Vascular oscillation (vasomotion) occurs in the microcirculation and is thought to be a significant contributor to tissue perfusion. Our aims were to assess the relationship of vasomotion to perfusion in the cutaneous microcirculation of diabetic patients, to determine the influence on it of endothelium-dependent and nonendothelium-dependent vasodilatory stimuli, and to assess the relationship to perfusion and vasomotion of various biochemical markers of vascular function (HbA1c, LDL- and HDL-cholesterol, triglycerides, insulin resistance, high sensitive C-reactive protein, L- and E-selectin, soluble ICAM, von Willebrand factor) and microalbuminuria. Perfusion and vasomotion (spectral density at low and very low frequencies) were measured by laser-Doppler flowmetry after local heat and iontophoresis of ACh and sodium nitroprusside. Perfusion responses to all stimuli were impaired in patients with Type 2 diabetes (heat: F = 28.0, P < 0.001; ACh: F = 7.11, P = 0.003; sodium nitroprusside: F = 4.0, P = 0.028). Responses to endothelium-dependent stimuli were further impaired in microalbuminuric patients (heat: P = 0.035; ACh: P = 0.034). Vasomotion responses at low frequencies after endothelium-dependent stimuli were impaired in diabetic patients compared with that shown in controls (heat: F = 5.62, P = 0.002; ACh: F = 4.32, P = 0.015). Multivariate modeling showed microalbuminuria to be the only consistent predictor of perfusion and vasomotion responses. The results suggest that microalbuminuria in Type 2 diabetes reflects a generalized disturbance of microvascular function related to endothelium-dependent mechanisms.

Objectives To evaluate the prevalence of incidental non-diabetic ocular comorbidities detected at first screen in a large diabetic retinopathy (DR) screening programme. Design Cross-sectional cohort study. Setting Single large metropolitan diabetic eye screening programme in Auckland, New Zealand. Participants Twenty-two thousand seven hundred and seventy-one participants who attended screening from September 2008 to August 2018. Results Hypertensive retinopathy (HTR) was observed in 14.2% (3236/22 771) participants. Drusen were present in 14.0% participants under the age of 55 years, increasing to 20.5% in those 55 years and older. The prevalence of neovascular age-related macular degeneration (AMD) was 0.5% in participants aged75 years. Retinal vein occlusion and retinal arterial embolus were prevalent in 0.7% and 0.02%, respectively, in participants aged75 years. Cataracts were common being present in 37.1% of participants over the age of 75 years. Only 386 individuals (1.7%) were labelled as glaucoma suspects. Geographic atrophy, epiretinal membrane, choroidal nevi and posterior capsular opacification had an increased prevalence in older individuals. Conclusions Our data suggest that AMD, HTR and cataracts are routinely detected during DR screening. The incorporation of the detection of these ocular comorbidities during DR screening provide opportunities for patients to modify risk factors (smoking cessation and diet for AMD, blood pressure for HTR) and allow access to cataract surgery.