{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:58:46Z","timestamp":1790657926203,"version":"4.1.0"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"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>Type 2 diabetes mellitus (T2DM) affects multiple ocular structures, yet the extent of corneal endothelial alterations across different stages of diabetic retinopathy (DR) and disease duration remains unclear. This meta-analysis quantified corneal endothelial changes in T2DM across subgroups defined by DR status and diabetes duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review adhered to PRISMA and MOOSE guidelines (PROSPERO: CRD420261473313). Five databases were searched from inception through July 15, 2026. Cross-sectional studies comparing endothelial cell density (ECD), coefficient of variation (CV), and percentage of hexagonal cells (HEX) in T2DM patients versus controls or between T2DM subgroups were included. Study quality was assessed using the AHRQ checklist. Effect sizes were calculated as Cohen\u2019s d using fixed-effect or random-effects models based on heterogeneity. Sensitivity analyses used the leave-one-out method; publication bias was assessed with funnel plots, Egger\u2019s test, and trim-and-fill analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-two studies (5,878 eyes) were included. T2DM patients showed significantly lower ECD (d = \u22120.35, P &amp;lt; 0.001), higher CV (d = 0.25, P &amp;lt; 0.001), and lower HEX (d = \u22120.28, P &amp;lt; 0.001) versus controls. Eyes with DR had lower ECD (d = \u22120.22, P\u00a0=\u00a00.002), higher CV (d = 0.26, P\u00a0=\u00a00.005), and lower HEX (d = \u22120.23, P\u00a0=\u00a00.02) versus eyes without DR. No significant differences emerged between PDR and NPDR. Longer disease duration (\u226510 years) was associated with lower\u00a0ECD (d = \u22120.39, P\u00a0=\u00a00.04) and lower HEX (d = \u22120.18, P\u00a0=\u00a00.003). Sensitivity\u00a0analyses showed that HEX (T2DM vs. controls), CV (PDR vs. NPDR), and\u00a0CV\u00a0(duration comparison) were not robust; trim-and-fill reversed the CV duration result.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>T2DM is associated with impaired corneal endothelial morphology, with greater changes in the presence of DR and longer duration. Several estimates were sensitive to individual studies or publication bias, warranting cautious interpretation. Preoperative endothelial assessment may be beneficial in diabetic patients, particularly those with DR or long disease duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261473313<\/jats:ext-link>\n                      , identifier CRD420261473313.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1982467","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:40:37Z","timestamp":1790656837000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Corneal endothelial changes in type 2 diabetes mellitus: a systematic review and meta-analysis with subgroup comparisons by diabetic retinopathy status and disease duration"],"prefix":"10.3389","volume":"17","author":[{"given":"Yongran","family":"Li","sequence":"first","affiliation":[{"name":"Center of Ophthalmology, Heyou Hospital","place":["Foshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenlin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jieyang People\u2019s Hospital","place":["Jieyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhimin","family":"Cen","sequence":"additional","affiliation":[{"name":"Center of Ophthalmology, Zhongshan Torch Development Zone People\u2019s Hospital","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dingwang","family":"Su","sequence":"additional","affiliation":[{"name":"Center of Ophthalmology, Zhongshan Torch Development Zone People\u2019s Hospital","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tulong","family":"Lin","sequence":"additional","affiliation":[{"name":"Center of Ophthalmology, Zhongshan Torch Development Zone People\u2019s Hospital","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021","volume":"402","year":"2023","journal-title":"Lancet (London England)"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1538143","article-title":"Global burden and risk factors of type 2 diabetes mellitus from 1990 to 2021, with forecasts to 2050","volume":"16","author":"Huang","year":"2025","journal-title":"Front Endocrinol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/nutd.2017.4","article-title":"A systematic review on the impact of diabetes mellitus on the ocular surface","volume":"7","author":"Shih","year":"2017","journal-title":"Nutr Diabetes"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.survophthal.2020.02.005","article-title":"Diabetic keratopathy: Insights and challenges","volume":"65","author":"Priyadarsini","year":"2020","journal-title":"Survey Ophthalmol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/848659","article-title":"Peripheral neuropathy and tear film dysfunction in type 1 diabetes mellitus","volume":"2014","author":"Misra","year":"2014","journal-title":"J Diabetes Res"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/opx.0000000000001955","article-title":"Impact of peripheral and corneal neuropathy on markers of ocular surface discomfort in diabetic chronic kidney disease","volume":"99","author":"Asiedu","year":"2022","journal-title":"Optometry Vision Science: Off Publ Am Acad Optometry"},{"key":"B7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0002-9394(82)90693-6","article-title":"Clinical investigations on the corneal endothelium-XXXVIII Edward Jackson Memorial Lecture","volume":"93","author":"Mishima","year":"1982","journal-title":"Am J Ophthalmol"},{"key":"B8","article-title":"To evaluate the corneal endothelial cell density and central corneal thickness in type 2 diabetes mellitus above 50 years with age matched controls","author":"S. 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