Abstract
BackgroundThe level of fasting plasma glucose (FPG) is positively associated with intraocular pressure. Diabetes causes early structural changes of retina, especially on ganglion cell layer. In this regard, the FPG level itself may also show an independent association with open angle glaucoma (OAG) development in general population. Herein, we investigate the association of the FPG level with the incidence of OAG.MethodsUsing nationally representative data from the Korean National Health Insurance System, 374,376 subjects ≥40 years of age without OAG who underwent health examinations from 2009 to 2013 were enrolled and followed to the end of 2014. Incident cases of OAG using the International Classification of Diseases 10 codes and medication information were analyzed based on the levels of FPG.ResultsSubjects with the highest FPG level (≥160 mg/dL), compared with the lowest level (<80 mg/dL), showed a higher hazard ratio (HR) [2.189; 95% confidence interval (CI): 1.779–2.695; P for trend < 0.001] for OAG after adjustments for age and sex. This result persisted after further adjustments for the presence of type 2 diabetes, current smoking, drinking, and exercise habits, diastolic blood pressure, body mass index (BMI), and total cholesterol level (HR: 1.588; 95% CI: 1.268–1.989; P for trend < 0.001). The positive association between the FPG level and the incidence of OAG was distinct in subjects 40–64 years of age, those with a BMI <25 kg/m2, and those without hypertension (HR 2.022; 95% CI: 1.494–2.736; P for trend <0.001: HR 1.817; 95% CI: 1.372–2.407; P for trend < 0.001: HR 1.706; 95% CI: 1.180–2.467; P for trend <0.001, respectively).ConclusionsThis nationwide population-based cohort study showed that the fasting glucose was associated with an increased risk of OAG. These findings suggest that subjects with high FPG levels require special attention when screening for glaucoma.
Highlights
Type 2 diabetes mellitus (T2D) is a global pandemic, from industrialized nations to the emerging economies of Asia, Latin America, and Africa [1,2,3]
Subjects with the highest fasting plasma glucose (FPG) level ( 160 mg/dL), compared with the lowest level (
The positive association between the FPG level and the incidence of OAG was distinct in subjects 40–64 years of age, those with a BMI
Summary
Type 2 diabetes mellitus (T2D) is a global pandemic, from industrialized nations to the emerging economies of Asia, Latin America, and Africa [1,2,3]. The public health burden of T2D is largely attributed to uncontrolled plasma glucose, which increases the likelihood of both macrovascular and microvascular complications. Diabetic retinopathy is one of the most wellknown complications of T2D. The pathogenesis of glaucoma, in which selective loss of retinal ganglion cells occurs, includes a vascular component as well as a mechanical component [6]. T2D and open-angle glaucoma (OAG) share pathophysiologies such as microvascular endothelial dysfunction and impaired blood flow autoregulation [7]. Defects in the retinal nerve fiber layer, one of the pathognomonic findings in glaucomatous optic neuropathy, are frequently detected in subjects with T2D [6, 8]
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