Abstract
BACKGROUND: Vitamin A deficiency (VAD) has been shown to be associated with diabetic retinopathy (DR). However, only a small number of studies have examined the association between VAD and DR in patients with type 2 diabetes (T2DM). The aim of this study was therefore to determine the association between serum vitamin A level and DR in T2DM patients. METHODS: From 2019 to 2024, information was retrospectively collected on 470 healthy controls and 1020 patients with T2DM (500 without DR and 520 with DR). Inclusion criteria included those older than 30 years and having undergone retinal examinations for DR severity grading and measurement of serum vitamin A level. RESULTS: Of the total participants, 44.03% had a deficient serum vitamin A level (<1.0 μmol/L). Vitamin A level in patients with DR was significantly reduced compared to those in healthy controls (P < 0.001). Multivariate logistic regression analysis showed that VAD was a predictor for DR in T2DM patients (OR = 0.81, P = 0.004, 95% CI 0.26-0.97). After adjustment for all confounders, the DR patients had a 2.21-fold increased risk for having VAD (P = 0.005). Stratification of the patients by DR grade showed that decreased vitamin A level was related to the severity of DR. The stratified analysis also showed that the association between vitamin A deficiency and DR was influenced by smoking status or a history of hypertension. In the T2DM patients, vitamin A level correlated negatively with DR severity, indicating a dose-related gradient and a significant risk of developing DR during two years of follow-up (RR = 0.91, P = 0.042, 95% CI 0.65-0.96). CONCLUSION: This study suggests that low serum levels of vitamin A correlate with the presence and severity of DR. VAD may therefore represent a potential biological vulnerability for DR.