{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T22:32:50Z","timestamp":1793313170089,"version":"4.5.0"},"reference-count":48,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,28]],"date-time":"2024-12-28T00:00:00Z","timestamp":1735344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Diabetes has become a global epidemic, contributing to significant health challenges due to its complications. Among these, diabetes can affect sight through various mechanisms, emphasizing the importance of early identification and management of vision-threatening conditions in diabetic patients. Changes in the crystalline lens caused by diabetes may lead to temporary and permanent visual impairment. Since individuals with diabetes are at an increased risk of developing cataracts, which significantly affects their quality of life, this study aims to identify the most common cataract subtypes in diabetic patients, highlighting the need for proactive screening and early intervention. Materials and Methods: This study included 201 participants with cataracts (47.6% women and 52.4% men), of whom 105 also had diabetes. With the use of machine learning, the patients were assessed and categorized as having one of the three main types of cataracts: cortical (CC), nuclear (NS), and posterior subcapsular (PSC). A Random Forest Classification algorithm was employed to predict the incidence of different associations of cataracts (1, 2, or 3 types). Results: Cataracts have been encountered more frequently and at a younger age in patients with diabetes. CC was significantly more frequent among patients with diabetes (p &lt; 0.0001), while the NS and PSC were only marginally, without statistical significance. Machine learning could also contribute to an early diagnosis of cataracts, with the presence of diabetes, duration of diabetes, or diabetic polyneuropathy (PND) having the highest importance for a successful classification. Conclusions: These findings suggest that diabetes may impact the type of cataract that develops, with CC being notably more prevalent in diabetic patients. This has important implications for screening and management strategies for cataract formation in diabetic populations.<\/jats:p>","DOI":"10.3390\/medicina61010029","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T10:17:40Z","timestamp":1735640260000},"page":"29","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Diabetes and Cataracts Development\u2014Characteristics, Subtypes and Predictive Modeling Using Machine Learning in Romanian Patients: A Cross-Sectional Study"],"prefix":"10.3390","volume":"61","author":[{"given":"Adriana","family":"Ivanescu","sequence":"first","affiliation":[{"name":"Doctoral School of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Second Department of Internal Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Opticlass Ophtalmology Clinic, 300012 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Popescu","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Diabetes, \u201cPius Br\u00eenzeu\u201d Emergency County Hospital, 300723 Timisoara, Romania"},{"name":"Centre for Molecular Research in Nephrology and Vascular Disease, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7904-6073","authenticated-orcid":false,"given":"Adina","family":"Braha","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Diabetes, \u201cPius Br\u00eenzeu\u201d Emergency County Hospital, 300723 Timisoara, Romania"},{"name":"Centre for Molecular Research in Nephrology and Vascular Disease, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Timar","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Diabetes, \u201cPius Br\u00eenzeu\u201d Emergency County Hospital, 300723 Timisoara, Romania"},{"name":"Centre for Molecular Research in Nephrology and Vascular Disease, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4086-0991","authenticated-orcid":false,"given":"Teodora","family":"Sorescu","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Diabetes, \u201cPius Br\u00eenzeu\u201d Emergency County Hospital, 300723 Timisoara, Romania"},{"name":"Centre for Molecular Research in Nephrology and Vascular Disease, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Lazar","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Centre for Molecular Research in Nephrology and Vascular Disease, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"First Department of Internal Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Hematology, Emergency Municipal Hospital, 300254 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0792-9202","authenticated-orcid":false,"given":"Romulus","family":"Timar","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Diabetes, \u201cPius Br\u00eenzeu\u201d Emergency County Hospital, 300723 Timisoara, Romania"},{"name":"Centre for Molecular Research in Nephrology and Vascular Disease, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5204-6954","authenticated-orcid":false,"given":"Laura","family":"Gaita","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Diabetes, \u201cPius Br\u00eenzeu\u201d Emergency County Hospital, 300723 Timisoara, Romania"},{"name":"Centre for Molecular Research in Nephrology and Vascular Disease, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"109119","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":"ref_2","doi-asserted-by":"crossref","first-page":"101636","DOI":"10.1016\/j.pmedr.2021.101636","article-title":"The Type 2 Diabetes \u201cmodern Preventable Pandemic\u201d and Replicable Lessons from the COVID-19 Crisis","volume":"25","author":"Singer","year":"2022","journal-title":"Prev. Med. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"26","DOI":"10.2337\/dci23-0085","article-title":"Economic Costs of Diabetes in the U.S. in 2022","volume":"47","author":"Parker","year":"2024","journal-title":"Diabetes Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1111\/1753-0407.12297","article-title":"Prevalence of Diabetes Mellitus and Prediabetes in the Adult R Omanian Population: PREDATORR Study","volume":"8","author":"Mota","year":"2016","journal-title":"J. Diabetes"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"92","DOI":"10.4239\/wjd.v6.i1.92","article-title":"Ocular Complications of Diabetes Mellitus","volume":"6","author":"Sayin","year":"2015","journal-title":"WJD"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Khan, J., and Shaw, S. (2023). Risk of Cataract and Glaucoma among Older Persons with Diabetes in India: A Cross-Sectional Study Based on LASI, Wave-1. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-38229-z"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6","DOI":"10.2337\/db20191-6","article-title":"Cataracts and Their Treatment in People with Diabetes","volume":"2019","author":"Bixler","year":"2019","journal-title":"Compendia"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Mrugacz, M., Pony-Uram, M., Bryl, A., and Zorena, K. (2023). Current Approach to the Pathogenesis of Diabetic Cataracts. IJMS, 24.","DOI":"10.3390\/ijms24076317"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.diabres.2008.08.023","article-title":"Cataract and Type 1 Diabetes Mellitus","volume":"82","author":"Esteves","year":"2008","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.1111\/dme.12053","article-title":"Frequency and Risk Factors of Non-Retinopathy Ocular Conditions in People with Diabetes: The Singapore Malay Eye Study","volume":"30","author":"Chiang","year":"2013","journal-title":"Diabet. Med."},{"key":"ref_11","first-page":"1272","article-title":"Age-Related Cataract and Its Types in Patients with and without Type 2 Diabetes Mellitus: A Hospital-Based Comparative Study","volume":"66","author":"Memon","year":"2016","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.ophtha.2003.06.016","article-title":"Nine-Year Incidence of Lens Opacities in the Barbados Eye Studies","volume":"111","author":"Leske","year":"2004","journal-title":"Ophthalmology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1136\/bjo.2004.045484","article-title":"Cataract Surgery and Subtype in a Defined, Older Population: The SEECAT Project","volume":"88","author":"Lewis","year":"2004","journal-title":"Br. J. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/S0002-9394(02)01844-5","article-title":"Incidence and Progression of Cataract in the Melbourne Visual Impairment Project","volume":"136","author":"McCarty","year":"2003","journal-title":"Am. J. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Li, L., Wan, X., and Zhao, G. (2014). Meta-Analysis of the Risk of Cataract in Type 2 Diabetes. BMC Ophthalmol., 14.","DOI":"10.1186\/1471-2415-14-94"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1038\/s41433-020-0806-3","article-title":"Global and Regional Prevalence of Age-Related Cataract: A Comprehensive Systematic Review and Meta-Analysis","volume":"34","author":"Hashemi","year":"2020","journal-title":"Eye"},{"key":"ref_17","first-page":"e32703","article-title":"Assessment of Knowledge Regarding Cataract Among Saudi Adult Population in Assir Region, Saudi Arabia","volume":"14","author":"Aldhabaan","year":"2022","journal-title":"Cureus"},{"key":"ref_18","first-page":"52","article-title":"Cataracts in Diabetic Patients: A Review Article","volume":"3","author":"Javadi","year":"2008","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/ICU.0b013e3282f154bd","article-title":"Cataract Surgery for the Developing World","volume":"19","author":"Tabin","year":"2008","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_20","first-page":"209","article-title":"Cataract: Trends in Surgical Procedures and Visual Outcomes; a Study in a Tertiary Care Hospital","volume":"62","author":"Naeem","year":"2012","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zhang, J.H., Ramke, J., Lee, C.N., Gordon, I., Safi, S., Lingham, G., Evans, J.R., and Keel, S. (2022). A Systematic Review of Clinical Practice Guidelines for Cataract: Evidence to Support the Development of the WHO Package of Eye Care Interventions. Vision, 6.","DOI":"10.3390\/vision6020036"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1034\/j.1600-0420.1999.770615.x","article-title":"The Decrease of Visual Acuity in Cataract Patients Waiting for Surgery","volume":"77","author":"Leinonen","year":"1999","journal-title":"Acta Ophthalmol. Scand."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"313","DOI":"10.2147\/CIA.S97295","article-title":"Age as an Independent Factor for the Development of Neuropathy in Diabetic Patients","volume":"11","author":"Baderca","year":"2016","journal-title":"CIA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/S0002-9394(98)00280-3","article-title":"Diabetes, Cardiovascular Disease, Selected Cardiovascular Disease Risk Factors, and the 5-Year Incidence of Age-Related Cataract and Progression of Lens Opacities: The Beaver Dam Eye Study","volume":"126","author":"Klein","year":"1998","journal-title":"Am. J. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"67","DOI":"10.31782\/IJCRR.2021.13607","article-title":"Analysis of Cataract in Diabetic and Non-Diabetic Patients","volume":"13","author":"Manasvi","year":"2021","journal-title":"IJCRR"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1080\/09553002.2020.1812759","article-title":"Etiology of Posterior Subcapsular Cataracts Based on a Review of Risk Factors Including Aging, Diabetes, and Ionizing Radiation","volume":"96","author":"Richardson","year":"2020","journal-title":"Int. J. Radiat. Biol."},{"key":"ref_27","first-page":"3021","article-title":"Refractive Associations with Cataract: The Blue Mountains Eye Study","volume":"40","author":"Lim","year":"1999","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"7547043","DOI":"10.1155\/2022\/7547043","article-title":"Prevalence and Risk Factors for Adult Cataract in the Jingan District of Shanghai","volume":"2022","author":"Hong","year":"2022","journal-title":"J. Ophthalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"608751","DOI":"10.1155\/2010\/608751","article-title":"Diabetic Cataract\u2014Pathogenesis, Epidemiology and Treatment","volume":"2010","author":"Pollreisz","year":"2010","journal-title":"J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/j.1755-3768.2011.02326.x","article-title":"The Prevalence of Cataract in a Population with and without Type 2 Diabetes Mellitus","volume":"90","author":"Olafsdottir","year":"2012","journal-title":"Acta Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Grzybowski, A., Kanclerz, P., Huerva, V., Ascaso, F.J., and Tuuminen, R. (2019). Diabetes and Phacoemulsification Cataract Surgery: Difficulties, Risks and Potential Complications. J. Clin. Med., 8.","DOI":"10.3390\/jcm8050716"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/S0161-6420(85)33877-0","article-title":"Prevalence of Cataracts in a Population-Based Study of Persons with Diabetes Mellitus","volume":"92","author":"Klein","year":"1985","journal-title":"Ophthalmology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1111\/j.1755-3768.1984.tb03972.x","article-title":"The Prevalence of Cataract in Insulin-Dependent and Non-Insulin-Dependent-Diabetes Mellitus","volume":"62","author":"Nielsen","year":"1984","journal-title":"Acta Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1001\/archopht.1991.01080020090051","article-title":"The Lens Opacities Case-Control Study. Risk Factors for Cataract","volume":"109","author":"Leske","year":"1991","journal-title":"Arch. Ophthalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1038\/s41433-017-0003-1","article-title":"Cataract in Patients with Diabetes Mellitus\u2014Incidence Rates in the UK and Risk Factors","volume":"32","author":"Becker","year":"2018","journal-title":"Eye"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1016\/j.ophtha.2011.03.032","article-title":"Age-Related Eye Disease Study Group Risk Factors Associated with Incident Cataracts and Cataract Surgery in the Age-Related Eye Disease Study (AREDS): AREDS Report Number 32","volume":"118","author":"Chang","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"100489","DOI":"10.1016\/j.optom.2023.100489","article-title":"Quality of Life Assessment for Nuclear, Cortical, Posterior Subcapsular Patients before and after Cataract Surgery","volume":"17","author":"Solomatin","year":"2024","journal-title":"J. Optom."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1001\/archopht.1994.01090170074026","article-title":"The VF-14. An Index of Functional Impairment in Patients with Cataract","volume":"112","author":"Steinberg","year":"1994","journal-title":"Arch. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1177\/1120672120929958","article-title":"Cataract Surgery and Dry Eye Disease: A Review","volume":"30","author":"Naderi","year":"2020","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"611","DOI":"10.4103\/IJO.IJO_1559_24","article-title":"Cataract with Diabetic Retinopathy: Optimizing the Visual Outcomes","volume":"4","author":"Temkar","year":"2024","journal-title":"Indian J. Ophthalmol.-Case Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1093\/ageing\/afy156","article-title":"The Impact of First- and Second-Eye Cataract Surgery on Motor Vehicle Crashes and Associated Costs","volume":"48","author":"Meuleners","year":"2019","journal-title":"Age Ageing"},{"key":"ref_42","first-page":"e66600","article-title":"Machine Learning and Vision: Advancing the Frontiers of Diabetic Cataract Management","volume":"16","author":"Mohammad","year":"2024","journal-title":"Cureus"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Sheng, B., Chen, X., Li, T., Ma, T., Yang, Y., Bi, L., and Zhang, X. (2022). An Overview of Artificial Intelligence in Diabetic Retinopathy and Other Ocular Diseases. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.971943"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1007\/s40123-023-00690-4","article-title":"Artificial Intelligence for Anterior Segment Diseases: A Review of Potential Developments and Clinical Applications","volume":"12","author":"Xu","year":"2023","journal-title":"Ophthalmol. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.ecl.2021.05.012","article-title":"Characterizing Multimorbidity from Type 2 Diabetes","volume":"50","author":"Cicek","year":"2021","journal-title":"Endocrinol. Metab. Clin. North Am."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"S68","DOI":"10.2337\/dc23-S005","article-title":"5. Facilitating Positive Health Behaviors and Well-Being to Improve Health Outcomes: Standards of Care in Diabetes-2023","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Sikalidis, A.K., and Maykish, A. (2020). The Gut Microbiome and Type 2 Diabetes Mellitus: Discussing a Complex Relationship. Biomedicines, 8.","DOI":"10.3390\/biomedicines8010008"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Ivanescu, A., Popescu, S., Ivanescu, R., Potra, M., and Timar, R. (2024). Predictors of Diabetic Retinopathy in Type 2 Diabetes: A Cross-Sectional Study. Biomedicines, 12.","DOI":"10.3390\/biomedicines12081889"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/29\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:55:16Z","timestamp":1760115316000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/29"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,28]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["medicina61010029"],"URL":"https:\/\/doi.org\/10.3390\/medicina61010029","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,28]]}}}