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K.M. Daum, S.N. Y. A. Arthur, S.A. Hardwick, D.J. Pillion, M. Sanspree, A.L. Schmidt, S.J. Wilson; Effect of Type 2 Diabetes Mellitus on the Diagnosis of Glaucoma in the Black Belt of Alabama . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3660.
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Purpose:. Residents of the Black Belt (BB) of Alabama, a rural and economically underdeveloped region, demonstrate some of the highest levels of type 2 diabetes mellitus (DM) in the United States. The potential effect of DM on glaucoma in this group has received little scrutiny. The purpose of this study is to assess the effect of type 2 DM on the diagnosis of glaucoma in this population. Methods: The Rural Alabama Diabetes and Glaucoma Initiative performed comprehensive vision examinations on volunteers from the BB of Alabama. Each individual completed an extensive battery of testing that included visual acuity, slit lamp examination, tonometry and fundus evaluation via fundus imaging and fundus lens. Individuals also completed Humphrey FDT fields testing. In addition to standard vision testing, blood pressure, blood glucose, and glycosolated hemoglobin (HbA1C) levels were measured. Patients were classified DM based on self–reported previous diagnosis or HbA1C>=7.0%. Patients with HbA1c levels between 6 and 7% were analyzed as pre–diabetic. Individuals were positively classified with glaucoma with evidence of reproducible field loss on FDT testing in concert with changes of the optic disk and/or IOP>=24 mm Hg. Results: The population of 2688 patients had a mean age of 44.2 yrs (Std Dev 19.6). The group was heavily female (37.0 males/100 females) and African–American (81.0%; 17.8% were European–American and 1.6% other ethnicity). Three hundred ninety–five patients (14.7%) self–reported a previous diagnosis of DM. Of the patients denying DM, an additional 64 patients had HbA1C levels >7.0% and were likely diabetic (overall prevalence estimate, 20.3%). Another group of 315 patients denying DM and with HbA1C levels between 6.0 and 7.0% were considered pre–DM. For the entire sample, 14.0% met the criteria for glaucoma. Individuals with DM were significantly more likely to meet the criteria for glaucoma using self–report or when classified by HbA1C levels (chi–square test, p<0.0039). Conclusions: These data suggest that this population is at high risk for type 2 DM and also for glaucoma. Individuals with self–reported DM or HbA1C >7.0% were 61% more likely to be diagnosed with glaucoma. DM has extraordinarily significant implications for vision care and the diagnosis of glaucoma in this population.
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