Insulin Use and Risk of Diabetic Macular Edema in Diabetes Mellitus: A Systemic Review and Meta-Analysis of Observational Studies

Abstract

BackgroundDiabetes mellitus is a common and serious disorder. A search of the literature reveals no comprehensive quantitative assessment of the association between insulin use and incidence of diabetic macular edema. Therefore, we performed a meta-analysis of observational studies to evaluate the effect of insulin use on the risk of developing macular edema.Material/MethodsComparative studies published until May 2014 were searched through a comprehensive search of the Medline, Embase, and the Cochrane Library electronic databases. A systematic review and quantitative analysis of comparative studies reporting the effect of insulin use on the incidence of macular edema was performed. All analyses were performed using the Review Manager (RevMan) v.5 (Nordic Cochrane Centre, Copenhagen, Denmark).ResultsA total of 202 905 individuals were included in the present meta-analysis. In a random-effects meta-analysis, the use of insulin was found to be associated with increased risk of macular edema (RR, 3.416; 95% CI, 2.417–4.829; I2, 86.6%). Analysis that just included high-quality studies showed that insulin use increased the risk of macular edema (RR, 2.728; 95% CI, 1.881–3.955; I2=77.7%). In cohort studies (RR, 4.509; 95% CI, 3.100–6.559; I2, 77.7%) but not in case-control studies (RR, 1.455; 95% CI, 0.520 to 4.066; I2, 95.9%), increased incidence of macular edema was observed.ConclusionsThe results of this meta-analysis of observational studies demonstrate that insulin use is a risk factor for diabetic macular edema. However, available data are still sparse, and in-depth analyses of the assessed associations in the context of additional longitudinal studies are highly desirable to enable more precise estimates and a better understanding of the role of insulin use in incidence of diabetic macular edema.

Associated factors and macular vascular perfusion change for diabetic macular edema at early stage: a cross-sectional observational study

“…Meanwhile, other DR-associated risk factors including diabetic duration, blood pressure, BMI, total cholesterol, triglycerides and renal biomarkers showed no signi cant correlation with early DME development. Our data supported previous ndings that insulin is an independent risk factor for DME and insulin usage increased the risk of DME regardless of blood sugar control [22][23][24]. In this study, a cutoff value of 30000U was provided for higher risk of early DME.…”

Clinical Characteristics of Patients with Newly Diagnosed Diabetic Macular Edema in Turkey: A Real-Life Registry Study—TURK-DEM

“…Other research reported that the 10-year incidence of DME was 14% in individuals with type 2 diabetes, and progression to DME occurred in 29% of individuals with type 1 diabetes over 25 years if left untreated [ 6 , 7 ]. Although DME resolves spontaneously in about 33% to 35% of patients, it tends to be chronic in most patients [ 3 , 8 , 9 ]. DME accounts for the loss of 3 Snellen lines of vision in 24% of eyes within 3 years [ 8 ] and in 12% of all new cases of blindness annually [ 10 ].…”

“…Although DME resolves spontaneously in about 33% to 35% of patients, it tends to be chronic in most patients [ 3 , 8 , 9 ]. DME accounts for the loss of 3 Snellen lines of vision in 24% of eyes within 3 years [ 8 ] and in 12% of all new cases of blindness annually [ 10 ]. The high prevalence and potential severity of DME point to the need for prompt and effective treatment [ 11 , 12 ].…”

Current Treatments for Diabetic Macular Edema

“…A comparison of the equilibrium dissociation constants of anti-VEGF agents aflibercept, ranibizumab, and bevacizumab to VEGF-A 165 as kinetic binding affinity parameters are 0.49, 46, and 58, respectively [41]. Aflibercept has been shown to bind most strongly to VEGF-A 165 .…”

“…The use of pioglitazone [162][163][164] and insulin [165] preparations has been reported to increase the risk of exacerbation of the macular edema. It has been reported that there was a lack of a significant longitudinal association between thiazolidinediones, including pioglitazone, and the incidence and progression of diabetic eye diseases in a 4-year followup study of 2856 participants in the ACCORD trial [166].…”