Associations between diabetic retinopathy and modifiable risk factors: An umbrella review of meta‐analyses

Abstract

Aims Several modifiable risk factors have been meta‐analysed for diabetic retinopathy (DR), such as physical activity and vitamin D status. To date, these factors have not been systematically aggregated and the credibility of evidence assessed. Therefore, the aim of this umbrella review was to aggregate all modifiable risks of DR and assess the credibility of the evidence. Methods An umbrella review of meta‐analyses was undertaken. For each meta‐analytic association, random‐effects effect size, 95% confidence intervals (CIs), heterogeneity, small‐study effects, excess significance bias and 95% prediction intervals were calculated. The credibility of significant evidence (p < 0.05) was graded from I to IV, using pre‐defined criteria. Results After initial searches, 13 studies were included covering 34 independent outcomes (total participants = 824,372). Positive associations were found between insulin usage and diabetic macular oedema (RR = 4.5; 95% CI 3.1–6.6), and DR risk (RR = 2.3; 95% CI 1.4–3.9) in people with type 2 diabetes. Vitamin D deficiency was associated with DR risk (OR = 2.8; 95% CI 1.1–7.1), as was obesity (RR = 1.34; 95% CI 1.06–1.68) and sedentary behaviour (RR = 1.22; 95%CI 1.03–1.44). Intensive blood pressure targets (RR = 0.8 95%CI 0.8–1.0), and moderate physical activity (RR = 0.69; 95%CI 0.53–0.91) yielded significant protective associations with DR. Conclusions People with type 2 diabetes on insulin have a high risk of macular oedema and DR. Vitamin D deficiency yielded almost three times greater odds of DR, while intensive blood pressure control reduces DR risk by 20% and moderate physical activity by 31%. Healthcare professionals should use this evidence to identify those people most at risk to ensure that proper treatment and healthy lifestyles are recommended.

Physical Activity Status and Diabetic Retinopathy: A Review

“…They also found a significant protective association between moderate physical activity and DR [29]. Kuwata et al (2017) found that higher physical activity levels were independently associated with a lower incidence of DR among Japanese patients with T2DM [30]. Khanam et al (2017) found that among other risk factors, physical inactivity was a significant risk factor for not only DR but also nephropathy and neuropathy [31].…”

Shedding light on eye disease in obesity: A review

“…Fluorescein angiography and optical coherence tomography (OCT) may be used to evaluate the degree of retinal ischemia and the presence of retinal vascular abnormalities. It is recommended for individuals with diabetes to schedule annual comprehensive eye exams to monitor for the development and progression of DR. Prevention of DR includes tight glycaemic control and minimization of risk factors such as obesity, vitamin D deficiency, hypertension (HTN), and sedentary behaviour 10 . An umbrella review of the modifiable risk factors of DR found that intensive blood pressure control reduced DR risk by 20%, and moderate physical activity by 31% 10 .…”

“…10 An umbrella review of the modifiable risk factors of DR found that intensive blood pressure control reduced DR risk by 20%, and moderate physical activity by 31%. 10 Treatment of NPDR largely involves risk factor mitigation; however, the presence of DME may necessitate anti-vascular endothelial growth factor (VEGF) injections or focal laser therapy to improve visual acuity and prevent progression. Primary treatment of PDR involves panretinal laser photocoagulation of the peripheral retina and/or regular anti-VEGF injections to slow the growth of aberrant retinal vessels and prompt their involution.…”

Associations between diabetic retinopathy, mortality, disease, and mental health: an umbrella review of observational meta-analyses

“…The credibility of analyses was assessed according to stringent criteria based on previously published umbrella reviews [11,16,[25][26][27]. In brief, significant pooled effect sizes from the re-performed meta-analysis were graded as Grade I, II, III, or IV based on several stringent criteria, including the strength of the effect size (including the PI excluding the null), the presence of small study effects, and the presence of excess significance bias (full criteria available in Table 1).…”

“…In order to address the breadth of meta-analytic literature across multiple outcomes in conditions such as DR, studies re increasingly adopting reviews of reviews (commonly called umbrella reviews), which can use novel evidence synthesis strategies to capture the breadth of outcomes associated with a given exposure [9,10]. For example, a recent umbrella review found that several modifiable risk factors were associated with DR, including vitamin D status and physical activity [11].…”