Features of the development and progression of diabetic macular edema in patients with type 2 diabetes

Abstract

Background. In the developed world, the prevalence of type 2 diabetes in the population aged 65 years and older is 33 %, and prediabetes is 50 %. Macular edema can be the first symptom of diabetic retinopathy or occur at any stage of its development. In developed countries, the most common cause of central vision loss in people under the age of 50 is diabetic macular edema (DME). Long-term studies have found that the risk of developing DME is higher in patients with type 2 diabetes. The purpose was to investigate the features of the development and progression of DME in patients with type 2 diabetes. Materials and methods. A total of 180 patients (360 eyes) with non-proliferative diabetic retinopathy and type 2 diabetes were examined. The nature, frequency, and features of the development and progression of DME were evaluated. All patients were examined for uncorrected visual acuity, best corrected visual acuity, intraocular pressure, static computed perimetry, optical coherence tomography and optical coherence tomography angiography. We used the Student’s t-test to determine the statistical significance of the mean differences in two independent groups. The null hypothesis was rejected and the differences between indicators were considered statistically significant at a significance level of p < 0.05. Results. In patients of the Ukrainian population with non-proliferative diabetic retinopathy and type 2 diabetes, the incidence of DME 0 averaged 55.56 %, DME 1 — 15.0 %, DME 2 — 15.56 %, DME 3 — 13.89 %. There was a statistically significant relationship between the frequency of DME of different stages and the duration of type 2 diabetes. At presentation, the frequency of DME 0 was on average 55.56 %; with the duration of type 2 diabetes of up to 10 years, it was 3 and 24 % statistically significantly higher (p < 0.05) than in patients with duration from 11 to 20 and above 20 years, respectively. The incidence of DME 1 was 15.0 %, DME 2 was 15.56 %; with the duration of type 2 diabetes of up to 10 years, it was 2 times lower (p < 0.05) than in patients with duration of 11 to 20 years and more than 20 years, respectively. The incidence of DME 3 was 13.89 %; with the duration of type 2 diabetes of up to 10 years, it was 3 times lower (p < 0.05) than in patients with duration of 11 to 20 years and above 20 years, respectively. A statistically significant dependence of the incidence of diabetic macular edema on treatment in patients with non-proliferative diabetic retinopathy and type 2 diabetes has been found. When taking hypoglycemic drugs, the incidence of DME 0 increases statistically significantly, and when insulin therapy is used, the incidence of DME 1–3 increases. Conclusions. A statistically significant relationship was found between the frequency of DME of different stages and the duration of type 2 diabetes. The longer the duration of type 2 diabetes, the higher the frequency of DME stages 1, 2 and 3. The incidence of DME 1–3 in patients on insulin therapy is 2 times higher compared to patients taking hypoglycemic drugs (p < 0.01).