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Diabetology
Special Issues
New Perspectives and Future Challenges in Diabetic Retinopathy
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New Perspectives and Future Challenges in Diabetic Retinopathy

A special issue of Diabetology (ISSN 2673-4540).

Deadline for manuscript submissions: 20 December 2026 | Viewed by 5814

Editor

Prof. Dr. Akifumi Kushiyama

E-Mail Website
Guest Editor
Department of Pharmacotherapy, Meiji Pharmaceutical University, Kiyose, Japan
Interests: diabetic complications; atherosclerosis; vascular endothelial function; epidemiology; bone metabolism; insulin resistance; angiogenesis

Special Issue Information

Dear Colleagues,

This Special Issue, "New Perspectives and Future Challenges in Diabetic Retinopathy", aims to explore the cutting edge of research into this sight-threatening complication of diabetes. Diabetic retinopathy remains a leading cause of blindness, and a deeper understanding of its complex pathophysiology is paramount for developing more effective treatments. We welcome contributions that unveil novel mechanistic insights into its development and progression, identify promising new therapeutic target molecules, and showcase innovative strategies for drug delivery to the retina. This includes, but is not limited to, advancements in areas such as ophthalmic formulations designed to enhance therapeutic efficacy and improve patient compliance through non-invasive routes. By bringing together diverse, cutting-edge perspectives, we hope to illuminate current hurdles and pave the way for future breakthroughs that will ultimately improve patient outcomes and preserve vision. We eagerly anticipate your valuable contributions to this rapidly evolving field.

Prof. Dr. Akifumi Kushiyama
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diabetology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • diabetic retinopathy
  • novel pathophysiology
  • therapeutic targets
  • drug delivery systems
  • future therapeutics

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Published Papers (4 papers)

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Research

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13 pages, 919 KB  
Article
Autonomic Dysfunction and Ocular Complications: The Role of Sudoscan in Diabetic Retinopathy Screening
by Andra-Elena Nica, Emilia Rusu, Carmen Dobjanschi, Florin Rusu, Claudia Sivu, Oana Andreea Parliteanu, Ioana Verde, Andreea Andrita and Gabriela Radulian
Diabetology 2026, 7(4), 63; https://doi.org/10.3390/diabetology7040063 - 30 Mar 2026
Viewed by 650
Abstract
Background: Diabetic retinopathy (DR) remains one of the most frequent and severe complications in patients with type 2 diabetes (T2DM), with significant implications for vision and quality of life. While classical screening methods are effective, they are not always accessible or systematically used. [...] Read more.
Background: Diabetic retinopathy (DR) remains one of the most frequent and severe complications in patients with type 2 diabetes (T2DM), with significant implications for vision and quality of life. While classical screening methods are effective, they are not always accessible or systematically used. Sudoscan, a device that evaluates sweat gland function by measuring electrochemical skin conductance (ESC)—an indicator of chloride ion flow through sweat glands and a marker of peripheral autonomic nerve function—has recently attracted attention as a potential adjunct tool for risk assessment of microvascular complications. Objectives: In this cross-sectional study, we investigated its utility in identifying DR among 271 adults with T2DM. DR was diagnosed in 35.8% of patients, and those affected showed lower Sudoscan scores in the lower limbs and higher scores indicating cardiovascular autonomic neuropathy. Methods: Statistical analyses, including ROC curve evaluation and multiple linear regression, revealed moderate diagnostic accuracy and significant correlations between Sudoscan parameters and DR severity. Results: Our results suggest that Sudoscan could serve as a fast, painless, and informative screening tool, particularly valuable in settings with limited access to ophthalmologic services. Conclusions: Although it does not replace fundus examination, it may offer complementary insights and help stratify patients by risk level, guiding more targeted monitoring and intervention strategies. Full article
(This article belongs to the Special Issue New Perspectives and Future Challenges in Diabetic Retinopathy)
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14 pages, 2417 KB  
Article
Absence of Tendon Reflexes as a Predictor of Diabetic Retinopathy: A Retrospective Cohort Study in Japan
by Taichi Muramatsu, Ayaka Sugiura, Daisuke Yamamuro, Ryosuke Kumazawa, Manabu Akazawa, Akifumi Kushiyama and Takako Kikuchi
Diabetology 2026, 7(4), 62; https://doi.org/10.3390/diabetology7040062 - 25 Mar 2026
Viewed by 628
Abstract
Background/Objective: This study investigated the association between tendon reflexes (Achilles and patellar) and the development of diabetic retinopathy (DR) in patients with type 2 diabetes (T2D). Methods: This single-center retrospective cohort study enrolled patients with T2D. The primary outcome was the [...] Read more.
Background/Objective: This study investigated the association between tendon reflexes (Achilles and patellar) and the development of diabetic retinopathy (DR) in patients with type 2 diabetes (T2D). Methods: This single-center retrospective cohort study enrolled patients with T2D. The primary outcome was the development of DR. Tendon reflex findings were classified into four groups (normal, decreased, absent, and not examined). A regression analysis using a Cox proportional hazard model was performed to evaluate the association between tendon reflex findings and the outcome. Results: A total of 1172 patients were included in the primary outcome analysis. The median follow-up period was 4.3 years, and 271 experienced DR development. In the multivariate analysis, an absent Achilles tendon reflex (hazard ratio [HR], 1.52; 95% confidence interval [CI]: 1.01–2.27) and an absent patellar tendon reflex (HR: 1.89, 95% CI: 1.18–3.03) were independently associated with DR development. Conclusions: The absence of the Achilles and patellar tendon reflexes may serve as risk markers for DR development. Clinical Practice Implications: Non-invasive assessment of tendon reflexes may serve as an adjunctive tool to identify patients with T2D at high risk for future DR, enabling timely ophthalmologic referral and targeted management. Full article
(This article belongs to the Special Issue New Perspectives and Future Challenges in Diabetic Retinopathy)
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11 pages, 3022 KB  
Article
A Real-World Comparison of Three Deep Learning Systems for Diabetic Retinopathy in Remote Australia
by Jocelyn J. Drinkwater, Qiang Li, Kerry Woods, Emma Douglas, Mark Chia, Yukun Zhou, Steve Bartnik, Yachana Shah, Vaibhav Shah, Pearse A. Keane and Angus W. Turner
Diabetology 2025, 6(12), 146; https://doi.org/10.3390/diabetology6120146 - 1 Dec 2025
Cited by 1 | Viewed by 1190
Abstract
Background/objective: Deep learning systems (DLSs) may improve access to screening for diabetic retinopathy (DR), a leading cause of vision loss. Therefore, the aim was to prospectively compare the performance of three DLSs, Google ARDA, Thirona RetCADTM, and EyRIS SELENA+, in the [...] Read more.
Background/objective: Deep learning systems (DLSs) may improve access to screening for diabetic retinopathy (DR), a leading cause of vision loss. Therefore, the aim was to prospectively compare the performance of three DLSs, Google ARDA, Thirona RetCADTM, and EyRIS SELENA+, in the detection of referable DR in a real-world setting. Methods: Participants with self-reported diabetes presented to a mobile facility for DR screening in the remote Pilbara region of Western Australia, which has a high proportion of First Nations people. Sensitivity, specificity, and other performance indicators were calculated for each DLS, compared to grading by an ophthalmologist adjudication panel. Results: Single field colour fundus photographs from 188 eyes of 94 participants (51% male, 70% First Nations Australians, and mean ± SD age of 60.3 ± 12.0 years) were assessed; 39 images had referable DR, 135 had no referable DR, and 14 images were ungradable. The sensitivity/specificity of ARDA was 100% (95% CI: 91.03–100%)/94.81% (89.68–97.47%), RetCAD was 97.37% (86.50–99.53%)/97.01% (92.58–98.83%) and SELENA+ was 91.67% (78.17–97.13%)/80.80% (73.02–86.74%). Conclusions: In a small, real-world service evaluation, comprising majority First Nations people from remote Western Australia, DLSs had high sensitivity and specificity for detecting referable DR. A comparative service evaluation can be useful to highlight differences between DLSs, especially in unique settings or with minority populations. Full article
(This article belongs to the Special Issue New Perspectives and Future Challenges in Diabetic Retinopathy)
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Review

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16 pages, 2288 KB  
Review
Diabetic Retinopathy and Other Microvascular Complications of Diabetes—A Review of Multi-Omics Research
by Julia Grzybowska-Adamowicz and Agnieszka Zmysłowska
Diabetology 2026, 7(1), 3; https://doi.org/10.3390/diabetology7010003 - 31 Dec 2025
Cited by 2 | Viewed by 2560
Abstract
Microvascular complications of diabetes include retinopathy (DR), diabetic kidney disease (DKD), and neuropathy (DN), which play a crucial role in diabetes management, as they significantly impair the functionality of the patient and remain major causes of morbidity despite advances in glycaemic control. The [...] Read more.
Microvascular complications of diabetes include retinopathy (DR), diabetic kidney disease (DKD), and neuropathy (DN), which play a crucial role in diabetes management, as they significantly impair the functionality of the patient and remain major causes of morbidity despite advances in glycaemic control. The aim of this review was to summarize multi-omics findings in DR, DKD, and DN. Multi-omics studies consist of genomic, epigenomic, transcriptomic, proteomic, and metabolomic research. These studies provided comprehensive insights into the complex mechanisms underlying microvascular complications of diabetes, such as inflammation, angiogenesis, and apoptosis in the retina, kidneys, and nervous system. They also enabled the search for emerging diagnostic, prognostic, and therapeutic biomarkers. Moreover, changes in microRNA levels were found to differentiate patients with non-proliferative and proliferative DR. In addition, different proteins and metabolites concentrations were noticed in diabetes macular oedema and tractional retinal detachment—serious complications of DR. Specific molecular signatures, such as miR-146a and miR-27 dysregulation, changes in levels of HLA-DRA, AGER, and HSPA1A proteins, and alterations in tyrosine, alanine, 2,4-dihydroxybutanoic acid, ribonic acid, myoinositol, ribitol, 3,4-dihydroxybutanoic acid, valine, glycine, and 2-hydroxyisovaleric acid, were found to be characteristic for all microvascular complications of diabetes. In the future, more studies in multi-omics are expected to help improve precision medicine approaches to treating diabetes, allowing for personalized prediction, prevention, and treatment of microvascular complications. Full article
(This article belongs to the Special Issue New Perspectives and Future Challenges in Diabetic Retinopathy)
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