{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:55:43Z","timestamp":1790596543481,"version":"4.1.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Diabetic retinopathy (DR) and diabetic kidney disease (DKD) are two prevalent diabetic complications significantly influencing global health and quality of life. However, little is known about their relationship in patients with type 2 diabetes mellitus (T2DM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>This study aimed to investigate the relationship between DR and DKD through a prospective observational research study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>T2DM patients were recruited from November 2020 to November 2022. A total of 223 T2DM patients were finally enrolled. Additionally, 50 healthy examinees were included as the control group. Diagnostic and staging criteria for DR are based on previously established standards. DKD was assessed using serum levels of cystatin C (CysC), \u03b22-microglobulin (\u03b22-MG), and homocysteine (Hcy). Traditional Chinese medicine (TCM) syndrome differentiation standards were based on the TCM Diagnosis and Treatment Standards for diabetes Retinopathy issued by the diabetes Branch of the Chinese Society of Traditional Chinese Medicine in 2011. The outcomes of interest were measured at baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study included 223 T2DM patients aged from 32 to 78 years. According to DR staging, patients were further categorized into four T2DM subgroups, namely, T2DM without DR, T2DM with light or moderate non-proliferative DR (lmNPDR), T2DM with heavy non-proliferative DR (hNPDR), and T2DM with proliferative DR (PDR). Among the participants, 154 (154\/223, 69.06%) were diagnosed with DR. As DR severity increased, the levels of three DKD indicators presented a significant upward trend compared to those in the control group, except for Hcy in the PDR subgroup. Spearman\u2019s correlation analysis revealed significant associations between each DKD indicator and the T2DM subgroups, with rs = 0.223, p = 0.001, for Hcy; rs = 0.452, p &amp;lt; 0.001, for CysC; and rs = 0.564, p &amp;lt; 0.001, for \u03b22-MG. Three TCM syndrome types were identified in the 223 T2DM patients. For four T2DM subgroups, the proportion of qi\u2013yin deficiency increased with decreasing DR severity, whereas the proportion of yin\u2013yang deficiency increased with increasing DR severity. Three DKD indicators exhibited statistically significant differences between the deficiency of the liver and kidney or yin\u2013yang deficiency and qi\u2013yin deficiency, except for Hcy in yin\u2013yang deficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study suggests a potential association between DR and DKD and provides evidence that the incidence of qi\u2013yin deficiency and yin\u2013yang deficiency exhibits opposite trends with respect to DR severity.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1473517","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T04:10:23Z","timestamp":1756699823000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The association of diabetic retinopathy and diabetic kidney disease in patients with type 2 diabetes mellitus: a prospective observational research study"],"prefix":"10.3389","volume":"16","author":[{"given":"Yutong","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuomin","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangxia","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.2337\/dci23-0036","article-title":"Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus","volume":"46","author":"Sacks","year":"2023","journal-title":"Diabetes Care"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.52239","article-title":"Adherence to a healthy lifestyle in association with microvascular complications among adults with type 2 diabetes","volume":"6","author":"Liu","year":"2023","journal-title":"JAMA Netw Open"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.2174\/1570161117666190502103733","article-title":"Microvascular complications of type 2 diabetes mellitus","volume":"18","author":"Faselis","year":"2020","journal-title":"Curr Vasc Pharmacol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/advs.202100275","article-title":"Emerging targets in type 2 diabetes and diabetic complications","volume":"8","author":"Demir","year":"2021","journal-title":"Adv Sci (Weinh)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-020-0278-5","article-title":"Genetics of diabetes mellitus and diabetes complications","volume":"16","author":"Cole","year":"2020","journal-title":"Nat Rev Nephrol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-020-01656-9","article-title":"Novel biomarkers of diabetic kidney disease: current status and potential clinical application","volume":"58","author":"Barutta","year":"2021","journal-title":"Acta Diabetol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3390\/nu15092031","article-title":"Vaccinium as potential therapy for diabetes and microvascular complications","volume":"15","author":"Huang","year":"2023","journal-title":"Nutrients"},{"key":"B9","article-title":"Diagnostic and therapeutic criteria of traditional Chinese medicine for diabetes retinopathy","volume":"6","author":"Duan","year":"2011","journal-title":"World J Integrated Traditional Western Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/1081657","article-title":"Administration of traditional chinese blood circulation activating drugs for microvascular complications in patients with type 2 diabetes mellitus","volume":"2016","author":"He","year":"2016","journal-title":"J Diabetes Res"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007939.pub2","article-title":"Single herbal medicine for diabetic retinopathy","volume":"12","author":"Zhang","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn311282-20210304-00142","article-title":"Guideline for the prevention and treatment of type 2 diabetes mellitus in China, (2020 edition)","volume":"37","year":"2021","journal-title":"Chin J Endocrinol Metab"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10215155","article-title":"Correlation of renal profiles with choroidal vascularity index in eyes with diabetic retinopathy","volume":"10","author":"Kim","year":"2021","journal-title":"J Clin Med"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(17)30293-0","article-title":"Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis","volume":"5","author":"Bourne","year":"2017","journal-title":"Lancet Glob Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e13089","DOI":"10.7717\/peerj.13089","article-title":"The application of sudoscan for screening microvascular complications in patients with type 2 diabetes","volume":"10","author":"Lin","year":"2022","journal-title":"PeerJ"},{"key":"B16","article-title":"Discussion on correlation between diabetic nephropathy and diabetic retinopathy in traditional Chinese medicine","volume":"42","author":"Bu","year":"2022","journal-title":"J Hunan Univ Med"},{"key":"B17","first-page":"77","article-title":"Prevalence of systemic co-morbidities in patients with various grades of diabetic retinopathy","volume":"140","author":"Venkatesh","year":"2014","journal-title":"Indian J Med Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"14158","DOI":"10.1038\/s41598-020-70998-9","article-title":"Risk factors for retinopathy in hemodialysis patients with type 2 diabetes mellitus","volume":"10","author":"M\u00fcller","year":"2020","journal-title":"Sci Rep"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/5193944","article-title":"The correlation between the level of skin advanced glycation end products in type 2 diabetes mellitus and the stages of diabetic retinopathy and the types of traditional chinese medicine syndrome","volume":"2022","author":"Zhang","year":"2022","journal-title":"Evid Based Complement Alternat Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1038\/s41574-020-00451-4","article-title":"Current understanding of the molecular and cellular pathology of diabetic retinopathy","volume":"17","author":"Antonetti","year":"2021","journal-title":"Nat Rev Endocrinol"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1473517\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T04:10:25Z","timestamp":1756699825000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1473517\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,1]]},"references-count":20,"alternative-id":["10.3389\/fendo.2025.1473517"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1473517","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,1]]},"article-number":"1473517"}}