# Serum Albumin and Glycemic Variability Could Contribute to Diabetic Retinopathy Progression by Regulating Chronic Inflammatory Pathways

## TL;DR

This study suggests that lower serum albumin and unstable blood sugar levels may worsen diabetic retinopathy by boosting inflammation.

## Contribution

The study identifies serum albumin decline and glycemic variability as novel predictors of diabetic retinopathy progression after bariatric surgery.

## Key findings

- Lower serum albumin levels were strongly linked to diabetic retinopathy progression (OR = 0.461).
- Glycemic variability correlated with increased DR severity (mean difference: 0.6583%).
- Albumin decrease predicted higher IL-6 and IL-1β levels, suggesting NLRP3 inflammasome involvement.

## Abstract

Despite managing glycemic levels and other risk factors, individuals with type 2 diabetes (T2DM) may still experience diabetic retinopathy (DR) progression. This study investigated clinical predictors of DR progression in T2DM patients following bariatric surgery.

This study was a retrospective post hoc analysis of participants from a clinical randomized controlled trial of bariatric surgery patients with T2DM (ACTRN12611000751976) who had complete DR screening and blood data at baseline and 5 years post‐bariatric surgery. Plasma cytokine concentrations were also examined.

DR progression was strongly associated with a postoperative decrease in serum albumin (OR = 0.461, 95% CI: 0.221–0.962, p = 0.039). This decrease also predicted postoperative increases in IL‐6 (OR = infinity, sensitivity = 100.00%, p = 0.0162) and IL‐1β (OR = 11.250, sensitivity = 81.82%, p = 0.0154), known to be linked to NLRP3 inflammasome activation. In addition, individuals who progressed in DR severity showed greater month‐to‐month HbA1c variability compared to stable individuals (mean difference: 0.6583%, 95% CI: 0.1821–1.134%, p = 0.0115).

Decreases in serum albumin and increased glycemic variability may influence DR progression through the NLRP3 inflammasome and inflammatory pathways. Further research is needed to clarify the role and mechanism of albumin loss in DR progression.