June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Glycemic thresholds for diabetic retinopathy and implications for diabetic retinopathy screening in the United States
Author Affiliations & Notes
  • Wen-Hsiang Lee
    Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, United States
    Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
  • Kevin J Moore
    Medical Education, University of Miami Miller School of Medicine, Miami, Florida, United States
    Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
  • Erin C Dunn
    Medical Education, University of Miami Miller School of Medicine, Miami, Florida, United States
    Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
  • Tulay Koru-Sengul
    Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
    Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States
  • Footnotes
    Commercial Relationships   Wen-Hsiang Lee, None; Kevin Moore, None; Erin Dunn, None; Tulay Koru-Sengul, None
  • Footnotes
    Support  In part by: NIH Center Core Grant P30EY014801; an unrestricted grant from Research to Prevent Blindness; and Department of Defense (DOD-Grant #W81XWH-09-1-0675).
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2908. doi:
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      Wen-Hsiang Lee, Kevin J Moore, Erin C Dunn, Tulay Koru-Sengul; Glycemic thresholds for diabetic retinopathy and implications for diabetic retinopathy screening in the United States. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2908.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Glycemic indices such as Hemoglobin A1c (HbA1c) and Fasting Plasma Glucose (FPG) can provide insight into patient diabetic retinopathy (DR) status. DR is one of the most common microvascular complications of Type I and II diabetes mellitus and affects more than 4 million Americans. The rise in diabetes over the coming decades puts more individuals at risk since diabetes is a leading cause of adult-onset blindness. HbA1c and FPG are used as diabetic diagnostic and progression markers. Using a cross-sectional study design, we evaluated the relationship between glycemic indices and DR to provide glycemic thresholds for clinical suspicion of patient DR status.

Methods : We analyzed clinical and sociodemographic characteristics from 5,704 adults (>40 years old) using data from the 2005-2008 National Health and Nutrition Examination Surveys (NHANES), a population-based nationally-representative sample. HbA1c, FPG, and 45-degree color retinal images were assessed. DR was defined as >14 on the Early Treatment Diabetic Retinopathy Study severity scale. Receiver operator curves (ROCs) were generated to obtain the optimal glycemic thresholds maximizing sensitivity and specificity. Statistical analysis was completed using SASv9.4.

Results : Compared to those without DR, patients with DR were on average older, had a higher BMI, larger waist circumference, lower total cholesterol, and higher FPG and HbA1c for the entire patient group. Youden’s Index for identifying DR (maximizing sensitivity and specificity) identified the optimal FPG threshold as 118 mg/dL (sensitivity: 46.3%; specificity: 80.8%; Odds ratio: 1.01; 95% Confidence interval (CI): 1.01 – 1.02). The optimal HbA1c threshold was 6.0% (sensitivity: 55.1%; specificity: 78.2%; Odds ratio: 1.79; 95% CI: 1.68 – 1.90). ROCs revealed HbA1c was a stronger discriminator of DR status compared to FPG (Area under the Curve (AUC): 0.71 vs 0.65).

Conclusions : This study proposes glycemic thresholds to differentiate between patients with and without DR. Health professionals can use these glycemic thresholds to monitor DR status and as a reminder of the importance of diabetic ophthalmologic examinations. Future longitudinal studies are necessary to better discern the ideal glycemic index thresholds to identify and to screen for DR in the clinical setting.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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