Abstract
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. Prospective, monocentric observational study. Patients presenting for the treatment of DME received laboratory and clinical examinations including 24-hour blood pressure measurement. 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. 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.
Highlights
The number of people with diabetes worldwide is estimated to increase from 451 million in 2017 to 693 million in 2045 [1]
diabetic macular edema (DME) patients are characterized by highly prevalent cardiovascular risk factors that are poorly controlled
Panretinal photocoagulation and intravitreal treatment with vascular endothelial growth factor (VEGF) inhibitors can often prevent or at least delay the progression of Diabetic retinopathy (DR) into severe proliferative forms [3,4,5]
Summary
The number of people with diabetes worldwide is estimated to increase from 451 million in 2017 to 693 million in 2045 [1]. Diabetic retinopathy (DR), and especially diabetic macular edema (DME), is the leading cause of significant vision loss in patients of working age [2]. Panretinal photocoagulation and intravitreal treatment with vascular endothelial growth factor (VEGF) inhibitors can often prevent or at least delay the progression of DR into severe proliferative forms [3,4,5]. The functional long-term outcome of patients with DME has been significantly improved by the introduction of intravitreal therapy with VEGF inhibitors or steroids [6]. It is known that an elevated blood pressure in particular has a negative impact on diabetic retinopathy [8]. A negative influence of co-existing obesity and dyslipidemia is discussed [9,10,11]. Ophthalmologists may not be fully aware of the patients’ general health and of possible negative factors influencing DR
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