The effects of physical activity on diabetic retinopathy in type 2 diabetes using automated vascular analysis: a cohort study.

BACKGROUND

Evidence regarding the association between physical activity (PA) and diabetic retinopathy (DR) remains inconsistent. Furthermore, its effects on retinal vessel diameters in type 2 diabetes are not well established. We aimed to investigate the relationship between PA, DR, and retinal vessel diameters, explore underlying mechanisms, and identify protective exercise regimens.

METHODS

We included patients with type 2 diabetes from the Shanghai Cohort Study of Diabetic Eye Disease. Retinal vessel diameters were measured using computer vision and deep learning. Anthropometric data were collected using standard methods, and PA data through interviews. In 2017, participants were categorised by their DR status. Those without DR were divided into active and inactive groups and followed for three years to assess the effect of PA. For statistical analyses, we used independent t-tests, χ2 tests, one-way analysis of variance, Bonferroni tests, multiple linear and logistic regression models, Kaplan-Meier, and Cox regression models.

RESULTS

In the cross-sectional analysis, we analysed a sample of 42 992 individuals, with a mean age of 64.42 (standard deviation (SD) = 6.87) years. PA was associated with reduced odds of moderate and severe non-proliferative DR, and with wider retinal arterioles and venules. In the longitudinal cohort, we analysed 3669 individuals, with a mean age of 63.1 (SD = 6.65) years. PA was a protective factor against incident DR (hazard ratio = 0.812; 95% confidence interval = 0.679-0.971) and was associated with increased peripheral retinal arteriolar calibre and arterio-venous ratio.

CONCLUSIONS

PA improved retinal vessel diameters and lowered DR incidence, highlighting the necessity for further research into the physiological mechanisms linking PA and DR. Promoting awareness and engagement in moderate/high-intensity exercise may enhance diabetes health management.

REGISTRATION: ClinicalTrials.gov NCT03665090.