Retinal arteriolar narrowing and risk of diabetes mellitus in middle-aged persons
Abstract
CONTEXT: Microvascular processes have been hypothesized to play a role in the pathogenesis of type 2 diabetes mellitus, but prospective clinical data regarding this hypothesis are unavailable. OBJECTIVE: To examine the relation of retinal arteriolar narrowing, a marker of microvascular damage from aging, hypertension, and inflammation, to incident diabetes in healthy middle-aged persons. DESIGN, SETTING, AND PARTICIPANTS: The Atherosclerosis Risk in Communities Study, an ongoing population-based, prospective cohort study in 4 US communities that began in 1987-1989. Included in this analysis were 7993 persons aged 49 to 73 years without diabetes, of whom retinal photographs were taken during the third examination (1993-1995). MAIN OUTCOME MEASURES: Incident diabetes (defined as fasting glucose levels of > or =126 mg/dL [7.0 mmol/L], casual levels of > or =200 mg/dL [11.1 mmol/L], diabetic medications use, or physician diagnosis of diabetes at the fourth examination) by quartile of retinal arteriole-to-venule ratio (AVR). RESULTS: After a median follow-up of 3.5 years, 291 persons (3.6%) had incident diabetes. The incidence of diabetes was higher in persons with lower AVR at baseline (2.4%, 3.1%, 4.0%, and 5.2%, from highest to lowest AVR quartile; P for trend < .001). After controlling for fasting glucose and insulin levels, family history of diabetes, adiposity, physical activity, blood pressure, and other factors, persons in the lowest quartile of AVR were 71% more likely to develop diabetes than those in the highest quartile (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.13-2.57; P for trend =.002). This association persisted with different diagnostic criteria (OR, 1.92; 95% CI, 1.10-3.36; P for trend =.01, using a fasting glucose level of > or =141 mg/dL [7.8 mmol/L] as a cutoff), and was seen even in people at lower risk of diabetes, including those without a family history of diabetes, without impaired fasting glucose, and with lower measures of adiposity. CONCLUSIONS: Retinal arteriolar narrowing is independently associated with risk of diabetes, supporting a microvascular role in the development of clinical diabetes.
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Prediabetes status may be associated with an increased risk of diabetic retinopathy, although findings vary depending on the method of detection.
“Prediabetes status may be associated with an increased risk of diabetic retinopathy although the findings vary depending on the method of detection.51,79–83”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [82]
Measures of retinal vascular changes, such as lower arteriole-to-venule ratio and increased retinal arteriole or venular calibre, have been shown to be related to prediabetes or increased risk of diabetes, but the evidence is not entirely consistent.
“Measures of retinal vascular changes, such as lower arteriole-to-venule ratio, increased retinal arteriole or venular calibre, have also been shown to be related to prediabetes or increased risk of diabetes, but the evidence is not entirely consistent.81–83”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [82]
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“Five studies assessed the relationship between retinal diameters and incident T2DM.(20,21,24,29,30) Table I in the online-only Data Supplement shows a higher incidence of T2DM with smaller baseline arteriolar diameters and AVR.”
BackgroundRetinal Microvascular Caliber and Chronic Kidney Disease in an Asian Population
Sabanayagam, C., Shankar, A., Koh, D. S. Q., Chia, K. S., Saw, S., Lim, S. C., Tai, E. S., & Wong, T. Y. (2008) · American Journal of Epidemiology · doi:10.1093/aje/kwn367 · Cited by 122 · see citing works
“Retinal arteriolar narrowing resulting from hypertension, cigarette smoking, inflammation, and other processes may provide a common pathophysiologic link for the development of diabetes and chronic kidney disease (12, 14).”
BackgroundSelf-citationThe innate immune system in diabetic retinopathy
Pan, W. W., Lin, F., & Fort, P. E. (2021) · Progress in Retinal and Eye Research · doi:10.1016/j.preteyeres.2021.100940 · Cited by 115 · see citing works
Hayden, M. R., & Tyagi, S. C. (2002) · Cardiovascular Diabetology · doi:10.1186/1475-2840-1-3 · Cited by 114 · see citing works
Retinal Arteriolar Narrowing Predicts Incidence of Diabetes
Nguyen, T. T., Wang, J. J., Islam, F. M. A., Mitchell, P., Tapp, R. J., Zimmet, P. Z., Simpson, R., Shaw, J., & Wong, T. Y. (2008) · Diabetes · doi:10.2337/db07-1376 · Cited by 112 · see citing works
“Two previous population-based studies reported that a smaller ratio of the retinal arteriolar to venular caliber (AV ratio) was associated with incident diabetes (8,9).”
BackgroundSelf-citationAge-related rarefaction in the fractal dimension of retinal vessel
Azemin, M. Z. C., Kumar, D., Wong, T. Y., Wang, J. J., Mitchell, P., Kawasaki, R., & Wu, H. R. (2010) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2010.04.010 · Cited by 109 · see citing works
“…is a non-invasively observed circulatory system in the human body, and may provide information about the microcirculation from healthy or diseased conditions of the retina and other vascular systems (Liew et al., 2008b; Wong et al., 2001; Wong et al., 2002a; Wong et al., 2002b; Wong, 2004).”
Self-citationRetinal vascular changes and diabetic retinopathy
Nguyen, T. T., & Wong, T. Y. (2009) · Current Diabetes Reports · doi:10.1007/s11892-009-0043-4 · Cited by 104 · see citing works
“In two early analyses, an association between smaller retinal AVR and incident diabetes was found in the ARIC study (OR 1.71; 95% CI, 1.13–2.57; comparing smallest to largest AVR quintile) and the BDES (OR 1.53; 95% CI, 1.03–2.27; comparing smallest to largest AVR quartile) [ 31 ,32].”
BackgroundInfluentialSelf-citationEffect of antihypertensive treatment on retinal microvascular changes in hypertension
Hughes, A. D., Stanton, A. V., Jabbar, A. S., Chapman, N., Martínez-Pérez, M. E., & Thom, S. (2008) · Journal of Hypertension · doi:10.1097/hjh.0b013e328304b072 · Cited by 101 · see citing works
Chronic inflammation role in the obesity-diabetes association: a case-cohort study
Luft, V. C., Schmidt, M. I., Pankow, J. S., Couper, D. J., Ballantyne, C. M., Young, J. H., & Duncan, B. B. (2013) · Diabetology & Metabolic Syndrome · doi:10.1186/1758-5996-5-31 · Cited by 98 · see citing works
“Additionally, adipokine-induced endothelial dysfunction of nutritive vascular beds with subsequent insulin resistance has been postulated [4], perhaps explaining why hypertension and markers of endothelial dysfunction, including those of microvascular circulation [18] have been found to predict the development of diab…”
BackgroundInfluence of Refractive Error and Axial Length on Retinal Vessel Geometric Characteristics
Lim, L. S., Cheung, C. Y.-L., Lin, X., Mitchell, P. L. R., Wong, T. Y., & Saw, S. (2010) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.10-6184 · Cited by 98 · see citing works
“Although the muscular wall of arterioles makes them more susceptible to luminal mechanical forces such as hydrostatic pressure,(56) retinal venule diameter is influenced primarily by factors such as metabolic syndrome, inflammation, and endothelial dysfunction.(14,57) The measures of network geometry that we analyzed…”
Self-citationCarrizzo, A., Izzo, C., Oliveti, M., Alfano, A., Virtuoso, N., Capunzo, M., Pietro, P. D., Calabrese, M., Simone, E. D., Sciarretta, S., et al. (2018) · International Journal of Molecular Sciences · doi:10.3390/ijms19102968 · Cited by 100 · see citing works
“Several markers and processes have revealed the alteration of endothelial function, such as elevated plasma levels of von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1), or cellular adhesion molecules [18–20]; impaired flow-mediated vasodilatation of the brachial artery [21]; altered forearm blood…”
BackgroundBMI and Retinal Vascular Caliber in Children
Cheung, N., Saw, S., Islam, A. F. M., Rogers, S., Shankar, A., de Haseth, K., Mitchell, P., & Wong, T. Y. (2007) · Obesity · doi:10.1038/oby.2007.576 · Cited by 96 · see citing works
“Studies show that narrower retinal arteriolar caliber is associated with hypertension (14), stroke (15), coronary heart disease (16), and diabetes (17), whereas wider retinal venular caliber has been linked to inflammation (18), metabolic syndrome (19), and obesity (20).”
BackgroundSelf-citationMicrovascular complications and diabetic retinopathy: recent advances and future implications
Barot, M., Gokulgandhi, M. R., Patel, S., & Mitra, A. K. (2013) · Future Medicinal Chemistry · doi:10.4155/fmc.12.206 · Cited by 92 · see citing works
Assessment of flow dynamics in retinal and choroidal microcirculation
Wei, X., Balne, P. K., Meissner, K. E., Barathi, V. A., Schmetterer, L. F., & Agrawal, R. V. (2018) · Survey of Ophthalmology · doi:10.1016/j.survophthal.2018.03.003 · Cited by 92 · see citing works
Retinal Vascular Signs and Cerebrovascular Diseases
Rim, T. H., Teo, A. W. J., Yang, H. H. S., Cheung, C. Y.-L., & Wong, T. Y. (2020) · Journal of Neuro-Ophthalmology · doi:10.1097/wno.0000000000000888 · Cited by 92 · see citing works
Self-citationMuris, D. M. J., Houben, A. J. H. M., Schram, M. T., & Stehouwer, C. D. A. (2013) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-012-9231-7 · Cited by 86 · see citing works
“Recently, we analyzed and pooled thirteen [81–93] prospective population-based studies in a meta-analysis”
Retinal Vascular Geometry in Asian Persons with Diabetes and Retinopathy
Cheung, C. Y.-L., Lamoureux, E. L., Ikram, M. K., Sasongko, M. B., Ding, J., Zheng, Y., Mitchell, P. L. R., Wang, J. J., & Wong, T. Y. (2012) · Journal of Diabetes Science and Technology · doi:10.1177/193229681200600315 · Cited by 84 · see citing works
Self-citationWong, T. Y., Wang, J. J., Rochtchina, E., Klein, R., & Mitchell, P. L. R. (2004) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2004.01.035 · Cited by 85 · see citing works
Self-citationNarasimha-Iyer, H., Beach, J. M., Khoobehi, B., & Roysam, B. (2007) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2007.900804 · Cited by 82 · see citing works
“tions include abnormality of the blood vessels [1].”
Backgroundde Jongh, R. T., IJzerman, R. G., Serné, E. H., Voordouw, J. J., Yudkin, J. S., de Waal, H. A. D., Stehouwer, C. D. A., & van Weissenbruch, M. M. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-1103 · Cited by 79 · see citing works
“This concept is supported not only cross-sectionally by relationships of microvascular dysfunction with insulin resistance, hypertension, and coronary heart disease risk as estimated by the Framingham risk score (5, 6) but also prospectively where arteriolar microvascular defects precede the occurrence of diabetes and…”
BackgroundHayden, M. R., Whaley‐Connell, A. T., & Sowers, J. R. (2005) · American Journal of Nephrology · doi:10.1159/000088810 · Cited by 78 · see citing works
Hypertensive Retinopathy: Incidence, Risk Factors, and Comorbidities
Erden, S., & Bıçakcı, E. (2012) · Clinical and Experimental Hypertension · doi:10.3109/10641963.2012.663028 · Cited by 79 · see citing works
Tikellis, G., Wang, J. J., Tapp, R. J., Simpson, R., Mitchell, P. R., Zimmet, P., Shaw, J. E., & Wong, T. Y. (2007) · Diabetologia · doi:10.1007/s00125-007-0822-x · Cited by 77 · see citing works
“In the Multi-Ethnic Study of Atherosclerosis (MESA), wider arterioles were related to higher serum glucose levels [26], but prospective data from the Atherosclerosis Risk In Communities (ARIC) study [27] and the Beaver Dam Eye Study suggest that wider arteriolar calibre is associated with a lower risk of diabetes [28].”
Self-citationRobust Methodology for Fractal Analysis of the Retinal Vasculature
Azemin, M. Z. C., Kumar, D., Wong, T. Y., Kawasaki, R., Mitchell, P. L. R., & Wang, J. J. (2010) · IEEE Transactions on Medical Imaging · doi:10.1109/tmi.2010.2076322 · Cited by 77 · see citing works
“It has been found to assist in identifying health or disease in the retina and other vascular systems [5]–[9].”
Self-citationRetinal vessel diameter, obesity and metabolic risk factors in school children (JuvenTUM 3)
Hanssen, H., Siegrist, M., Neidig, M., Renner, A., Birzele, P., Siclovan, A., Blume, K., Lammel, C., Haller, B., Schmidt‐Trucksäss, A., et al. (2011) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2011.12.029 · Cited by 76 · see citing works
Nguyen, T. T., Kawasaki, R., Kreis, A., Wang, J. J., Shaw, J. E., Vilser, W., & Wong, T. Y. (2009) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.09-3442 · Cited by 72 · see citing works
Self-citationZheng, Y., Cheung, N., Aung, T., Mitchell, P., He, M., & Wong, T. Y. (2009) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.09-3444 · Cited by 73 · see citing works
Self-citationEnd-organ dysfunction and cardiovascular outcomes: the role of the microcirculation
Lockhart, C., Hamilton, P., Quinn, C. E., & McVeigh, G. E. (2009) · Clinical Science · doi:10.1042/cs20080069 · Cited by 73 · see citing works
Roy, M. S. (2011) · Archives of Ophthalmology · doi:10.1001/archophthalmol.2010.340 · Cited by 72 · see citing works
Low Birthweight Is Associated With Narrower Arterioles in Adults
Liew, G., Wang, J. J., Duncan, B. B., Klein, R., Sharrett, A. R., Brancati, F. L., Yeh, H., Mitchell, P., & Wong, T. Y. (2008) · Hypertension · doi:10.1161/hypertensionaha.107.101584 · Cited by 71 · see citing works
Self-citationRetinal Neurovascular Coupling in Diabetes
Garhöfer, G., Chua, J., Tan, B., Wong, D. W. K., Schmidl, D., & Schmetterer, L. F. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9092829 · Cited by 72 · see citing works
van Hecke, M. V., Dekker, J. M., Nijpels, G., Stolk, R. P., Henry, R. M. A., Heine, R. J., Bouter, L. M., Stehouwer, C. D. A., & Polak, B. C. P. (2006) · Clinical Science · doi:10.1042/cs20050270 · Cited by 70 · see citing works
Clinical utility of the resistive index in atherosclerotic renovascular disease
Crutchley, T. A., Pearce, J. D., Craven, T. E., Stafford, J. M., Edwards, M. S., & Hansen, K. J. (2008) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2008.08.008 · Cited by 69 · see citing works
Retinal microvascular abnormalities and cognitive dysfunction: a systematic review
Ding, J., Patton, N., Deary, I. J., Strachan, M. W. J., Fowkes, F. G. R., Mitchell, R. J., & Price, J. F. (2008) · British Journal of Ophthalmology · doi:10.1136/bjo.2008.141994 · Cited by 69 · see citing works
Kifley, A., Wang, J. J., Cugati, S., Wong, T. Y., & Mitchell, P. L. R. (2008) · Microcirculation · doi:10.1080/10739680701812220 · Cited by 69 · see citing works
“Study (ARIC) and Beaver Dam Eye Study, suggested that a smaller retinal arteriole-to-venule ratio, previously thought to represent narrower retinal arterioles, is associated with incident type 2 diabetes [27, 29].”
ResultSelf-citationDo retinopathy signs in non-diabetic individuals predict the subsequent risk of diabetes?
Wong, T. Y. (2006) · British Journal of Ophthalmology · doi:10.1136/bjo.2005.084400 · Cited by 67 · see citing works
Self-citationLong-term Effects of Smoking on Retinal Microvascular Caliber
Kifley, A., Liew, G., Wang, J. J., Kaushik, S., Smith, W. T., Wong, T. Y., & Mitchell, P. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwm255 · Cited by 66 · see citing works
Self-citationIslam, A. F. M., Nguyen, T. T., Wang, J. J., Tai, E. S., Shankar, A., Saw, S., Aung, T., Lim, S.-C., Mitchell, P. L. R., & Wong, T. Y. (2008) · Eye · doi:10.1038/eye.2008.362 · Cited by 65 · see citing works
Self-citationQuantitative Analysis of Retinal Vessel Attenuation in Eyes with Retinitis Pigmentosa
Ma, Y., Kawasaki, R., Dobson, L. P., Ruddle, J. B., Kearns, L. S., Wong, T. Y., & Mackey, D. A. (2012) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.11-8596 · Cited by 63 · see citing works
Self-citationSabanayagam, C., Lye, W. K., Klein, R., Klein, B. E. K., Cotch, M. F., Wang, J. J., Mitchell, P. L. R., Shaw, J. E., Selvin, E., Sharrett, A. R., et al. (2015) · Diabetologia · doi:10.1007/s00125-015-3717-2 · Cited by 63 · see citing works
“This meta-analysis reported smaller retinal arteriole-to-venule ratio (AVR) to be associated with incident diabetes based on published data from three studies [19, 20, 23].”
InfluentialSelf-citationThe Diabetic Retinopathy “Pandemic” and Evolving Global Strategies: The 2023 Friedenwald Lecture
Wong, T. Y., & Tan, T. (2023) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.64.15.47 · Cited by 61 · see citing works
Self-citationDifferential association of retinal arteriolar and venular caliber with diabetes and retinopathy
Tsai, A. S. H., Wong, T. Y., Lavanya, R., Zhang, R., Hamzah, H., Tai, E. S., & Cheung, C. Y.-L. (2011) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2011.07.032 · Cited by 61 · see citing works
“[9] Wong TY, Klein R, Sharrett AR, Schmidt MI, Pankow JS, Couper DJ, et al.”
BackgroundSelf-citationRetinal vascular imaging in early life: insights into processes and risk of cardiovascular disease
Li, L., Ikram, M. K., & Wong, T. Y. (2015) · The Journal of Physiology · doi:10.1113/jp270947 · Cited by 61 · see citing works
“…al. 2012), Interactive Vessel Analysis (IVAN) was widely used in US studies (Wong et al. 2004; Liew et al. 2008a) and Asian studies (Li et al. 2011b), while Singapore I Vessel Assessment (SIVA) was newly developed and applied in recent Singaporean studies (Wong et al. 2002b; Cheung et al. 2011a).”
BackgroundMethodSelf-citationZaleska-Żmijewska, A., Wawrzyniak, Z. M., Dąbrowska, A., & Szaflik, J. P. (2019) · Journal of Diabetes Research · doi:10.1155/2019/9548324 · Cited by 58 · see citing works
Diabetes mellitus: oxidative stress and wine
Caimi, G., Carollo, C., & Presti, R. L. (2003) · Current Medical Research and Opinion · doi:10.1185/030079903125002324 · Cited by 58 · see citing works
Retinal microvascular changes and subsequent vascular events after ischemic stroke
Silva, D. A. D., Manzano, J. J. F., Liu, E. Y., Woon, F. P., Wong, W. K., Chang, H. M., Chen, C., Lindley, R. I., Wang, J. J., Mitchell, P., et al. (2011) · Neurology · doi:10.1212/wnl.0b013e31822c623b · Cited by 57 · see citing works
Self-citationWong, T. Y., Klein, R., Islam, A. F. M., Cotch, M. F., Couper, D. J., Klein, B. E. K., Hubbard, L. D., & Sharrett, A. R. (2007) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2007.02.020 · Cited by 56 · see citing works
Self-citationImpact of Size at Birth on the Microvasculature: The Avon Longitudinal Study of Parents and Children
Tapp, R. J., Williams, C., Witt, N., Chaturvedi, N., Evans, R., Thom, S., Hughes, A. D., & Ness, A. (2007) · PEDIATRICS · doi:10.1542/peds.2006-2951 · Cited by 56 · see citing works
“bifurcations minus 1), and (5) arteriolar optimality ratio”
BackgroundRetinal Vascular Caliber and Diabetes in a Multiethnic Asian Population
Jeganathan, V. S. E., Sabanayagam, C., Tai, E. S., Lee, J., Lamoureux, E. L., Sun, C., Kawasaki, R., & Wong, T. Y. (2009) · Microcirculation · doi:10.1080/10739680902975222 · Cited by 56 · see citing works
“Large population-based studies show that changes in retinal vascular caliber are associated with development of diabetes and impaired glucose metabolism [24,12,36,11,8,46,42], as well as coronary heart disease, stroke, and other diabetic complications, independent of traditional risk factors [18,44,16].”
BackgroundSelf-citationvan der Heijden, D. J., van Leeuwen, M. A. H., Janssens, G. N., Lenzen, M. J., van de Ven, P. M., Eringa, E. C., & van Royen, N. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.117.006082 · Cited by 56 · see citing works
Sabanayagam, C., Shankar, A., Klein, B. E. K., Lee, K. E., Muntner, P., Nieto, F. J., Tsai, M. Y., Cruickshanks, K. J., Schubert, C. R., Brazy, P. C., et al. (2011) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2010.11.025 · Cited by 54 · see citing works
Development of an automated system to classify retinal vessels into arteries and veins
Sáez, M., Vázquez, S. G., Penedo, M. G., Barceló, M. A., Pena-Seijo, M., de Tuero, G. C., & Pose‐Reino, A. (2012) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2012.02.008 · Cited by 54 · see citing works
“[1] T.”
Background
- Authors
- Wong, T. Y.
- Affiliations
- University of Wisconsin System (US)
- Corresponding author
- Wong, Tien Yin
- ORCID
- Wong, Tien Yin
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2002-05-15
- Volume
- 287
- Issue
- 19
- Pages
- 2528
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2087898657
- Cited by
- 320
- References
- 32
- Citations by year
- 2026: 11 · 2025: 5 · 2024: 11 · 2023: 7 · 2022: 9 · 2021: 13 · 2020: 9 · 2019: 13 · 2018: 12 · 2017: 14 · 2016: 5 · 2015: 12 · 2014: 9 · 2013: 16 · 2012: 18
- FWCI
- 7.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion)
- Funders
- National Institutes of Health (n01hc035126-003, n01hc55021-47-0-1, n01hc55020-39-0-0, n01hc55016-37-0-0, n01hc055022-024, n01hc035125-006, n01hc55019-35-0-1, n01hc55018-38-0-1, n01hc55015-48-0-1)
- National Heart, Lung, and Blood Institute (N01-HC55022, N01-HC-55018, N01 HC 55020, N01 HC 55019, N01 HC-35125, NN01-HC-35126, N1-HC-55021, N01-HC55016, N01‐HC‐55015)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- retinal arteriolar narrowing, type 2 diabetes, incident diabetes risk, microvascular damage, middle-aged adults, Atherosclerosis Risk in Communities Study, fundus images, hypertension, aging, family history of diabetes, impaired fasting glucose, adiposity, physical activity, blood pressure, fasting blood glucose, insulin levels, diabetes prevention
- MeSH terms
- Aged, Aging, Diabetes Mellitus, Female, Humans, Hypertension, Inflammation, Male, Microcirculation, Middle Aged, Photography, Prospective Studies, Retinal Vessels, Risk Factors, Retinal Artery Occlusion, Logistic Models
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