{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T06:05:04Z","timestamp":1790057104103,"version":"4.0.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"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>Diabetic retinopathy (DR) remains the leading cause of blindness among working-age adults. With the rising prevalence of diabetes, the burden of DR continues to escalate, substantially impairing patients\u2019 quality of life. Identifying clinical factors associated with prevalent DR may help refine risk-based ophthalmic assessment. Using a large cross-sectional dataset, this study examined associations between routinely available clinical indicators and the presence of DR. Particular attention was given to heart rate (HR), an understudied and readily available vital sign, and to diabetes treatment histories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Leveraging data from the China DiaChronic Study, this cross-sectional analysis included data from 1,477 patients with diabetes. Categorical variables (sex, smoking and alcohol status, education) were analyzed by chi-square tests; continuous variables by independent-samples t-tests or Wilcoxon rank-sum tests. Binary logistic regression estimated factors associated with prevalent DR after adjustment for demographic, metabolic, diabetes-duration, and treatment-history variables; variance inflation factors (VIFs) were used to assess multicollinearity; ROC curves described cross-sectional discrimination; formal interaction terms assessed whether selected associations differed by HbA1c category; and Spearman correlation assessed relationships between HbA1c and other parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,477 patients, 259 (17.5%) had DR. After additional adjustment for diabetes duration and medication histories, higher systolic blood pressure (SBP), heart rate (HR), HbA1c, blood urea nitrogen (BUN), urinary albumin-creatinine ratio (UACR), and longer diabetes duration were associated with prevalent DR (all\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.05), with VIFs ranging from 1.07 to 1.59. HbA1c showed the greatest cross-sectional discrimination (AUC 0.672, 95% CI 0.637-0.707), followed by UACR (AUC 0.655, 95% CI 0.617\u20130.692), although both AUCs were modest. Exploratory stratification by HbA1c &amp;lt;6.5% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0446, DR\u00a0=\u00a037) versus \u22656.5% (\n                      <jats:italic>n<\/jats:italic>\n                      =\u00a01,031, DR\u00a0=\u00a0222) showed different within-stratum patterns, but formal interaction tests for SBP, HR, BUN, and UACR were not statistically significant (all\n                      <jats:italic>P<\/jats:italic>\n                      for interaction &amp;gt;0.05). Spearman correlation showed FBG, HR, BUN, and UACR positively correlated with HbA1c (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.094-0.641,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.05), with UACR exhibiting the strongest association after FBG (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.216,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher SBP, HR, HbA1c, BUN, UACR, and longer diabetes duration were associated with prevalent DR after multivariable adjustment. Among these, the association with HR is the most potentially novel and may reflect cardiac autonomic dysfunction rather than a direct causal effect. Although HbA1c and UACR showed only modest cross-sectional discrimination, the findings support integrated cardiometabolic, renal, and diabetes-history assessment to complement guideline-recommended retinal screening. Prospective validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1922694","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:39:16Z","timestamp":1790055556000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with diabetic retinopathy: a cross-sectional study of 1477 patients across four cities in Anhui, China"],"prefix":"10.3389","volume":"17","author":[{"given":"Yanlei","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]},{"name":"Department of Endocrinology, The Second Affiliated Hospital of Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liya","family":"Ai","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Xing","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaiyu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilong","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated 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