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Original research
Associations of grip strength with retinal and choroidal thickness in patients with type 2 diabetes mellitus without retinopathy: a cross-sectional study
  1. Zihan Qiu1,
  2. Wei Wang1,
  3. Yan Tan1,
  4. Miao He2,
  5. Langhua Wang1,
  6. Yuting Li1,
  7. Xia Gong1,
  8. Wenyong Huang1
  1. 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  2. 2Department of Ophthalmology, Guangdong General Hospital, Guangzhou, China
  1. Correspondence to Dr Wei Wang; zoc_wangwei{at}; Professor Wenyong Huang; andyhwyz{at}


Objective To evaluate the associations of grip strength with retinal or choroidal thickness in patients with type 2 diabetes mellitus without retinopathy.

Design Observational study-cross-sectional design.

Setting and participants This study included the Chinese patients with type 2 diabetes without retinopathy registered in the community health system in Guangzhou, China.

Measures The grip strength in both hands were measured by using a dynamometer. The retinal and choroidal thickness in macular region stratified by Early Treatment Diabetic Retinopathy Study (ETDRS) sectors were measured by a swept-source optical coherence tomography.

Results A total of 1029 patients were included. Both retinal thickness and choroidal thickness decreased with the lower quartile of grip strength. Regression analyses indicated that the average retinal and choroidal thickness increased by 0.14 µm (95% CI: 0.03 to 0.25 µm, p=0.011) and 0.57 µm (95% CI: 0.03 to 1.11 µm, p=0.037), respectively, for each additional kilogram of grip strength following adjustment for age and sex. Further adjustments were made for axial length, haemoglobin A1c, length of time the patient had diabetes, insulin usage, height, weight and systolic and diastolic blood pressure, which resulted in an average retinal and choroidal thickness increase of 0.13 µm (95% CI: 0.02 to 0.24 µm, p=0.024) and 0.65 µm (95% CI: 0.13 to 1.16 µm, p=0.013), respectively, for each additional kilogram of grip strength. Consistent results were obtained in the analyses in ETDRS 9 sectors.

Conclusion Lower hand grip strength was found to be significantly associated with thinner retinal and choroidal layers in patients with diabetes. Grip strength may provide a useful and easily administered indicator of retinal status in patients with diabetes.

  • diabetic retinopathy
  • epidemiology
  • clinical audit

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  • Contributors WW, YL and WH designed and conducted the study; ZQ, WW, YT, MH, LW, XG, YL and WH contributed to collection, management, analysis and interpretation of the data; ZQ, WW and WH prepared the manuscript; all authors reviewed and finally approved the manuscript.

  • Funding This research was supported in part by the National Natural Science Foundation of China (81570843; 81900866), the Guangdong Province Science & Technology Plan (2017KYPJ094).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The protocol was approved by the Committee of Zhongshan Ophthalmic Center (protocol number IRB#2017-05-0621).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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