Peripheral arterial disease is associated with retinal fluid and microvascular alterations in type 2 diabetes

doi:10.4239/wjd.122779

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Diabetes. Sep 15, 2026; 17(9): 122779
Published online Sep 15, 2026. doi: 10.4239/wjd.122779

Table 1 Baseline demographic and clinical characteristics of all participants with type 2 diabetes mellitus based on peripheral arterial disease status, n (%)/mean ± SD

	Patients with type 2 diabetes mellitus		P value
	PAD- (n = 187)	PAD+ (n = 25)	P value
Age, years	56.9 ± 9.7	61.6 ± 8.9	0.023
Sex, male	120 (64.2)	19 (76.0)	0.345
Smoking status			0.267
Never	89 (51.4)	10 (40.0)
Current	42 (24.3)	9 (36.0)
Ex-smoker	42 (24.3)	6 (24.0)
Smoking, pack-years	9.5 ± 14.6	14.5 ± 17.0	0.459
Duration of diabetes, years	17.3 ± 7.7	19.6 ± 10.6	0.310
Medication			0.671
Insulin only	1 (0.5)	0 (0.0)
OHA	121 (64.7)	19 (76.0)
Insulin + OHA	65 (34.8)	6 (24.0)
HTN	79 (42.2)	15 (60.0)	0.202
DR stage			0.793
No DR	23 (12.3)	3 (11.5)
Mild NPDR	81 (43.3)	13 (50.0)
Moderate NPDR	41 (21.9)	6 (23.1)
Severe NPDR	32 (17.1)	4 (15.4)
PDR	10 (5.3)	0 (0.0)
Biological parameters
HbA1c	7.8 ± 1.3	7.5 ± 0.8	0.174
Glucose	148.0 ± 49.4	136.4 ± 30.7	0.111
Total cholesterol	144.1 ± 35.0	146.5 ± 33.4	0.746
Triglyceride	132.8 ± 75.9	125.4 ± 55.7	0.640
HDLc	45.1 ± 11.3	42.4 ± 8.7	0.257
LDLc	89.6 ± 28.2	96.1 ± 30.6	0.284
Creatinine	1.0 ± 0.8	1.1 ± 0.3	0.553
eGFR	82.5 ± 21.7	71.7 ± 18.8	0.018
Clinical parameters
BMI, kg/m²	25.6 ± 3.7	26.3 ± 4.2	0.327
SBP, mmHg	132.0 ± 17.8	144.0 ± 18.3	0.002
DBP, mmHg	74.7 ± 10.5	81.0 ± 12.9	0.006
Visual acuity, logMAR	0.07 ± 0.09	0.04 ± 0.07	0.158
OCTA parameters
SCP fovea VD, %	15.1 ± 4.7	15.6 ± 5.6	0.372
SCP parafoveal VD, %	46.4 ± 3.9	43.9 ± 3.7	0.003
DCP fovea VD, %	28.2 ± 6.0	29.5 ± 8.0	0.409
DCP parafoveal VD, %	49.7 ± 3.8	46.6 ± 3.6	< 0.001
Signal strength	65.8 ± 6.8	66.0 ± 7.4	0.090
OCT parameters
CFT, μm	251.0 ± 23.1	250.2 ± 25.3	0.872
PFT, μm	315.7 ± 16.8	313.7 ± 20.8	0.582
Inner retinal CFT, μm	70.0 ± 12.7	71.0 ± 14.1	0.702
Inner retinal PFT, μm	128.0 ± 9.8	126.6 ± 11.8	0.521

PAD: Peripheral arterial disease; OHA: Oral hypoglycemic agents; HTN: Hypertension; DR: Diabetic retinopathy; NPDR: Non-proliferative diabetic retinopathy; PDR: Proliferative diabetic retinopathy; HbA1c: Glycated hemoglobin; HDLc: High-density lipoprotein cholesterol; LDLc: Low-density lipoprotein cholesterol; eGFR: Estimated glomerular filtration rate; BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; logMAR: Logarithm of the minimum angle of resolution; OCTA: Optical coherence tomography angiography; SCP: Superficial capillary plexus; VD: Vascular density; DCP: Deep capillary plexus; OCT: Optical coherence tomography; CFT: Central foveal thickness; PFT: Parafoveal thickness.

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Table 2 Clinical characteristics of participants by capillary plexus parafoveal vascular density-superficial capillary plexus parafoveal vessel density quartiles, n (%)/mean ± SD

	SCP, quartile 1 (n = 53)	SCP, quartile 2 (n = 53)	SCP, quartile 3 (n = 53)	SCP, quartile 4 (n = 53)	P value
Parafoveal VD, %	41.0 ± 2.9	45.0 ± 0.6	47.7 ± 0.6	50.7 ± 1.6
Age, years	57.3 ± 11.7	60.1 ± 8.4	58.4 ± 8.8	54.0 ± 8.7	0.051
Sex, male	38 (71.7)	33 (62.3)	36 (67.9)	32 (60.4)	0.593
Smoking status					0.216
Never	25 (47.2)	30 (56.6)	28 (52.8)	30 (56.6)
Current	20 (37.7)	11 (20.8)	10 (18.9)	10 (18.9)
Ex-smoker	8 (15.1)	12 (22.6)	15 (28.3)	13 (24.5)
Smoking, pack-years	10.7 ± 14.2	12.6 ± 17.2	8.4 ± 14.3	8.1 ± 13.6	0.231
Duration of diabetes, years	17.0 ± 9.4	19.3 ± 7.9	18.1 ± 7.0	16.0 ± 7.7	0.385
Medication					0.527
Insulin only	0 (0.0)	1 (1.9)	0 (0.0)	0 (0.0)
OHA	31 (58.5)	37 (69.8)	36 (67.9)	36 (67.9)
Insulin + OHA	22 (41.5)	15 (28.3)	17 (32.1)	17 (32.1)
HTN	25 (47.2)	26 (49.1)	29 (54.7)	14 (26.4)	0.020
DR stage					0.003
No DR	3 (5.7)	5 (9.4)	7 (13.2)	10 (18.9)
Mild NPDR	15 (28.3)	22 (41.5)	27 (50.9)	30 (56.6)
Moderate NPDR	15 (28.3)	15 (28.3)	11 (20.8)	6 (11.3)
Severe NPDR	13 (24.5)	10 (18.9)	8 (15.1)	5 (9.4)
PDR	7 (13.2)	1 (1.9)	0 (0.0)	2 (3.8)
Biological parameters
HbA1c	7.9 ± 1.3	7.7 ± 1.1	7.8 ± 1.3	7.6 ± 1.2	0.181
Fasting glucose	144.8 ± 44.8	145.7 ± 46.6	147.7 ± 54.6	148.3 ± 45.4	0.669
Total cholesterol	145.5 ± 37.7	142.5 ± 32.2	150.7 ± 38.2	138.8 ± 29.8	0.583
Triglyceride	129.5 ± 76.4	127.7 ± 68.6	155.6 ± 92.8	114.9 ± 45.0	0.723
HDLc	44.1 ± 11.5	46.9 ± 12.6	42.5 ± 9.3	45.4 ± 10.3	0.942
LDLc	91.1 ± 32.4	87.4 ± 26.2	96.7 ± 30.8	86.3 ± 23.3	0.765
Creatinine	1.0 ± 0.7	1.1 ± 0.9	1.1 ± 1.0	0.9 ± 0.2	0.269
eGFR	81.4 ± 22.5	76.2 ± 24.2	78.6 ± 19.8	88.7 ± 18.0	0.067
Clinical parameters
BMI, kg/m²	25.3 ± 3.7	24.8 ± 3.7	26.4 ± 3.5	26.1 ± 3.9	0.081
SBP, mmHg	132.0 ± 19.8	132.9 ± 19.1	134.7 ± 15.7	133.9 ± 18.5	0.508
DBP, mmHg	74.4 ± 11.8	75.9 ± 11.9	75.5 ± 9.5	75.8 ± 10.6	0.562
Visual acuity, logMAR	0.09 ± 0.10	0.06 ± 0.09	0.08 ± 0.09	0.05 ± 0.07	0.067
OCTA parameters
FAZ size, mm²	0.34 ± 0.10	0.33 ± 0.01	0.30 ± 0.11	0.34 ± 0.10	0.516
FAZ perimeter, mm	2.4 ± 0.4	2.3 ± 0.3	2.2 ± 0.4	2.4 ± 0.4	0.433
SCP fovea VD, %	13.3 ± 3.9	14.6 ± 4.9	16.6 ± 4.8	16.0 ± 4.9	< 0.001
DCP fovea VD, %	25.8 ± 6.6	28.3 ± 5.9	30.3 ± 5.9	28.8 ± 5.7	0.004
DCP parafoveal VD, %	46.8 ± 4.4	49.2 ± 3.4	50.5 ± 2.8	51.0 ± 3.6	< 0.001
Signal strength	66.7 ± 6.9	66.1 ± 6.1	69.5 ± 6.9	70.3 ± 6.9	0.001
OCT parameters
CFT, μm	251.5 ± 25.1	250.0 ± 23.2	256.0 ± 24.5	246.3 ± 19.7	0.508
PFT, μm	314.7 ± 20.3	313.0 ± 19.0	316.3 ± 13.8	317.9 ± 15.3	0.218
Inner retinal CFT, μm	69.9 ± 13.0	69.8 ± 12.1	73.1 ± 14.6	67.7 ± 11.2	0.679
Inner retinal PFT, μm	125.5 ± 11.3	124.9 ± 10.6	128.9 ± 8.4	132.0 ± 8.1	< 0.001
Presence of PAD	11 (20.8)	8 (15.1)	5 (9.4)	1 (1.9)	0.019
Development of IRF	25 (47.2)	12 (22.6)	9 (17.0)	7 (13.2)	< 0.001
Development of DME	6 (11.3)	4 (7.5)	2 (3.8)	3 (5.7)	0.473

SCP: Superficial capillary plexus; VD: Vascular density; OHA: Oral hypoglycemic agents; HTN: Hypertension; DR: Diabetic retinopathy; NPDR: Non-proliferative diabetic retinopathy; PDR: Proliferative diabetic retinopathy; HbA1c: Glycated hemoglobin; HDLc: High-density lipoprotein cholesterol; LDLc: Low-density lipoprotein cholesterol; eGFR: Estimated glomerular filtration rate; BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; logMAR: Logarithm of the minimum angle of resolution; OCTA: Optical coherence tomography angiography; FAZ: Foveal avascular zone; DCP: Deep capillary plexus; OCT: Optical coherence tomography; CFT: Central foveal thickness; PFT: Parafoveal thickness; PAD: Peripheral arterial disease; IRF: Intra-retinal fluid; DME: Diabetic macular edema.

Full Size Table

Table 3 Clinical characteristics of participants by capillary plexus parafoveal vascular density-deep capillary plexus parafoveal vessel density quartiles, n (%)/mean ± SD

	DCP, quartile 1 (n = 53)	DCP, quartile 2 (n = 53)	DCP, quartile 3 (n = 53)	DCP, quartile 4 (n = 53)	P value
Parafoveal VD, %	44.0 ± 2.3	48.5 ± 1.0	51.2 ± 0.7	53.9 ± 1.1	< 0.001
Age, years	58.0 ± 10.5	58.1 ± 9.5	57.7 ± 8.9	55.9 ± 9.9	0.273
Sex, male	38 (70.4)	28 (52.8)	41 (77.4)	32 (60.4)	0.042
Smoking status					0.010
Never	22 (43.1)	35 (68.6)	17 (37.8)	25 (49.0)
Current	16 (31.4)	3 (5.9)	17 (37.8)	15 (29.4)
Ex-smoker	13 (25.5)	13 (25.5)	11 (24.4)	11 (21.6)
Smoking, pack-years	27.4 ± 8.1	33.8 ± 9.3	24.5 ± 11.6	28.4 ± 12.3	0.695
Duration of diabetes, years	17.1 ± 7.9	18.4 ± 8.5	18.9 ± 8.0	15.8 ± 8.1	0.521
Medication					0.563
Insulin only	0 (0.0)	0 (0.0)	1 (1.9)	0 (0.0)
OHA	36 (66.7)	33 (62.3)	38 (71.7)	33 (62.3)
Insulin + OHA	18 (33.3)	20 (37.7)	14 (26.4)	20 (37.7)
HTN	25 (46.3)	19 (35.8)	27 (50.9)	23 (43.4)	0.460
DR stage					< 0.001
No DR	4 (7.4)	3 (5.7)	6 (11.3)	13 (24.5)
Mild NPDR	15 (27.8)	23 (43.4)	28 (52.8)	28 (52.8)
Moderate NPDR	11 (20.4)	16 (30.2)	13 (24.5)	7 (13.2)
Severe NPDR	16 (29.6)	11 (20.8)	6 (11.3)	3 (5.7)
PDR	8 (14.8)	0 (0.0)	0 (0.0)	2 (3.8)
Biological parameters
HbA1c	7.9 ± 1.3	7.9 ± 1.2	7.6 ± 1.1	7.6 ± 1.3	0.037
Fasting glucose	150.5 ± 47.2	151.2 ± 51.6	143.9 ± 37.6	140.2 ± 53.0	0.191
Total cholesterol	146.4 ± 40.0	142.3 ± 29.2	143.9 ± 38.5	145.8 ± 31.2	0.982
Triglyceride	136.4 ± 70.3	129.4 ± 62.5	119.5 ± 69.7	144.8 ± 90.8	0.739
HDLc	43.9 ± 10.8	45.7 ± 11.2	45.5 ± 12.7	44.0 ± 9.3	0.998
LDLc	93.2 ± 33.7	87.9 ± 25.9	89.2 ± 29.9	91.9 ± 24.3	0.887
Creatinine	1.0 ± 0.7	1.0 ± 0.3	1.2 ± 1.3	0.9 ± 0.3	0.852
eGFR	80.6 ± 23.2	79.3 ± 20.2	81.9 ± 24.1	82.8 ± 19.0	0.485
Clinical parameters
BMI, kg/m²	25.5 ± 3.9	25.7 ± 3.8	25.9 ± 4.1	25.7 ± 3.1	0.694
SBP, mmHg	138.8 ± 19.6	131.5 ± 19.4	133.7 ± 18.6	129.2 ± 13.7	0.016
DBP, mmHg	78.4 ± 11.4	74.2 ± 11.2	74.4 ± 10.8	74.7 ± 10.0	0.107
Visual acuity, logMAR	0.08 ± 0.12	0.07 ± 0.09	0.06 ± 0.07	0.06 ± 0.07	0.083
OCTA parameters
FAZ size, mm²	0.34 ± 0.11	0.33 ± 0.10	0.32 ± 0.09	0.32 ± 0.10	0.119
FAZ perimeter, mm	2.4 ± 0.4	2.4 ± 0.4	2.3 ± 0.4	2.3 ± 0.4	0.158
SCP fovea VD, %	14.5 ± 5.0	15.6 ± 5.2	14.8 ± 4.1	15.8 ± 4.9	0.314
DCP fovea VD, %	43.6 ± 4.6	46.2 ± 3.3	46.6 ± 2.9	48.1 ± 3.5	< 0.001
DCP parafoveal VD, %	26.2 ± 7.2	29.1 ± 5.6	28.3 ± 5.1	29.8 ± 6.4	0.009
Signal strength	63.6 ± 5.5	66.8 ± 7.4	70.6 ± 5.2	71.9 ± 6.2	< 0.001
OCT parameters
CFT, μm	250.1 ± 25.2	252.4 ± 22.3	251.3 ± 23.3	250.0 ± 22.9	0.925
PFT, μm	319.3 ± 20.2	318.0 ± 15.5	313.9 ± 16.9	310.6 ± 15.0	0.004
Inner retinal CFT, μm	69.8 ± 14.4	70.1 ± 10.9	70.4 ± 13.8	70.1 ± 12.4	0.893
Inner retinal PFT, μm	128.5 ± 11.2	128.0 ± 9.7	128.0 ± 10.3	126.7 ± 9.1	0.368
Presence of PAD	14 (25.9)	9 (17.0)	0 (0.0)	3 (5.7)	< 0.001
Development of IRF	24 (45.3)	12 (24.0)	4 (8.2)	4 (8.2)	< 0.001
Development of DME	10 (18.9)	3 (5.7)	1 (1.9)	1 (1.9)	0.003

DCP: Deep capillary plexus; VD: Vascular density; OHA: Oral hypoglycemic agents; HTN: Hypertension; DR: Diabetic retinopathy; NPDR: Non-proliferative diabetic retinopathy; PDR: Proliferative diabetic retinopathy; HbA1c: Glycated hemoglobin; HDLc: High-density lipoprotein cholesterol; LDLc: Low-density lipoprotein cholesterol; eGFR: Estimated glomerular filtration rate; BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; logMAR: Logarithm of the minimum angle of resolution; OCTA: Optical coherence tomography angiography; FAZ: Foveal avascular zone; SCP: Superficial capillary plexus; OCT: Optical coherence tomography; CFT: Central foveal thickness; PFT: Parafoveal thickness; PAD: Peripheral arterial disease; IRF: Intra-retinal fluid; DME: Diabetic macular edema.

Full Size Table

Citation: Yang JM, Kwak J, Min SH, Choi SU, Park J, Yon DK, Lee JY, Kim JG, Yoon YH, Kim YJ. Peripheral arterial disease is associated with retinal fluid and microvascular alterations in type 2 diabetes. World J Diabetes 2026; 17(9): 122779
URL: https://www.wjgnet.com/1948-9358/full/v17/i9/122779.htm
DOI: https://dx.doi.org/10.4239/wjd.122779

Yang JM, Kwak J, Min SH, Choi SU, Park J, Yon DK, Lee JY, Kim JG, Yoon YH, Kim YJ. Peripheral arterial disease is associated with retinal fluid and microvascular alterations in type 2 diabetes. World J Diabetes 2026; 17(9): 122779 [DOI: 10.4239/wjd.122779]

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