Abstract
Purpose :
Associations between microvascular complications of diabetes mellitus (DM), including diabetic nephropathy (DNeph), neuropathy (DNeu) and retinopathy (DR) have been reported, particularly for proliferative DR (PDR). Less is known specifically about their relationship with diabetic macular edema (DME), despite it being the leading cause of vision loss in patients with DM type-2 (DM2) and DR. The contributions of tobacco exposure to PDR and DME are also controversial. We further explore these associations using manually phenotyped cohorts of patients with progressive DR stages.
Methods :
Vanderbilt’s deidentified health record database, the Synthetic Derivative, was used to obtain clinical data from cohorts of patients with DM and no DR (N=239), no DME (N=365), DME (N=213), no PDR (N=341), and PDR (N=237). Continuous variables for multivariate logistic regression analysis included: DM duration (days) and Max HbA1c (%, A1c/glycated hemoglobin). Categorical variables included: hypertension, DNeu, DNeph, PDR, and DME (absent vs present), DM type (Type 1 vs Type 2), vital status (living vs deceased), race (black, vs. white, vs. other), and tobacco use (never vs remote {>5yrs from last exam or death} or current {within 5yr}). A two-sided T-test with p<0.05 was used for statistical significance.
Results :
Max A1c and DM duration were significantly associated with PDR (p=0.029 and p=0.002, respectively) and DME (p=5.96e-05 and p=0.003, respectively). However, vital status, DNeu and DNeph were only significantly associated with PDR (p=0.013, p=0.001, and p=0.001, respectively) but not with DME. DM1 was significantly associated with PDR (p=3.30e-11) as DM2 was with DME (p=0.013). Relative to no tobacco exposure, remote (p=0.007), but NOT current tobacco use was significantly associated with increased odds of DME (Varma 2014), but neither was significantly associated with PDR. White race was significantly associated with a decreased presence of PDR relative to black race (p=0.037) but not to “other” race (p=0.109) and no association was found between race and DME.
Conclusions :
Our results suggest that, although DME and PDR both represent progression in DR and are managed similarly, the factors that affect their development and their pathophysiology are likely significantly different. Exploring these differences may lead to the development of more effective therapies for these potentially blinding conditions.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.