General health of patients with diabetic macular edema-The LIPSIA study

Abstract

Purpose: Cardiovascular risk factors such as hypertension or dyslipidemia can influence the incidence and progression of diabetic retinopathy (DR) and diabetic macular edema (DME). The aim of this study is to describe the comorbidities in patients with DME.

Methods: Prospective, monocentric observational study. Patients presenting for the treatment of DME received laboratory and clinical examinations including 24-hour blood pressure measurement.

Results: Seventy-five consecutive patients were included in the study. The mean age was 61.0 ± 14.5 years, and 83% had type 2 diabetes. The mean body mass index (BMI) was 32.8 ± 6.0 kg/m2. Overweight (BMI ≥ 25 kg/m2) was present in 92% of all patients. HbA1c values were > 7.0% in 57%. Although 87% of the patients already received antihypertensive therapy, the blood pressure (BP) of 82% was still above the recommended target values of systolic < 140 mmHg and diastolic < 80 mmHg. An insufficient nocturnal fall of the systolic BP (< 10%, non-dipping or reverse dipping) was observed in 62%. In 83% of the patients the glomerular filtration rate was ≤ 90 ml/min/1.73m2. Despite 65% of the cohort already receiving lipid-lowering therapy, LDL cholesterol was above the target value of 1.4 mmol/l in 93%. All patients had at least one cardiovascular risk factor in addition to diabetes (overweight, hypertension, insufficient nocturnal BP fall, dyslipidemia, or renal dysfunction) and 86% had ≥ 3 risk factors.

Conclusion: DME patients are characterized by highly prevalent cardiovascular risk factors that are poorly controlled. These comorbidities reduce the prognosis and negatively influence existing DR and DME. The data reveal an important opportunity for improving patient care by interaction of the ophthalmologist with the general practitioner and internal specialists for the detection and treatment of these conditions.

Fig 1. Proportion of patients with dyslipidemia (low-density lipoprotein cholesterol ≥ 1.4 mmol/l), overweight (body mass index [BMI] ≥ 25 kg/m²), ≥ stage 2 chronic kidney disease (CKD, glomerular filtration rate [GFR] ≤ 90 ml/min/1.73 m²), hypertension (systolic blood pressure [BP] ≥ 140 mmHg and/or diastolic BP ≥ 80 mmHg), obesity (BMI ≥ 30 kg/m²), insufficient nocturnal PB fall (< 10% of the daily systolic average value), insufficient glucose control (HbA1c > 7.0%), ≥ stage 3 CKD (GFR ≤ 60 ml/min/1.73 m²) and hypertriglyceridemia (fasting triglycerides ≥ 1.7 mmol/l).