Retinal microvascular calibre and risk of diabetes mellitus: a systematic review and participant-level meta-analysis

Charumathi Sabanayagam, Weng Kit Lye, Ronald Klein, Barbara E.K. Klein, Mary Frances Cotch, Jie Jin Wang, Paul Mitchell, Jonathan E. Shaw, Elizabeth Selvin, A. Richey Sharrett, Tien Y. Wong

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Aims/hypothesis: The calibre of the retinal vessels has been linked to diabetes mellitus but studies have not shown consistent results. We conducted a participant-level meta-analysis to evaluate the association between retinal arteriolar and venular calibre and diabetes. Methods: We performed a systematic review on MEDLINE and EMBASE for articles published up to December 2014. We identified five population-based prospective cohort studies that provided individual-level data on 18,771 diabetes-free participants. We used discrete time proportional hazards models to estimate pooled HRs of diabetes associated with 1 SD (20 μm) change in retinal vascular calibre. Results: We identified 2,581 incident cases of diabetes over a median follow-up period of 10 years (interquartile interval of 3.4–15.8 years). After adjustment for demographic, lifestyle and clinical factors, retinal venular calibre was significantly associated with incident diabetes (pooled HR 1.09 [95% CI 1.02, 1.15] per SD increase in venular calibre). This association persisted in analyses excluding individuals with <5 years of follow-up (1.07 [1.0, 1.12]) or those with impaired fasting glucose at baseline (1.10 [1.03, 1.17]); in subgroup analyses, the association was stronger in men than in women but was consistent across subgroups of race/ethnicity, smoking status, hypertension and BMI categories. Retinal arteriolar calibre was not associated with diabetes (0.95 [0.86, 1.06] per SD decrease in arteriolar calibre). Conclusions/interpretation: Wider retinal venules but not narrower retinal arterioles were associated with a modestly increased risk for diabetes. Knowledge of pathological mechanisms underlying wider retinal venule may provide further insights concerning microvascular alterations in diabetes.

Original languageEnglish (US)
Pages (from-to)2476-2485
Number of pages10
Issue number11
StatePublished - Nov 3 2015


  • Cohort studies
  • Diabetes
  • Meta-analysis
  • Retinal vessels
  • Systematic review

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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