Glycemic control is an important modifiable risk factor for uveitis in patients with diabetes: A retrospective cohort study establishing clinical risk and ophthalmic disease burden.

AIM

To characterize the risk uveitis, scleritis or episcleritis in relation to diabetes, glycaemic control, and co-existence of retinopathy.

METHODS

Using the Royal College of General Practitioners Research and Surveillance Centre database, we established the prevalence of acute uveitis and scleritis or episcleritis over a six-year period among populations without(n = 889,856) and with diabetes(n = 48,584). We evaluated the impact of glycaemic control on disease risk. Regression modeling was used to identify associations, adjusting for clinical and demographic confounders.

RESULTS

Incidence of acute uveitis was higher among patients with diabetes; Type 1 OR:2.01 (95% CI 1.18-3.41; p = 0.009), and Type 2 OR:1.23 (1.05-1.44; p = 0.01). Glycaemic control was established as an important effect modifier for uveitis risk, whereby those with poorer control suffered higher disease burden. Results confirmed a dose-response relationship such that very poor glycaemic control OR:4.72 (2.58-8.65; p < 0.001), poor control OR:1.57 (1.05-2.33; p = 0.03) and moderate control OR:1.20 (0.86-1.68; p = 0.29) were predictive of uveitis. Similar results were observed when evaluating retinopathy staging: proliferative retinopathy OR:2.42 (1.25-4.69; p = 0.01). These results were not maintained for scleritis or episcleritis.

CONCLUSION

Acute uveitis is more common in patients with diabetes; at highest risk are those with type 1 disease with poor glycaemic control. Glycaemic improvements may prevent recurrence.