Type 2 diabetes is a heterogeneous disease that can be subdivided based on beta-cell function and insulin sensitivity. We aimed to investigate the presence, incidence and progression of diabetic retinopathy (DR) according to subtypes of type 2 diabetes. In a national cohort, we identified three subtypes of type 2 diabetes which included classical, hyperinsulinemic and insulinopenic type 2 diabetes based on HOMA2 measurements. From the Danish Registry of Diabetic Retinopathy (DiaBase) we extracted information on level of DR. We used several national health registries to link information on comorbidity, medications and laboratory tests. We found individuals with hyperinsulinemic type 2 diabetes were less likely to have DR at entry date compared to classical type 2 diabetes, whereas individuals with insulinopenic type 2 diabetes were more likely to have DR. In multivariable Cox regression analysis, individuals with hyperinsulinemic type 2 diabetes had a decreased risk of both incidence and progression of DR compared to classical type 2 diabetes. We did not find any clear difference in risk of incident or progression of DR in individuals with insulinopenic compared to classical type 2 diabetes. These findings indicate that subcategorization of type 2 diabetes is important in evaluating the future risk of DR.

中文翻译：

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2 型糖尿病亚型的糖尿病视网膜病变风险

2 型糖尿病是一种异质性疾病，可以根据 β 细胞功能和胰岛素敏感性进行细分。我们的目的是根据 2 型糖尿病的亚型调查糖尿病视网膜病变 (DR) 的存在、发病率和进展。在一个全国队列中，我们根据 HOMA2 测量结果确定了 2 型糖尿病的三种亚型，包括经典型、高胰岛素血症型和胰岛素缺乏型 2 型糖尿病。我们从丹麦糖尿病视网膜病变登记处 (DiaBase) 中提取了有关 DR 级别的信息。我们使用了几个国家卫生登记处来链接有关合并症、药物和实验室检测的信息。我们发现，与经典 2 型糖尿病相比，高胰岛素血症 2 型糖尿病患者在入组时患 DR 的可能性较小，而胰岛素缺乏型 2 型糖尿病患者则更有可能患 DR。在多变量 Cox 回归分析中，与经典 2 型糖尿病相比，高胰岛素血症 2 型糖尿病患者的 DR 发生率和进展风险均降低。与典型 2 型糖尿病患者相比，我们没有发现胰岛素缺乏患者的 DR 发生或进展风险有任何明显差异。这些发现表明 2 型糖尿病的细分对于评估未来 DR 的风险非常重要。