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. 2019 Oct 11;7(1):e000638.
doi: 10.1136/bmjdrc-2018-000638. eCollection 2019.

Visual impairment and mortality in patients with type 2 diabetes

Volkert Siersma  1 , Rasmus Køster-Rasmussen  1 , Christine Bruun  1 , Niels de Fine Olivarius  1 , Audun Brunes  2
Affiliations

Visual impairment and mortality in patients with type 2 diabetes

Volkert Siersma et al. BMJ Open Diabetes Res Care. .

Abstract

Objective: To evaluate whether visual acuity impairment was an independent predictor of mortality in patients with type 2 diabetes.

Research design and methods: This is a 19-year follow-up of a cohort of 1241 patients newly diagnosed with type 2 diabetes and aged 40 years or over. Visual acuity was assessed by practicing ophthalmologists both at diabetes diagnosis and after 6 years. The logarithmic value of the visual acuity (logMAR) was the exposure. Multivariable Cox regression models were adjusted for multiple potential confounders including cardiovascular disease, and censored for potential mediators, that is, fractures/trauma. Primary outcomes were from national registers: all-cause mortality and diabetes-related mortality.

Results: Visual impairment at diabetes diagnosis was robustly associated with subsequent 6-year all-cause mortality. Per 1 unit reduced logMAR acuity the incidence rate of all-cause mortality increased with 51% (adjusted HR: 1.51; 95% CI 1.12 to 2.03) and of fractures/trauma with 59% (HR: 1.59; 95% CI 1.18 to 2.15), but visual acuity was not associated with diabetes-related mortality. After censoring for fractures/trauma, visual acuity was still an independent risk factor for all-cause mortality (HR: 1.68; 95% CI 1.23 to 2.30). In contrast, visual acuity 6 years after diabetes diagnosis was not associated with the subsequent 13 years' incidence of any of the outcomes, as an apparent association with all-cause mortality and diabetes-related mortality was explained by confounding from comorbidity.

Conclusions: Visual acuity measured by ophthalmologists in patients newly diagnosed with type 2 diabetes was an independent predictor of mortality in the short term.

Keywords: mortality; type 2 diabetes; vision impairment.

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Conflict of interest statement

Competing interests: NdFO reports grants from The Danish Medical Research Council, grants from The Danish Research Foundation for General Practice, grants from The Danish Ministry of Health, grants from The Health Insurance Foundation, grants from The Pharmacy Foundation and grants from the Novo Nordisk Farmaka Denmark, during the conduct of the study.

Figures

Figure 1
Figure 1
Patient flow through study.
Figure 2
Figure 2
Kaplan-Meier plot of all-cause mortality from diabetes diagnosis (A) and from follow-up after 6 years (B) in categories of visual acuity: normal vision (red), impaired vision (blue), and blind (purple).
See this image and copyright information in PMC

References

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