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Olivier Lichtwitz, Nicolas Leveziel, Michèle Boissonnot, Aurélie Miot, Xavier Piguel, Florence Torremocha, Pierre-Jean Saulnier, Richard Maréchaud, Samy Hadjadj; Correlation between Diabetic Macular Edema (DME) and extraocular complications observed during diabetes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4918.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic macular edema is the main cause of visual loss during diabetes. Some clinical (hypertension, nephropathy) or biological parameters (glycatedhemoglobin) are well-known risk factors for DME. The objective of the study was to identify clinical factors that may be associated with the presence of the DME.
This is a longitudinal study including type 2 diabetic patients to evaluate the risk of complications related to diabetes. The diagnosis of DME was established with retinal color photographs and/or fundus examination. Epidemiological data, cardiovascular events (angina, myocardial infarction, transient ischemic attack, stroke)and other complications (nephropathy, history of amputation) were analysed.Diabetic patients with DME were compared with diabetic patients without DME.
Among 2864 patients (mean age 63 years, mean duration of diabetes of 14.7 years, mean HbA1c 7.6%) included in the study, 357 patients (12.5%) had a DME (131 women, 226 men, mean age 65.8 years, mean duration of diabetes of 18,7 years, glycosylated haemoglobin 7.7%). In univariate analysis, DME was significantly associated with the duration of diabetes (OR=1.04, p<0.0001), glycatedhemoglobinlevels (OR=1.18, p=0.001), systolic blood pressure (OR=1.02, p<0.0001), history of cardiovascular disease (OR=2.4, p<0.0001), renal impairment (OR>7, p<0.0003) and with any history of amputation (OR=3.7, p<0.0001). In multivariate analysis, DME was significantly associated with the duration on diabetes (OR adjusted=1.03, CI 95% 1.01-1.05, p=0,002), glycatedhemoglobin (OR adjusted =1.2, CI 95% 1.1-1.4, p=0.0003), systolic blood pressure (OR adjusted =1.01, CI 95% 1.01-1.02, p=0,01), renal impairment (OR adjusted>5, p<0.006) and with any history of amputation (OR adjusted =2.6, CI 95% 1.4-5, p=0.003).
This study demonstrates a strong association between DME andany history amputation. Our study provides other associations between DME and extraocular events that have been previously investigated in other studies. A common microvascular determinism may be explained the relationship between amputation and DME. The identification of clinical and biological risk factors for DME could lead to define more precisely the at-risk population. Based on these risk factors, a prospective follow-up of patients may lead to validate predictive models fordevelopment of DME.
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