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Elaine Tran, Jeffrey L Goldberg, Suzann Pershing; Systemic predictors of diabetic eye disease development and severity. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2893.
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To investigate the effect of presenting levels of blood glucose, blood pressure, serum lipids, and urinary albumin on development and severity of diabetic eye disease.
Using longitudinal electronic medical records from a VA Medical Center, we identified patients with diagnosed diabetes mellitus and at least one eye exam between 1996 and 2009. Adjusting for sociodemographic factors, we used multivariable logistic and linear regressions to determine the effects of hemoglobin A1c (HbA1c) levels, blood pressure, microalbuminuria, and serum lipid levels on diagnosis of diabetic retinopathy, proliferative retinopathy, and macular edema.
Of 9440 diabetics, 6198 (65.66%) were diagnosed with diabetic retinopathy. Patients were more likely to present with diabetic retinopathy if they had HbA1c > 8.5 (OR=1.726, CI 1.329-2.243, p≤0.01), systolic blood pressure > 140mmHg (OR=1.474, CI 1.291-1.682, p≤0.01), total cholesterol > 240 mg/dL (OR=1.479, CI 1.294-1.692, p≤0.01), high density lipoprotein (HDL) < 40 mg/dL (OR=0.760, CI 0.659-0.875, p≤0.01), blood urea nitrogen (BUN) > 40 (OR=1.483, CI 1.090-2.017, p≤0.05), and to use insulin (OR=2.99, CI 2.600-3.459; p≤0.01). Patients were more likely to present with proliferative retinopathy if they had HbA1c > 8.5 (OR=2.122, CI 1.024-4.399, p≤0.01), systolic blood pressure > 140mg/dL (OR=2.001, CI 1.392-2.876, p≤0.01), HDL < 40mg/dL (OR=0.648 for HDL > 40mg/dL, CI 0.439-0.956, p≤0.05), BUN > 40mg/dL (OR=2.956, CI 1.542-5.667, p≤0.01), and to use insulin (OR= 4.528, CI 2.897-7.078, p≤0.01). And patients were more likely to present with diabetic macular edema if they had HbA1c > 8.5 (OR=1.532, CI 0.724-3.244, p≤0.01), systolic blood pressure > 140mg/dL (OR=1.829, CI 1.273-2.629, p≤0.01), total cholesterol > 240 mg/dL (OR=2.156, CI 1.259-3.694, p≤0.05), and to use insulin (OR=3.197, CI 2.121-4.820, p≤0.01). In linear regression, measures correlated with greater retinopathy severity included HbA1c levels > 8.5 (p≤0.01), systolic blood pressure > 140mmHg (p≤0.01), and urine microalbumin > 0.10 (p≤0.01).
Markers of systemic health may be predictive of diabetic eye disease. Higher HbA1c, systolic blood pressure, serum triglyceride, and urine albumin levels as well as use of insulin, suggestive of more advanced diabetes, appear to be highly associated with presence and severity of diabetic eye disease at first presentation.
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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