Associations of glycated hemoglobin (HbA1c) level with central corneal and macular thickness in diabetic patients without macular edema

Year 2018, Volume: 4 Issue: 4, 294 - 299, 04.10.2018

Kuddusi Teberik , Mehmet Tahir Eski , Murat Kaya

https://doi.org/10.18621/eurj.362263

Cited By: 1

Abstract

Objectives: To determine the correlation
between central corneal thickness (CCT) and central macular thickness (CMT),
and fasting plasma glucose levels and HbA1c levels before diabetic macular
edema (DME) in type 2 diabetes mellitus (DM) patients without diabetic
retinopathy.

Methods: Forty-four eyes of subjects diagnosed with type 2 DM,
and 45 healthy control subjects participated in this study. Detailed
ophthalmologic examination was performed with all participants. CMT was
measured in both groups by Spectral-domain optical coherence tomography. CCT
measurements were made with an Echoscan US-500 ultrasonic pachymeter. Blood
biochemical tests for glycated hemoglobin (HbA1c) and fasting plasma glucose
levels were run on all patients.

Results: The results of the study
showed that the mean CCT was significantly thicker in type 2 DM patients 563.84
± 33.25 μm
than in the controls 550.13 ± 28.41 μm (p = 0.039). The mean of CMT was 231.27 ±
37.74 μm
in the study group and 225.38 ± 38.33 μm in the control
group (p > 0.05). No relationship
was found between CCT and CMT and HbA1c level in the study and control groups.

Conclusions:
The mean CCT was significantly thicker in type 2 DM patients without diabetic
retinopathy than in the controls. The mean CMT is thicker in type 2 DM patients
without diabetic retinopathy patients than in the controls, but this difference
was not statistically significant. Optical coherence tomography can be a
perfect detector for early detection of DME. 

Keywords

Diabetic macular edema, HbA1c, fasting plasma glucose levels, central corneal thickness, central macular thickness

References

• [1] Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy. N Engl J Med 2012;366:1227-39.
• [2] Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet 2010;376: 24-36.
• [3] Klein R, Lee KE, Gangnon RE, Klein BE. The 25-year incidence of visual impairment in type 1 diabetes mellitus. the wisconsin epidemiologic study of diabetic retinopathy. Ophthalmology 2010;117 63-70.
• [4] Moss SE, Klein R, Klein BE. The 14-year incidence of visual loss in a diabetic population. Ophthalmology 1998;105:998-1003.
• [5] Chu J, Ali Y. Diabetic retinopathy. Drug Deve Res 2008;69:1-14.
• [6] Wild S, Roglic G, Greene A. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.
• [7] Matsuura H, Setogawa T, Tamai A. Electron microscopic studies on retinal capillaries in human diabetic retinopathy. Yonago Acta Med 1976;20:7-10.
• [8] Antonetti DA, Lieth E, Barber AJ, Gardner TW. Molecular mechanisms of vascular permeability in diabetic retinopathy. Semin Ophthalmol 1999;14:240-8.
• [9] de Oliveira F. Pericytes in diabetic retinopathy. Br J Ophthalmol 1966;50:134-43.
• [10] Craitoiu S, Mocanu C, Olaru C, Rodica M. Retinal vascular lesions in diabetic retinopathy. Oftalmologia 2005;49:82-7.
• [11] Chou TH, Wu PC, Kuo JZ, Lai CH, Kuo CN. Relationship of diabetic macular oedema with glycosylated haemoglobin. Eye (Lond) 2009;23:1360-3.
• [12] GirachA, Lund-Andersen H. Diabetic macular oedema: a clinical overview. Int J Clin Pract 2007;61:88-97.
• [13] Wat N, Wong RL, Wong IY. Associations between diabetic retinopathy and systemic risk factors. Hong Kong Med J 2016;22:589-99.
• [14] Frank RN. Diabetic retinopathy. N Engl J Med 2004;350:48-58.
• [15] The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977-86.
• [16] UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998;352:837-53.
• [17] Schultz RO, Van Horn DL, Peters MA, Klewin KM, Schutten WH. Diabetic keratopathy. Trans Am Ophthalmol Soc 1981;79:180-99.
• [18] Kaji Y. Prevention of diabetic keratopathy. Br J Ophthalmol 2005;89:254-5.
• [19] Saito J, Enoki M, Hara M, Morishige N, Chikama T, Nishida T. Correlation of corneal sensation, but not of basal or reflex tear secretion, with the stage of diabetic retinopathy. Cornea 2003;22:15-8.
• [20] Zhivov A, Winter K, Hovakimyan M, Peschel S, Harder V, Schober HC, et al. Imaging and quantification of subbasal nerve plexus in healthy volunteers and diabetic patients with or without retinopathy. PLoS One 2013;8:e52157.
• [21] Chang PY, Carrel H, Huang JS,Wang IJ, Hou YC, Chen WL, et al. Decreased density of corneal basal epithelium and subbasal corneal nerve bundle changes in patients with diabetic retinopathy. Am J Ophthalmol 2006;142:488-90.
• [22] Siribunkum J, Kosrirukvongs P, Singalavanija A. Corneal abnormalities in diabetes. J Med Assoc Thai 2001;84:1075-83.
• [23] Lee JS, Oum BS, Choi HY, Lee JE, Cho BM. Differences in corneal thickness and corneal endothelium related to duration in diabetes. Eye 2006;20:315-8.
• [24] Inoue K, Kato S, Inoue Y, Amano S, Oshika T. The corneal endothelium and thickness in type II diabetes mellitus. Jpn J Ophthalmol 2002;46:65-9.
• [25] Busted N, Olsen T, Schmitz O. Clinical observations on the corneal thickness and the corneal endothelium in diabetes mellitus. Br J Ophthalmol 1981;65:687-90.
• [26] Wiemer NG, Dubbelman M, Kostense PJ, Ringens PJ, Polak BC. The influence of chronic diabetes mellitus on the thickness and the shape of the anterior and posterior surface of the cornea. Cornea 2007;26:1165-70.
• [27] Wiemer NG, Dubbelman M, Hermans EA, Ringens PJ, Polak BC. Changes in the internal structure of the human crystalline lens with diabetes mellitus type 1 and type 2. Ophthalmology 2008;115:2017-23.
• [28] Shenoy R, Khandekar R, Bialasiewicz A, Al Muniri A. Corneal endothelium in patients with diabetes mellitus: a historical cohort study. Eur J Ophthalmol 2009;19:369-75.
• [29] Schultz RO, Matsuda M, Yee R, Edelhauser HF, Schultz KJ. Corneal endothelial changes in type 1 and 2 diabetes mellitus. Am J Ophthalmol 1984;98:401-10.
• [30] Torun B, Ülkü G, Yılmaz T. [Evaluation of central corneal thickness in patients with diabetes mellitus]. Fırat Tıp Dergisi 2010;15:128-30. [Article in Turkish]
• [31] McNamara NA, Brand RJ, Polse KA, Bourne WM. Corneal function during normal and high serum glucose levels in diabetes. Invest Ophthalmol Vis Sci 1998;39:3-17.
• [32] Herse PR. Corneal hydration control in normal and alloxan induced diabetic rabbits. Invest Ophthalmol Vis Sci 1990;31:2205-13.
• [33] Su DH, Wong TY, Wong WL, Saw SM, Tan DT, Shen SY, et al. Singapore Malay Eye Study Group. Diabetes, hyperglycemia, and central corneal thickness: the Singapore Malay Eye Study. Ophthalmology 2008;115:964-8.
• [34] Ozdamar Y, Cankaya B, Ozalp S, Acaroglu G, Karakaya J, Ozkan SS. Is there a correlation between diabetes mellitus and central corneal thickness? J Glaucoma 2010;19:613-6.
• [35] Browning DJ, Fraser CM, Propst BW. The variation in optical coherence tomography-measured macular thickness in diabetic eyes without clinical macular edema. Am J Ophthalmol 2008;145:889-93.
• [36] Sugimoto M, Sasoh M, Ido M, Wakitani Y, Takahashi C, Uji Y. Detection of early diabetic change with optical coherence tomography in type 2 diabetes mellitus patients without retinopathy. Ophthalmologica 2005;219:379-85.
• [37] Bressler NM, Edwards AR, Antoszyk AN, Beck RW, Browning DJ, Ciardella AP, et al. Diabetic Retinopathy Clinical Research Network. Retinal thickness on Stratus optical coherence tomography in people with diabetes and minimal or no diabetic retinopathy. Am J Ophthalmol 2008;145:894-901.
• [38] Moreira RO, Trujillo FR, Meirelles RM, Ellinger VC, Zagury L. Use of optical coherence tomography (OCT) and indirect ophthalmoscopy in the diagnosis of macular edema in diabetic patients. Int Ophthalmol 2001;24:331-6.
• [39] Varma R, Macias GL, Torres M, Klein R, Klein R, Peña FY, et al.; Los Angeles Latino Eye Study Group. Biologic risk factors associated with diabetic retinopathy: the Los Angeles Latino Eye Study. Ophthalmology 2007;114:1332-40.
• [40] Klein R, Klein BEK, Moss SE, Cruickshanks KJ. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XV. The long-term incidence of macular edema. Ophthalmology 1995;102:7-16.