Disturbances in lipid metabolism may play a critical role in the development and progression of diabetic retinopathy in patients with type 2 diabetes. Data presented at EASD 2025 reveal that specific plasma lipid profiles could enhance risk prediction for this sight-threatening complication.

In a community-based longitudinal study involving 762 adults with type 2 diabetes, five plasma lipids—including cholesterol ester (20:4), fatty acid (20:3), lysophosphatidylglycerols (18:0 and 18:1), and phosphatidylcholine (18:0_20:3)—were independently associated with either new or worsening diabetic retinopathy or incident retinopathy over four to six years of follow-up. Patients with abnormalities in these lipid markers showed a higher likelihood of retinopathy progression, even after adjusting for conventional risk factors such as glycaemic control, blood pressure, and albuminuria.

The addition of these lipid parameters to conventional risk models significantly improved predictive performance, with net reclassification improvements of 5.7% for new or worsening retinopathy and 28.3% for incident retinopathy. These findings suggest that lipid dysregulation contributes to retinal microvascular damage and highlight potential mechanistic pathways for future therapeutic targets.