Year : 1979 | Volume
: 27 | Issue : 4 | Page : 116--118
Role of serum lipids in diabetic retinopathy
OP Kulshrestha, SK Nayar, DP Sharma
Upgraded Department of Ophthalmology, S.M.S. Medical College, Jaipur, India
O P Kulshrestha
Professor of Ophthalmology, S.M.S. Medical College and Hospital Jaipur
|How to cite this article:|
Kulshrestha O P, Nayar S K, Sharma D P. Role of serum lipids in diabetic retinopathy.Indian J Ophthalmol 1979;27:116-118
|How to cite this URL:|
Kulshrestha O P, Nayar S K, Sharma D P. Role of serum lipids in diabetic retinopathy. Indian J Ophthalmol [serial online] 1979 [cited 2020 May 31 ];27:116-118
Available from: http://www.ijo.in/text.asp?1979/27/4/116/32596
In view of the conflicting views and limitec knowledge concerning the role of serum lipid fractions in diabetic retinopathy, this study way under-taken.
Materials and Methods
This study was carried out on a total of 100 subjects The cases were divided in three groups as (a) Group A50 normal cases (b) Group B-25 cases of diabetes without retinopathy and (c) Group C-25 cases o diabetes with retinopathy.
The investigations included-complete urine exami nation and estimation of fasting and post-prandial blooc sugar, serum cholesterol (Sackett's method of micro-determination), serum phospho-lipids (Young-Burg anc Yourburg's method), serum free fatty acids (Datta am Chakrabarty's modified method) and serum total lipid: (Bloove's method).
1. Serum cholesterol-[Table 1] shows the mean serum cholesterol level in normal persons without diabetes to be 158.62±17.99 mg. percent. In group C it was 281.41±61.5 mg. percent as compared to 250.04±43.9 mg. percent of Group B. The difference between these two groups of course being not significant statistically.
[Table 2] shows a tendency of an increase of serum cholesterol level in the retinopathy of grade III, IV, and V.
2. Non-esteri fzed fatty acids (Nefa)
[Table 3] shows the values of nonesterified fatty acids significantly higher in higher grades of retinopathy i.e. III, IV and V as compared to grades I and II.
3. Total lipids
[Table 4] denotes the total lipid levels of grade I to be 953-1002 as compared to grade IV i.e. 1307-1424 which is markedly different and significant apart from the increase in grade II, III, and V.
[Table 5] shows the serum cholesterol level to be high in group B and C as compared to A., but there is no marked difference between group B and C. Phospholipids also show a similar increase in levels as cholesterol. The total lipids are significantly higher in group B and C. Phospholipids also show a similar level as cholesterol. The total lipids are significantly higher in group B and C as compared to A and also on the higher level when group B and C are compared separately. Nefa levels in group C are statistically higher than in Group B. (746-914).
The diabetics with retinopathy showed insignificantly high serum cholesterol levels as compared to diabetics without retinopathy, but' showed significantly higher mean values than the control group. The cholesterol level had an upward trend in the higher grades of retinopathy i.e. grade 1 (238.14 mg.%) and grade IV (329.0 mg.%). The significant elevation of serum cholesterol in cases with diabetic retinopathy has also been observed by Richard and Dinesh and Gupta. In contrast to this Misra and Rajyashree did not find the elevated serum cholesterol as significant in diabetics with or without retinopathy.
Hypercholesteraemia in cases with retinopathy proved an apparent correlation between the serum cholesterol level and angiopathy diabetics. Although an association of higher blood sugar levels and poor diabetic control in these cases could well be playing a precipitating role. Cholesterol is probably an important factor associated with atherosclerosis, which may be directly related to the venous status in diabetes. The control of serum cholesterol has equivocal role in checking vascular complications or their severity.
Schrade et al reported higher values of blood phospholipids in diabetics but on the contrary Gupta found no difference between the values of blood phospholipids in uncomplicated diabetics and healthy subjects. In this study the results are sowewhat similar between group A and B, whereas the difference is not significant between group B and C. In cases of diabetes without and with retinopathy the serum phospholipids are almost without much variation. Similar observations were recorded by some workers from India (Gupta, 1967 and Raiyshree et al. also reported increased serum total lipids in cases with retinopathy than those without retinopathy. However, it is difficult to interpret in absolute terms the significance of variations in level of phospholipids in absence of clear understanding of their physiological role.
The mean value of Nefa was 1008.23± 34.45 uEq/L in group C and it was significantly higher to those of group B (816.4±32.38 uEq/L) and group A (497.6±116.07). Apart from this, an insignificant increase of Nefa value were recorded in higher grades of retinopathy. Schrade et al and Mishra et al reported elevated levels of non esterified fatty acids in patients with diabetic retinopathy as compared to those without retinopathy.
Nefa generally arise from neutral fats due to the enzyme lipoproteinlipase. After release they are transported in the plasma in the form of albumin fatty acid complex which reaches the metabolic machinary of the cells and are utilised. Nefa level may not only therefore serve as a guide to the utilization of lipids but also give an idea of the degree of atheromatosis as it is linked up with various physiopathological conditions.
Summary and conclusion
A biochemical study of 100 cases with 50 normal individuals; 25 diabetics without retinopathy and 25 diabetics with retinopathy was carried out. The serum lipid levels comprising of serum cholesterol, serum phospholipids, serum total lipids and serum non-esterified fatty acids were estimated in all the cases. Serum cholesterol levels were higher in poorly controlled diabetics compared to the controlled ones (310.0 mg.% and 263.3 mg.% respectively. The serum cholesterol levels of blood showed an upward trend in the higher grades of retinopathy (grade 1-238.14 mg.% and grade IV 329.0 mg.% respectively).
The serum phospholipid levels are almost without much variations in the groups of diabetics with and without retinopathy. The serum total lipid levels are significantly elevated in diabetics with retinopathy as compared to those without (1785±260 mg.% and 830 + 155.0 mg.% respectively).
The serum non-esterified fatty acids are markedly elevated in the uncontrolled diabetics as compared to the controlled ones, which levels significantly higher in group C (i.e. diabetics, with retinopathy-(10008.23 mg.%) in comparison to group B (diabetics without retinopathy816.4 mg.%).
|1||Ballantyne, A.J. and Michelson, I.C., Text book of Fundus of the Eye. Edinb., 170, 1962.|
|2||Cairo, F., Pirie, A., and Ramsell: Diabetes and the eye. Blackwell Scientific Publ. London., 1967.|
|3||Carpenter, A. and Taylor, F., 1963, Brit. J. Ophthal., 47, 590.|
|4||Datta, C.K., Bakshi, R.K. and Chakrabarti, B.K., 1970, Ind. Heart J., 22, 24.|
|5||Dinesh Kumar and Gupta, N.N., 1967, J. Ass, Physicians India. 15, 357.|
|6||Misra, R.N., 1963, J. Ass. Phys. India. 11, 625.|
|7||Rajyashree, K., Mehra, K.S., and Mathur, J.S., 1969, J. All Ind. Ophthal. Soc., 17, 39.|
|8||Schrade, W., Rochle, E., Biegler, R. and Marmuth, E., 1963, Fatty acids composition of lipids fraction in diabetic serum. Lancet., 1, 28, 285.|