Dry eye disease in patients with type II diabetes mellitus: A retrospective, population-based cohort study in Taiwan

Abstract

PurposeTo investigate the risk and protective factors of dry eye disease (DED) in patients with type II diabetes mellitus (DM).DesignA retrospective cohort study using Chang- Gung research database collecting data from 2005 to 2020.MethodsPatients with type II DM were included, and those with previous ocular diseases were excluded. Ten thousand twenty nine developed DED (DED group), and 142,491 didn't (non-DED group). The possible risk and protective factors were compared and analyzed using the logistic regression model.ResultsA majority of the DED group were female with significantly higher initial and average glycated hemoglobin levels, and higher incidence of diabetic neuropathy and retinopathy. In conditional logistic regression model, advanced age was a risk factor. After adjusting for sex, age, and DM duration; average glycated hemoglobin level, diabetic neuropathy, retinopathy, and nephropathy with eGFR 30 ~ 59 and intravitreal injection, vitrectomy, pan-retinal photocoagulation, and cataract surgery were contributing factors of DED. Considering antihyperglycemic agents, DPP4 inhibitor, SGLT2 inhibitor, GLP-1 agonist, and insulin monotherapy and dual medications combining any two of the aforementioned agents were protective factors against DED compared with metformin alone. In the monotherapy group, SLGT2 inhibitor had the lowest odds ratio, followed by GLP1 agonist, DPP4 inhibitor, and insulin.ConclusionsDED in patients with DM is associated with female sex, advanced age, poor diabetic control, microvascular complications and receiving ocular procedures. GLP-1 agonist, SGLT-2 inhibitor, DPP4 inhibitor, and insulin are superior to metformin alone in preventing DM-related DED. A prospective randomized control trial is warranted to clarify our results.

Dry Eye and Some Related Factors in Patients with Type 2 Diabetic Nephropathy: A Cross-Sectional Study in Vietnam

“…There are no separate studies on dry eye in T2DN patients. However, our results are consistent with the cohort study by Pan et al, 19 which suggested that dry eye increased with a decline in renal function in T2DM patients. In patients with type 2 diabetes, dry eye is associated with several mechanisms, including (1) lacrimal unit dysfunction, (2) abnormal enzyme metabolism and reduced mucus secretion leading to abnormal tear dynamics, (3) lacrimal gland dysfunction due to diabetic neuropathy, and (4) tear film dysfunction.…”

“…25 An association between dry eye and HbA1C has been reported in several studies in T2DM patients. 7,17,19 High HbA1C level represents chronic hyperglycemia, which increases tear glucose levels, leading to hyperosmolarity, a risk factor for dry eye. 26 In addition, hyperglycemia initiates an inflammatory cascade that generates innate and adaptive immune responses in the lacrimal function unit.…”

Recent advances in thermogels for the management of diabetic ocular complications

“…DED is another common ocular complication that occurs in up to 54% of the diabetic population and its pathogenesis is rather multifactorial. 138 Chronic hyperglycaemia in diabetes contributes to several risk factors for DED, such as diabetic periphery neuropathy, reduced insulin levels, micro-vasculopathy, and systemic hyperosmolarity. These factors can induce lacrimal functional unit (LFU) dysfunction, abnormal tear dynamics and tear film dysfunction, which results in DED.…”

The use of sodium-glucose cotransporter 2 inhibitors and the incidence of uveitis in type 2 diabetes: a population-based cohort study

“…Development and progression of diabetic retinopathy could be suppressed by the application of SGLT2 inhibitors in some previous research but without a universal consensus [ 14 – 18 ]. It has also been reported that the incidence of dry eye disease could be reduced via use of SGLT2 inhibitors [ 19 , 20 ]. Still, there is a paucity of studies evaluating the correlation between SGLT2 inhibitors and uveitis development.…”