June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Specific markers of metabolic dysfunction are associated with new diagnosis of diabetic macular edema
Author Affiliations & Notes
  • Anjali Shah
    Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
  • Shreya Mittal
    Department of Statistics, University of Michigan, Ann Arbor, Michigan, United States
  • Joshua D Stein
    Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
    Department of Health Policy and Management, University of Michigan, Ann Arbor, Michigan, United States
  • Rachana Haliyur
    Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   Anjali Shah None; Shreya Mittal None; Joshua Stein None; Rachana Haliyur None
  • Footnotes
    Support  Blue Cross and Blue Shield of Michigan Foundation
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 2654. doi:
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      Anjali Shah, Shreya Mittal, Joshua D Stein, Rachana Haliyur; Specific markers of metabolic dysfunction are associated with new diagnosis of diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2023;64(8):2654.

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

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Abstract

Purpose : Center-involving diabetic macular edema (DME), a leading cause of blindness in patients with diabetic retinopathy, can occur regardless of underlying retinopathy stage and have variable response to intraocular treatment. This study tests the hypothesis that measurable markers of dysmetabolism specifically associate with diagnosis of DME.

Methods : Retrospective analysis of individuals with diabetes (n=315781) using electronic health record data from a large multicenter consortium called Sight Outcomes Research Collaborative (SOURCE) was performed. The following measures were evaluated for association with a new diagnosis of DME: at least 1 record of elevated blood pressure, abnormal fasting lipid profile, increased body mass index (BMI), and hemoglobin A1C (HgA1C) >/= 6. Patients with pre-existing macular edema of any other type were excluded. Multivariable logistic regression assessed the association of these markers and other covariates with a new diagnosis of DME. Polynomial terms up to degree four were included to model age.

Results : Of those assessed with diabetes, 3552 individuals were newly diagnosed with DME (0.01%) with an average time of 25 months from first encounter. When compared to controls (n=312229), those with DME were slightly older (65±14.74 v 53±20.31), male sex (53 v 43%) and were more likely to have elevated HgA1C (38 v 10%) and BMI (36 v 18%), hypertension (HTN) (29 v. 8%), and dyslipidemia measured by low HDL (33 v 17%) and elevated triglycerides (21 v 10%). Logistic regression confirmed development of DME is associated with abnormal HgA1C (OR=27.3 [95% CI: 22.5, 33.1) but also showed HTN (OR=13.1 [95% CI: 11.0, 15.7]), low HDL (OR=1.56 [95% CI: 1.28,1.89]), and male sex (OR=2.33 [95% CI: 2.06, 2.64]) had greater odds of having a diagnosis of DME when holding other variables constant. There was a significant association with age and diagnosis of DME. Interestingly, no statistically significant association was found with either abnormal BMI or triglycerides.

Conclusions : While poor metabolic control has been hypothesized in development of DME, no existing large cohort studies have defined this association. In addition to elevated HgA1C, age, male sex, HTN, and low HDL were associated with a new diagnosis of DME. By next assessing association with need for intraocular therapy, findings will allow advanced predictive tools to define screening and tailored care for DME.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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