clemow L, Ruderman NB. Ten-year experience with an exercise-based outpatient life-style modification program in the treatment of diabetes mellitus. Diabetes care. 1992 Nov 1;15(11):1800-10.
29. Kuwata H, Okamura S, Hayashino Y, Tsujii S, Ishii H, Diabetes Distress and Care Registry at Tenri Study Group. Higher levels of physical activity are independently associated with a lower incidence of diabetic retinopathy in Japanese patients with type 2 diabetes: A prospective cohort study, Diabetes Distress and Care Registry at Tenri (DDCRT15). PloS one. 2017 Mar 3;12(3):e0172890.
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