ArticleFrontiers in endocrinology2026
Age at type 2 diabetes onset, HOMA-derived indices and risks of diabetic retinopathy: a real-world cross-sectional study.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The roles of insulin resistance (IR) and β-cell dysfunction in diabetic retinopathy (DR) remain controversial, and whether age at type 2 diabetes mellitus (T2DM) onset modifies these associations is unclear. This study aimed to evaluate the associations of HOMA-IR and HOMA-β with DR risk, stratified by age at diagnosis. Methods: In this real-world cross-sectional study, we analyzed data from 6,996 patients with T2DM from Lishui People's Hospital, China. Participants were categorized by age at onset (<65 vs. ≥65 years) and HOMA indices (HOMA-β <66 vs. ≥66; HOMA-IR <5 vs. ≥5). Multivariable logistic regression was used to assess adjusted odds ratios (aORs) for DR. Results: A total of 1,360 DR cases were identified in 6996 participants. Low HOMA-β was significantly associated with higher DR odds, especially in the younger-onset group (aOR = 2.97, 95% CI: 2.24-3.99). High HOMA-IR was associated with increased DR odds in younger-onset participants (aOR = 3.14, 95% CI: 2.31-4.33). Notably, among participants with high HOMA-β or low HOMA-IR, age at T2DM onset did not significantly modify the association with DR. Subgroup analyses showed strong associations in those with renal dysfunction or not using lipid-lowering agents. Conclusion: Both β-cell dysfunction and insulin resistance were independently associated with increased odds of diabetic retinopathy in younger-onset type 2 diabetes. Age at onset significantly modified these associations, supporting age-stratified screening and tailored management strategies.
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