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. 2022 Aug 9;11(16):4659.
doi: 10.3390/jcm11164659.

Glycemic Control after Initiation of Anti-VEGF Treatment for Diabetic Macular Edema

Hideyuki Oshima  1 , Yoshihiro Takamura  1 , Takao Hirano  2 , Masahiko Shimura  3 , Masahiko Sugimoto  4 , Teruyo Kida  5 , Takehiro Matsumura  1 , Makoto Gozawa  1 , Yutaka Yamada  1 , Masakazu Morioka  1 , Masaru Inatani  1
Affiliations

Glycemic Control after Initiation of Anti-VEGF Treatment for Diabetic Macular Edema

Hideyuki Oshima et al. J Clin Med. .

Abstract

Diabetic macular edema (DME) induces visual disturbance, and intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs are the accepted first-line treatment. We investigate its impact on glycemic control after starting VEGF treatment for DME on the basis of a questionnaire and changes in hemoglobin A1c (HbA1c). We conducted a retrospective multicenter study analyzing 112 patients with DME who underwent anti-VEGF therapy and their changes in HbA1c over two years. Central retinal thickness and visual acuity significantly improved at three months and throughout the period after initiating therapy (p < 0.0001); a significant change in HbA1c was not found. A total of 59.8% of patients became more active in glycemic control through exercise and diet therapy after initiating therapy, resulting in a significantly lower HbA1c at 6 (p = 0.0047), 12 (p = 0.0003), and 18 (p = 0.0117) months compared to patients who did not. HbA1c was significantly lower after 18 months in patients who stated that anti-VEGF drugs were expensive (p = 0.0354). The initiation of anti-VEGF therapy for DME affects HbA1c levels in relation to more aggressive glycemic control.

Keywords: DME; HbA1c; anti-VEGF therapy; diabetic macular edema; glycemic control; hemoglobin A1c; medical expenses.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Changes in central retinal thickness (CRT) and best-corrected visual acuity (BCVA) after initiation of anti-vascular endothelial growth factor (VEGF) therapy. (A) CRT and (B) BCVA were measured at 0 (baseline), and 3, 6, 12, 18, and 24 months after initial injection of anti-VEGF agents. BCVA is expressed as the logarithm of the minimal angle of resolution (logMAR). Data are represented as means ± standard deviations (SD). # p < 0.05 (versus baseline by Steel’s multiple-comparison test).
Figure 2
Figure 2
Time course of hemoglobin A1c (HbA1c) after initiation of anti-vascular endothelial growth factor (VEGF) therapy. The levels of HbA1c were measured in all eyes (A) and in patients with ≥7.2% (●), and <7.2% (○) HbA1c at baseline (B). Data are represented as means ± standard deviation (SD). # p < 0.05 (versus baseline by Steel’s multiple-comparison test).
Figure 3
Figure 3
Linear correlation between changes in best-corrected visual acuity (BCVA) [logarithm of the minimal angle of resolution (logMAR)] and hemoglobin A1c (HbA1c) over the two-year period. (A) No significant correlation was found in all patients. (B) In patients with worsening BCVA, significant correlations were found (p = 0.0155, R2 = 0.299). Solid line: simple regression analysis. Broken line: robust regression analysis. The vertical dotted line indicates no change compared with baseline in HbA1c and BCVA values. Proximity to the lower-left corner implies improvement of BCVA and a decrease in HbA1c levels over the period.
Figure 4
Figure 4
Temporal profile of hemoglobin A1c (HbA1c) in the groups according to the survey responses after initiation of anti-vascular endothelial growth factor (VEGF) therapy. HbA1c levels were measured in patients who answered yes (●), and no (○) to Questions 1–4. Data are represented by mean ± standard deviation (SD). * p < 0.05 (versus group by Mann–Whitney U test).
Figure 5
Figure 5
Time course of hemoglobin A1c (HbA1c) after initiation of anti-vascular endothelial growth factor (VEGF) therapy. HbA1c levels were measured in patients with a 30% copayment (●), and 10% or 20% copayment (○) (A); and in patients aged ≥70 years (●), and <70 years (○) (B). Data is represented as mean ± standard deviation (SD).
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