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Cited by 180Retinal Diseases and TreatmentsDiabetes Management and ResearchChronic Kidney Disease and Diabetes

Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

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Pearce, Ian, Simó, Rafael, Lövestam‐Adrian, Monica, Wong, David T., Evans, Marc·2019·Diabetes, Obesity and Metabolism
DOI 10.1111/dom.13550PMC PMC6667892
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Abstract

The aim of this systematic review was to examine the associations between diabetic retinopathy (DR) and the common micro‐ and macrovascular complications of diabetes mellitus, and how these could potentially affect clinical practice. A structured search of the PubMed database identified studies of patients with diabetes that assessed the presence or development of DR in conjunction with other vascular complications of diabetes. From 70 included studies, we found that DR is consistently associated with other complications of diabetes, with the severity of DR linked to a higher risk of the presence of, or of developing, other micro‐ and macrovascular complications. In particular, DR increases the likelihood of having or developing nephropathy and is also a strong predictor of stroke and cardiovascular disease, and progression of DR significantly increases this risk. Proliferative DR is a strong risk factor for peripheral arterial disease, which carries a risk of lower extremity ulceration and amputation. Additionally, our findings suggest that a patient with DR has an overall worse prognosis than a patient without DR. In conclusion, this analysis highlights the need for a coordinated and collaborative approach to patient management. Given the widespread use of DR screening programmes that can be performed outside of an ophthalmology office, and the overall cost‐effectiveness of DR screening, the presence and severity of DR can be a means of identifying patients at increased risk for micro‐ and macrovascular complications, enabling earlier detection, referral and intervention with the aim of reducing morbidity and mortality among patients with diabetes. Healthcare professionals involved in the management of diabetes should encourage regular DR screening.

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  • Patients diagnosed with hypertension are at higher risk for poor visual outcomes.

    “Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”

    From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [19]

    The Results section (page unavailable) reports that diabetic retinopathy was more prevalent in people with diabetes who had orthostatic hypertension. The Introduction (page unavailable) explains that retinopathy can cause vision loss, but the review does not establish that patients diagnosed with hypertension generally have a higher risk of poor visual outcomes. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Patients diagnosed with kidney disease are at higher risk for poor visual outcomes.

    “Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”

    From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [19]

    The Results section reports that, among patients with diabetes, nephropathy was a risk factor for diabetic retinopathy, including severe forms. That supports an increased risk of some adverse eye outcomes, but the review does not establish a general increase in poor visual outcomes or visual-acuity loss among all patients diagnosed with kidney disease; it also reports mixed findings for diabetic macular oedema. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Patients covered under Medicaid insurance are at higher risk for poor visual outcomes.

    “Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”

    From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [19]

    The Introduction discusses diabetic retinopathy, vision loss, and delayed screening, but does not link Medicaid coverage to visual outcomes. Searches of our copy for Medicaid, insurance coverage, and payer status found no passage addressing that association. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Pearce, I., Simó, R., Lövestam‐Adrian, M., Wong, D. T., & Evans, M.
Affiliations
  • Royal Liverpool University Hospital (GB)
  • Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (ES)
  • Lund University (SE)
  • St. Michael's Hospital (CA)
  • University Hospital Llandough (GB)
Corresponding author
Evans, Marc
ORCID
Venue
Diabetes, Obesity and Metabolism
Publisher
Wiley
Published
2018-10-29
Volume
21
Issue
3
Pages
467-478
ISSN
  • 1462-8902 (ISSN-L)
  • 1463-1326
DOI
10.1111/dom.13550
PMC
PMC6667892
OpenAlex
W2895653157
Cited by
180
References
2
Citations by year
2026: 18 · 2025: 17 · 2024: 30 · 2023: 21 · 2022: 28 · 2021: 27 · 2020: 24 · 2019: 12 · 2018: 1 · 2016: 1
FWCI
2.73
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Obesity and Metabolism (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Funders
Bayer
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
diabetic retinopathy, diabetes complications, diabetic nephropathy, stroke, cardiovascular disease, peripheral arterial disease, lower extremity ulceration, amputation, proliferative diabetic retinopathy, retinopathy screening, microvascular complications, macrovascular complications, prognosis
MeSH terms
Delivery of Health Care, Diabetic Retinopathy, Eye Diseases, Humans, Risk Factors, Comorbidity, Diabetes Complications, Peripheral Arterial Disease

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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