Abstract
Purpose :
While diabetic ketoacidosis (DKA) is associated with neurological complications, the long-term impact of DKA on diabetic retinopathy in type 2 diabetes remains unexplored. This study aims to assess the association between DKA and the risk of diabetic retinopathy, along with related ophthalmic interventions, in type 2 diabetes.
Methods :
We conducted a nationwide study using data from the Taiwan National Health Insurance Research Database, examining individuals newly diagnosed with type 2 diabetes before experiencing an episode of DKA between the years 2000 and 2019. Each DKA case subject was matched with a control subject diagnosed with type 2 diabetes, based on anti-diabetic regimen, age, gender, and diabetes duration within the initial three months post-diagnosis. Employing the Fine and Gray competing risk model, we assessed the risk of diabetic retinopathy and delineated the risk profiles for non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR) and ophthalmic interventions related to these conditions.
Results :
The subdistribution hazard ratio (sHR) analysis revealed a 1.71-fold increased risk of diabetic retinopathy among patients with a history of DKA (P < 0.001). This risk remained elevated even after adjustments for income level, selected comorbidities, and medications. Individuals with a history of DKA had a significantly higher adjusted sHR for receiving panretinal photocoagulation (P = 0.007) and intravitreal injection (P = 0.024). Longer duration of DKA, exceeding 24 months, escalated the risk for NPDR (adjusted sHR 2.15 [95% CI 1.52–3.05]), whereas duration between 1 to 24 months increased the risk for PDR (adjusted sHR 3.72 [95% CI 1.76–7.88]). Specific susceptibilities for PDR (adjusted sHR 1.82 [95% CI 0.99–3.33]) and NPDR (adjusted sHR 6.52 [95% CI 2.30–18.49]) were observed in age groups 46-55 and 56-65, respectively.
Conclusions :
Our findings underscore the significantly heightened risk of developing diabetic retinopathy and the corresponding need for ophthalmic interventions among patients with a history of DKA. This emphasizes the importance of implementing intensified screening programs and intervention strategies for DKA patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.