The Association of Sickle-Cell Disorders With Diabetic Retinopathy: A Large Database Study

Abstract

PurposeTo evaluate the association of sickle-cell disease (SCD) and sickle-cell trait (SCT) disease with diabetic retinopathy (DR) in patients with diabetes mellitus (DM). DesignPopulation-based, retrospective cohort study utilizing data from the TriNetX Research Network, including 119 million patients across 80 healthcare organizations worldwide. ParticipantsDM patients (Type 1 (T1DM) or 2 (T2DM)), with or without SCD and SCT, were included. Three cohorts were analyzed, including (1) DM patients without SCD, SCT, or Sickle-cell/Hb-C; (2) DM with SCD; and (3) DM with SCT. MethodsAll patients with DM were categorized into three cohorts based on the presence of SCD and SCT. Each cohort underwent 1:1 propensity score matching for demographics, blood glucose levels, hemoglobin A1C, and other relevant comorbidities. Main Outcome MeasuresRisk of DR in DM patients with and without SCD or SCT. ResultsThere was no significant difference in the risk of any T1DR between those with and without SCD. However, for those with SCT, there was a notable 2-fold increased risk for T1-PDR (RR: 2.03; 95% CI: 1.33-3.01). In contrast, there was an elevated risk for any T2DR in patients with SCD (RR: 1.50; 95% CI: 1.19-1.88), particularly due to higher proliferative DR risks in T2DM patients (RR: 1.83; 95% CI: 1.29-2.60). The risk of mild to moderate T2DM non-proliferative DR was also found to be higher in patients with SCT. ConclusionsThe risk of any DR was increased in T2DM patients with SCD or SCT, with increased risks for proliferative DR in patients with SCT and T1DM. This indicates there may be a potential role of SC disorders in diabetic eye disease progression.