{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T05:09:09Z","timestamp":1778476149790,"version":"3.51.4"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The roles of insulin resistance (IR) and \u03b2-cell dysfunction in diabetic retinopathy (DR) remain controversial, and whether age at type 2 diabetes mellitus (T2DM) onset modifies these associations is unclear. This study aimed to evaluate the associations of HOMA-IR and HOMA-\u03b2 with DR risk, stratified by age at diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this real-world cross-sectional study, we analyzed data from 6,996 patients with T2DM from Lishui People\u2019s Hospital, China. Participants were categorized by age at onset (&amp;lt;65 vs. \u226565 years) and HOMA indices (HOMA-\u03b2 &amp;lt;66 vs. \u226566; HOMA-IR &amp;lt;5 vs. \u22655). Multivariable logistic regression was used to assess adjusted odds ratios (aORs) for DR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1,360 DR cases were identified in 6996 participants. Low HOMA-\u03b2 was significantly associated with higher DR odds, especially in the younger-onset group (aOR = 2.97, 95% CI: 2.24\u20133.99). High HOMA-IR was associated with increased DR odds in younger-onset participants (aOR = 3.14, 95% CI: 2.31\u20134.33). Notably, among participants with high HOMA-\u03b2 or low HOMA-IR, age at T2DM onset did not significantly modify the association with DR. Subgroup analyses showed strong associations in those with renal dysfunction or not using lipid-lowering agents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both \u03b2-cell dysfunction and insulin resistance were independently associated with increased odds of diabetic retinopathy in younger-onset type 2 diabetes. Age at onset significantly modified these associations, supporting age-stratified screening and tailored management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1772578","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T04:26:54Z","timestamp":1778473614000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Age at type 2 diabetes onset, HOMA-derived indices and risks of diabetic retinopathy: a real-world cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Yewen","family":"Lin","sequence":"first","affiliation":[{"name":"Department of ophthalmology, The First Affiliated Hospital of Lishui University, Lishui People's Hospital","place":["Lishui, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiuju","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of ophthalmology, The First Affiliated Hospital of Lishui University, Lishui People's Hospital","place":["Lishui, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minghua","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of ophthalmology, The First Affiliated Hospital of Lishui University, Lishui People's Hospital","place":["Lishui, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zihui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of ophthalmology, The First Affiliated Hospital of Lishui University, Lishui People's Hospital","place":["Lishui, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisha","family":"Ni","sequence":"additional","affiliation":[{"name":"Department of ophthalmology, The First Affiliated Hospital of Lishui University, Lishui People's Hospital","place":["Lishui, Zhejiang, 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