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World J Diabetes. Mar 15, 2026; 17(3): 114603
Published online Mar 15, 2026. doi: 10.4239/wjd.v17.i3.114603
Published online Mar 15, 2026. doi: 10.4239/wjd.v17.i3.114603
Beyond glycemia: The influence of systemic inflammation, lipids, and the gut-retina axis in diabetic retinopathy
Marco Zeppieri, Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
Marco Zeppieri, Alessandro Drigo, Rosa Giglio, Daniele Tognetto, Leandro Inferrera, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste 34129, Italy
Matteo Capobianco, Federico Visalli, Department of Ophthalmology, University of Catania, Catania 95123, Italy
Francesco Cappellani, Caterina Gagliano, Fabiana D’Esposito, Department of Medicine and Surgery, University of Enna “Kore”, Enna 94100, Italy
Francesco Cappellani, Caterina Gagliano, Eye Center, “G.B. Morgagni-DSV”, Catania 95100, Italy
Mutali Musa, Department of Optometry, University of Benin, Benin 300283, Nigeria
Mutali Musa, Department of Ophthalmology, Africa Eye Laser Center Ltd, Benin 300211, Nigeria
Marieme Khouyyi, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina 98121, Italy
Fabiana D’Esposito, Imperial College Ophthalmic Research Group Unit, Imperial College, London NW1 5QH, United Kingdom
Co-first authors: Marco Zeppieri and Alessandro Drigo.
Co-corresponding authors: Marco Zeppieri and Caterina Gagliano.
Author contributions: Zeppieri M and Drigo A made equal contributions as co-first authors; Zeppieri M, Visalli F, Musa M, Capobianco M, Cappellani F, Khouyyi M, Giglio R, Tognetto D, Gagliano C, and D’Esposito F wrote the outline; Zeppieri M, Inferrera L, Visalli F, Musa M, Capobianco M, Cappellani F, and Khouyyi M did the research and writing of the manuscript; Zeppieri M, Inferrera L, Visalli F, Musa M, Capobianco M, Cappellani F, Khouyyi M, Giglio R, Tognetto D, Gagliano C, D’Esposito F assisted in the writing of the draft and final paper; Zeppieri M, Inferrera L, Gagliano C, D’Esposito F, Cappellani F were responsible for the conception and design of the study; Zeppieri M, Drigo A, Visalli F, Musa M, Gagliano C, D’Esposito F, Cappellani F contributed to the scientific editing; Zeppieri M, Drigo A, Visalli F, Musa M, Capobianco M, Cappellani F, Khouyyi M, Giglio R, Tognetto D, Gagliano C, and D’Esposito F assisted in the editing, making critical revisions of the manuscript and viewing all versions of the manuscript; Zeppieri M and Gagliano C made equal contributions as co-corresponding authors. All authors provided the final approval of the article.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Marco Zeppieri, MD, PhD, Consultant, Department of Ophthalmology, University Hospital of Udine, Piazza Santa Maria della Misericordia, 15, Udine 33100, Italy.
Received: September 24, 2025
Revised: October 20, 2025
Accepted: December 17, 2025
Published online: March 15, 2026
Processing time: 169 Days and 23.1 Hours
Revised: October 20, 2025
Accepted: December 17, 2025
Published online: March 15, 2026
Processing time: 169 Days and 23.1 Hours
Core Tip
Core Tip: Diabetic retinopathy is now recognized as a systemic condition affected not just by chronic hyperglycemia but also by ongoing inflammation, lipid dysregulation, and abnormalities in the gut flora. These interrelated pathways lead to retinal vascular impairment, neurodegeneration, and disease advancement. Identifying these characteristics provides a comprehensive framework for understanding disease pathophysiology and discovering novel therapeutic targets that extend beyond glycemic control.