Ophthalmologists who’re vital to lowering systemic threat in sufferers with diabetic retinopathy

Ophthalmologists play an essential role in reducing the cardiovascular and cerebrovascular risks associated with moderate to severe non-proliferative and proliferative diabetic retinopathy. This is evident from research published in Ophthalmology.

The study shows that diabetic retinopathy is significantly linked to future risk of cerebrovascular accident, myocardial infarction, heart failure, and death. Higher degrees of retinopathy seem to put an increased risk of any outcome, according to researchers.

To assess the association between the severity of diabetic retinopathy and the risk of future cardiovascular or cerebrovascular events and all-cause mortality, the researchers conducted a retrospective cohort study in patients with type 2 diabetes.

Participants were patients at Kaiser Permanente Southern California. All were screened for diabetic retinopathy, with the degree of diabetic retinopathy determined from fundus photos and evaluated at a central clinical reading center. The primary study outcome was the 5-year risk of a first-time cerebrovascular accident, myocardial infarction, heart failure, and all-cause mortality.

The cohort included 107,218 adults with type 2 diabetes, 104,118 of whom had interpretable fundus photos. After exclusion, 77,376 were available for analysis (mean age 59.7 years; 53.6% men); Of these, 12,756 had minimal non-proliferative diabetic retinopathy, 2620 had moderate to severe non-proliferative diabetic retinopathy, and 607 had proliferative diabetic retinopathy. Patients with at least moderate to severe illness were more likely to be Hispanic men with higher HbA1c, lipoprotein cholesterol, microalbumin, and low-density creatinine ratios.

The researchers found that higher levels of retinopathy were associated with higher raw event rates and rate ratios across all 4 endpoints. A multivariable time-to-event analysis, which took into account the patient’s demographic and clinical characteristics, found that “the effects of all levels of retinopathy were significant” and occurred in 95% across all study results, with the effects being of increased severity the retinopathy increased.

In particular, increased HbA1c levels, longer duration of diabetes, history of hypertension and / or tobacco consumption, and higher urinary creatinine levels were significantly associated with a higher risk for all 4 study results. Conversely, a woman, a Hispanic or Asian race, and a higher, high-density lipoprotein cholesterol and estimated glomerular filtration rate were all associated with a lower risk of knowing the study results.

Limitations of the study include the use of screening program data that may have underrepresented more severe forms of diabetic retinopathy, possible underestimation of duration of diabetes in study participants, and the possibility of confounders not being considered.

“Ophthalmologists can make an important contribution to ensuring better diabetes and cardiovascular control through their frequent contact with diabetics, especially those who are diabetic,” the study concludes. “These results underscore the important role ophthalmologists can play in treating diabetes and preventing vascular disease and death.”

reference

Modjtahedi BS, Wu J, Luong TQ, Gandhi NK, Fong DS, Chen W. Severity of diabetic retinopathy and the risk of future cerebrovascular disease, cardiovascular disease, and all-cause mortality. Ophthalmology. Published online on December 24, 2020. doi: 10.1016 / j.ophtha.2020.12.019

This article originally appeared on Ophthalmology Advisor