Publication Name	World Journal of Clinical Cases
Manuscript ID	120247
Country	Italy

Category	Ophthalmology
Manuscript Type	Minireviews
Article Title	Underlying cause of diabetic retinopathy: Metabolic instability
Manuscript Source	Invited Manuscript
All Author List	Francesco Cappellani, Matteo Capobianco, Francesco Leonforte, Alessandro Avitabile, Federico Visalli, Marieme Khouyyi, Rosa Giglio, Leandro Inferrera, Daniele Tognetto, Fabiana D’Esposito, Caterina Gagliano and Marco Zeppieri
Funding Agency and Grant Number
Corresponding Author	Marco Zeppieri, Consultant, MD, PhD, Postdoc, Department of Ophthalmology, University Hospital of Udine, p. le S. Maria della Misericordia 15, Udine 33100, Italy. mark.zeppieri@asufc.sanita.fvg.it
Key Words	Metabolic instability; Diabetic retinopathy; Glycemic variability; Metabolic memory; Continuous glucose monitoring; Oxidative stress; Neurovascular unit
Core Tip	Diabetic retinopathy is becoming acknowledged as a result of dynamic metabolic stress rather than merely prolonged hyperglycemia. Variations in glucose levels, repeated glycemic fluctuations, and hypoglycemia collectively affect the retinal neurovascular unit, promoting oxidative stress, inflammation, mitochondrial dysfunction, and epigenetic reprogramming. These pathways may expedite microvascular and neuronal damage despite seemingly acceptable average glucose indices. Recognizing diabetic retinopathy as a marker of metabolic instability complicates traditional risk assessment and underscores the need for new, sensitive, temporally resolved metabolic indicators.
Citation	Cappellani F, Capobianco M, Leonforte F, Avitabile A, Visalli F, Khouyyi M, Giglio R, Inferrera L, Tognetto D, D’Esposito F, Gagliano C, Zeppieri M. Underlying cause of diabetic retinopathy: Metabolic instability. World J Clin Cases 2026; In press

Received	2026-02-24 06:31
Peer-Review Started	2026-02-24 06:32
First Decision by Editorial Office Director	2026-03-02 08:48
Return for Revision	2026-03-02 08:48
Revised	2026-03-03 16:23
Publication Fee Transferred
Second Decision by Editor	2026-03-17 03:05
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-03-17 08:54
Articles in Press	2026-03-17 08:54
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	2307-8960 (online)
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