The association of smoking and risk of diabetic retinopathy in patients with type 1 and type 2 diabetes: a meta-analysis
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META-ANALYSIS
The association of smoking and risk of diabetic retinopathy in patients with type 1 and type 2 diabetes: a meta-analysis Xiaoling Cai1 Yifei Chen2 Wenjia Yang1 Xueying Gao1 Xueyao Han1 Linong Ji ●
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Received: 9 May 2018 / Accepted: 24 July 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Purpose To clarify the relevance between smoking and diabetic retinopathy in patients with type 1 and type 2 diabetes mellitus. Methods Published evidence were searched in MEDLINE and EMBASE from the databases began until Feb. 2017. Studies evaluating the association between smoking and diabetic retinopathy or evaluating the risk factors of diabetic retinopathy including smoking were included. Results Totally 73 studies were identified, among which 19 studies included type 1 diabetes patients and 56 studies included type 2 diabetes patients. In type 1 diabetes, compare with non-smokers, the risk of diabetic retinopathy significantly increased in smokers (risk ratio (RR) = 1.23, 95% CI 1.14, 1.33, P < 0.001), and the risk of proliferative diabetic retinopathy also significantly increased in smokers (RR = 1.48, 95% CI 1.20, 1.81, P < 0.001). In type 2 diabetes, compare with non-smokers, the risk of diabetic retinopathy significantly decreased in smokers (RR = 0.92, 95% CI 0.86, 0.98, P = 0.02) and the risk of proliferative diabetic retinopathy also significantly decreased in smokers (RR = 0.68, 95% CI 0.61, 0.74, P < 0.001). Conclusions Compare with non-smokers, the risk of diabetic retinopathy significantly increased in smokers with type 1 diabetes while significantly decreased in smokers with type 2 diabetes. However, this result did not change the importance of smoking cessation for public health. Keywords Diabetic retinopathy Smoke Type 1 diabetes Type 2 diabetes ●
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Introduction Diabetic retinopathy (DR), as a specific microvascular complication of diabetes, is the leading cause of blindness among adults in developed countries [1]. Risk factors for diabetic retinopathy, with clear evidence in previous epidemiology studies, included duration of diabetes,
These authors contributed equally: Xiaoling Cai, Yifei Chen. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12020-018-1697-y) contains supplementary material, which is available to authorized users. * Linong Ji [email protected] 1
Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
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Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
hyperglycemia, nephropathy, hypertension, and hyperlipidemia [1–5]. However, other potential risk factors for diabetic retinopathy, such as smoking [6] and alcohol [7], haven’t been clearly demonstrated. Smoking, due to its effect on reducing retinal blood flow [8–10], is considered to affect the manifestations of diabetic retinopa
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