Diabetic retinopathy (DR) is a major microvascular complication of diabetes and remains the leading cause of preventable blindness worldwide. Early diagnosis through annual screening for DR, and early, appropriate treatment can reduce the risk of blindness. However, given the increasing incidence and prevalence of type 2 diabetes mellitus, it is crucial to identify patients who are at a higher risk of developing DR based on risk factors and biomarkers, and confer a priority for the access to ophthalmological services. The major risk factors for the onset of DR (e.g., duration of diabetes, poor glycemic control, high systolic blood pressure [SBP] and high body mass index [BMI]) are well‐established; however, these traditional risk factors are inadequate to predict the risk of DR. Therefore, novel clinical factors that are associated with DR should be identified for the prediction of the risk for onset of DR.

A previous cross‐sectional study showed that among the abnormal capillary features, the presence of crossing capillaries in the finger nailfold was associated with an increased risk for DR. As the microvascular morphology of the finger nailfold can be examined easily, non‐invasively and safely, crossing capillaries might potentially be a novel DR biomarker that could be used in the clinical setting. However, a recent cross‐sectional study showed no significant association between crossing capillaries and the presence of DR. It should be noted, however, that these two studies evaluated the presence of crossing capillaries using semiquantitative capillary assessments, which could have resulted in low reliability. Furthermore, these previous studies were not adequately controlled for confounding factors that could affect the abnormal morphology of nailfold capillaries and DR.

Therefore, the study aimed to assess the association between crossing capillaries of the finger nailfold and DR in patients with type 2 diabetes mellitus while controlling for confounding factors and by using a quantitative capillary assessment.

After adjusting for age, sex, diabetes duration, glycated hemoglobin, systolic blood pressure, body mass index, and use of renin–angiotensin system inhibitor and antihyperlipidemic medication, the percentage of crossing capillaries was significantly associated with DR (multivariable‐adjusted odds ratios for increasing tertiles of the percentage of crossing capillary:2.05 [95% confidence interval 0.53–7.94], and 4.33 [95% confidence interval 1.16–16.21]; P‐trend = 0.028).

A higher percentage of crossing capillaries in the nailfold was associated with a higher risk of DR, independent of traditional risk and inhibiting factors, in patients with type 2 diabetes mellitus.

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Pancreatic disorders and Therapy