Study of the relation between plasma level of von Willebrand factor and diabetic retinopathy in type 2 diabetes

Abstract

Purpose: Diabetic retinopathy (DR) is a major preventable health complication of type 2 diabetes (T2DM). Hyperglycemia represents the main mechanism in the pathogenesis of DR leading eventually to endothelial dysfunction. vWF is a marker of endothelial dysfunction, but its relation to DR is not yet well-established. Methods: The present study included 60 patients with T2DM divided into three equal groups according to the presence and the stage of retinopathy. Each patient was subjected to full history taking, physical examination including fundus examination, and laboratory investigations including glycemic and lipid profile, urinary albumin to creatinine ratio (UACR), and plasma vWF level. Results: Plasma vWF was significantly higher in patients with DR than in patients without retinopathy. vWF was positively correlated to age, HbA1c, diabetes duration, and UACR in DR groups and the total sample. Univariate regression analysis revealed that HbA1c, vWF, BMI, diabetes duration, and UACR were independent risk factors for DR, while multivariate regression analysis showed none of them to be an independent risk factor for DR. A vWF cut-off value of > 180 could differentiate patients with DR from patients without DR with a sensitivity of 97.5%, specificity of 75%, and AUC 0.937*. Conclusions: vWF level is higher in patients with DR reflecting the role of endothelial dysfunction in the development of DR. Moreover, it is one of the risk factors affecting DR in univariate but not in multivariate analysis. A cut-off value of vWF level was set to differentiate between patients with and without DR.