Endocrine Abstracts

Evidence is accumulating that type 2 diabetes (T2D) is associated with cognitive impairment and dementia. In fact, numerous epidemiological studies have demonstrated that T2D patients have a significantly higher risk of developing neurodegenerative diseases and, in particular, Alzheimer’s disease (AD). In clinical practice there are no reported phenotypic indicators or specific examinations to identify T2D patients at risk of developing AD. This gap should be urgently bridged given the rise in the global prevalence of T2D with cognitive impairment and in anticipation of improved treatments for the prodromal stages of AD. Diabetic retinopathy (DR) is one of the most frequent diabetic complications and the leading cause of visual impairment and preventable blindness. Although traditionally DR has been considered a microvascular disease, there is emerging evidence that neurodegeneration is an early pathogenic event. In fact, the American Diabetes Association has recently defined DR as a highly specific neurovascular complication. Since the retina is ontogenically a brain-derived tissue and it has been suggested that it may provide an easily accessible and non-invasive way of examining the pathology of the brain. Therefore, it could be postulated that in patients developing neurodegeneration of the brain there is a co-occurring neurodegenerative process in the retina (‘the eye as a window of the brain’). In this regard, we have recently suggested that retinal sensitivity assessed by microperimetry could be a useful biomarker for identifying patients with T2D who are at risk of developing AD. This nested case-control pilot study will be commneted on. We have recently found by proteomic analysis of human retinas from diabetic patients several genuine pathways triggered in the brain of neurodegenerative diseases. These findings suggest that the study of neurodegeneration in the diabetic retina could be useful to further understand the neurodegenerative processes that occur in the brain of persons with diabetes.