The effect of insulin on response to intravitreal anti-VEGF injection in diabetic macular edema in type 2 diabetes mellitus

Gurung, Rajya Laxmi; FitzGerald, Liesel M.; Liu, Ebony; McComish, Bennet J; Kaidonis, Georgia; Ridge, Bronwyn; Hewitt, Alex W.; Vote, Brendan J.; Verma, Nitin; Craig, Jamie E; Burdon, Kathryn P.

doi:10.1186/s12886-022-02325-x

Cited by 4 publications

(5 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The cohort and data acquisition have been described previously [ 50 ]. Briefly, the study included Type 1 (T1) or Type 2 (T2) diabetes patients (≥ 18 years) who received intravitreal anti-VEGF injections (Bevacizumab; Genentech: Ranibizumab; Novartis: Aflibercept, Regeneron) between 2013 and 2020 for the treatment of CI-DME confirmed by optical coherence tomography (OCT).…”

Section: Methodsmentioning

confidence: 99%

“…In patients receiving bilateral anti-VEGF injections, the better-responding eye was chosen for the study. Relevant demographic and ocular parameters were retrospectively collected from medical charts as previously described [ 50 ]. BCVA in Snellen’s visual acuity score was converted to early treatment diabetic retinopathy study (ETDRS) letter scores [ 51 ].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Predictive factors for treatment outcomes with intravitreal anti-vascular endothelial growth factor injections in diabetic macular edema in clinical practice

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are the standard of care for diabetic macular edema (DME), a common complication of diabetes. This study aimed to identify factors influencing DME intravitreal anti-VEGF treatment outcomes in real-world practice. Methods This was a multi-center retrospective observational study using medical chart review of participants receiving anti-VEGF injections for DME (N = 248). Demographic and clinical variables were assessed for association with best corrected visual acuity (BCVA) and central macular thickness (CMT) outcomes using regression models. Results There was a significant improvement in BCVA (p < 0.001) and CMT (p < 0.001) after 12 months of treatment, although 21% of participants had decreased BCVA, and 41% had a < 10% CMT reduction at 12 months. Higher baseline BCVA (p = 0.022, OR=-0.024, 95% CI=-0.046,-0.004) and longer duration of diabetic retinopathy (p = 0.048, OR=-0.064, 95% CI=-0.129,-0.001) were negative predictors for BCVA response, whereas Aflibercept treatment (p = 0.017, OR = 1.107, 95% CI = 0.220,2.051) compared with other drugs and a positive “early functional response” (p < 0.001, OR=-1.393, 95% CI=-1.946,-0.857) were positive predictors. A higher baseline CMT (p < 0.001, OR = 0.019, 95% CI = 0.012,0.0261) and an “early anatomical response”, (p < 0.001, OR=-1.677, 95% CI=-2.456, -0.943) were predictors for greater reduction in CMT. Overall, the variables could predict only 23% of BCVA and 52% of CMT response. Conclusions The study shows a significant proportion of DME patients do not respond to anti-VEGF therapy and identifies several clinical predictors for treatment outcomes. Trial registration The study was approved through the Human Research Ethics Committee, University of Tasmania (approval number H0012902), and the Southern Adelaide Clinical Human Research Ethics Committee (approval number 86 − 067).

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Predictive factors for treatment outcomes with intravitreal anti-vascular endothelial growth factor injections in diabetic macular edema in clinical practice

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…The associations of SBP were stronger for those with two or more DMCs compared with those with only one DMCs. Considering that insulin therapy was an independent risk factor for diabetic complications [ 23 ], and patients with insulin use are usually sicker and develop complications earlier, we examined the association of different BP levels and BP stage by adjusting for use of insulin rather than of anti-hyperglycaemic medication (Table S10 in the Online Supplementary Document ). However, the results were similar to those gained after adjusting for anti-hyperglycaemic medication.…”

Section: Resultsmentioning

confidence: 99%

Association of blood pressure with incident diabetic microvascular complications among diabetic patients: Longitudinal findings from the UK Biobank

Liu

Zhu

et al. 2023

J Glob Health

View full text Add to dashboard Cite

Background Evidence suggests a correlation of blood pressure (BP) level with presence of diabetic microvascular complications (DMCs), but the effect of BP on DMCs incidence is not well-established. We aimed to explore the associations between BP and DMCs (diabetic retinopathy, diabetic kidney disease, and diabetic neuropathy) risk in participants with diabetes. Methods This study included 23 030 participants, free of any DMCs at baseline, from the UK Biobank. We applied multivariable-adjusted Cox regression models to estimate BP-DMCs association and constructed BP genetic risk scores (GRSs) to test their association with DMCs phenotypes. Differences in incidences of DMCs were also compared between the 2017 ACC/AHA and JNC 7 guidelines (traditional criteria) of hypertension. Results Compared to systolic blood pressure (SBP)<120 mm Hg, participants with SBP≥160 mm Hg had a hazard ratio (HR) of 1.50 (95% confidence interval (CI) = 1.09, 2.06) for DMCs. Similarly, DMCs risk increased by 9% for every 10 mm Hg of higher SBP at baseline (95% CI = 1.04, 1.13). The highest tercile SBP GRS was associated with 32% higher DMCs risk (95% CI = 1.11, 1.56) compared to the lowest tercile. We found no significant differences in DMCs incidence between JNC 7 and 2017 ACC/AHA guidelines. Conclusions Genetic and epidemiological evidence suggests participants with higher SBP had an increased risk of DMCs, but hypertension defined by 2017 ACC/AHA guidelines may not impact DMCs incidence compared with JNC 7 criteria, contributing to the care and prevention of DMCs.

show abstract

“…Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents have been established as the first-line treatment option for CI-DME with vision loss [ 49 , 50 ]. However, there still exists significant heterogeneity in treatment response to anti-VEGF agents for individual patients caused by risk factors including morphological subtype, baseline VA, and concomitant treatments [ 51 , 52 ]. This variability in treatment outcomes can pose a risk to adherence and ultimately, patient satisfaction.…”

Section: Main Textmentioning

confidence: 99%

Novel artificial intelligence algorithms for diabetic retinopathy and diabetic macular edema

Yao,

Lim,

Lim

et al. 2024

Eye and Vis

View full text Add to dashboard Cite

Background Diabetic retinopathy (DR) and diabetic macular edema (DME) are major causes of visual impairment that challenge global vision health. New strategies are needed to tackle these growing global health problems, and the integration of artificial intelligence (AI) into ophthalmology has the potential to revolutionize DR and DME management to meet these challenges. Main text This review discusses the latest AI-driven methodologies in the context of DR and DME in terms of disease identification, patient-specific disease profiling, and short-term and long-term management. This includes current screening and diagnostic systems and their real-world implementation, lesion detection and analysis, disease progression prediction, and treatment response models. It also highlights the technical advancements that have been made in these areas. Despite these advancements, there are obstacles to the widespread adoption of these technologies in clinical settings, including regulatory and privacy concerns, the need for extensive validation, and integration with existing healthcare systems. We also explore the disparity between the potential of AI models and their actual effectiveness in real-world applications. Conclusion AI has the potential to revolutionize the management of DR and DME, offering more efficient and precise tools for healthcare professionals. However, overcoming challenges in deployment, regulatory compliance, and patient privacy is essential for these technologies to realize their full potential. Future research should aim to bridge the gap between technological innovation and clinical application, ensuring AI tools integrate seamlessly into healthcare workflows to enhance patient outcomes.

show abstract

The effect of insulin on response to intravitreal anti-VEGF injection in diabetic macular edema in type 2 diabetes mellitus

Cited by 4 publications

References 42 publications

Predictive factors for treatment outcomes with intravitreal anti-vascular endothelial growth factor injections in diabetic macular edema in clinical practice

Predictive factors for treatment outcomes with intravitreal anti-vascular endothelial growth factor injections in diabetic macular edema in clinical practice

Association of blood pressure with incident diabetic microvascular complications among diabetic patients: Longitudinal findings from the UK Biobank

Novel artificial intelligence algorithms for diabetic retinopathy and diabetic macular edema

Contact Info

Product

Resources

About