Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.
Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China.
Front Endocrinol (Lausanne). 2022 Jul 22;13:764254. doi: 10.3389/fendo.2022.764254. eCollection 2022.
To study the association between different hypoglycemic regimens and postoperative diabetic macular edema (DME).
A secondary analysis based on a retrospective cohort study.
In this secondary analysis, 124 eyes from patients with proliferative diabetic retinopathy (PDR) who underwent pars plana vitrectomy (PPV) between January 2008 and September 2012 were included. We found that compared with oral hypoglycemic medication, oral hypoglycemic medication plus insulin treatment revealed an insignificant relationship with postoperative DME (odds ratio [OR]=0.8, 95% confidence interval [CI]: 0.12-5.21, P=0.8167), only insulin treatment revealed a significant association with postoperative DME (OR=0.10, 95% CI: 0.01-0.84, P=0.0337) after adjusted age, sex. After adjusted age, sex, diabetes mellitus (DM) duration, glycosylated hemoglobin (HbA1c), the results did not have obvious changes (OR=0.61, 95% CI: 0.09-4.26, P=0.6187; OR=0.07, 95% CI: 0.01-0.65, P=0.0197). Furthermore, after adjusted age, sex, DM duration, HbA1c, hypertension, intraoperative retinal photocoagulation, vitreous hemorrhage, macular detachment, fibrovascular membrane, intraocular lens implantation and microincision vitrectomy surgery, the results were consistent (OR=0.66, 95% CI: 0.05-9.49, P=0.7621; OR=0.06, 95% CI: 0.00-0.81, P=0.0342). The same trend was observed in these adjusted models as well (p for trend was 0.0254, 0.0141, and 0.0311, respectively).
In conclusion, our results of the secondary analysis should be interpreted as a significant association between insulin treatment and reduced risks of postoperative DME in Japanese PDR patients with PPV surgery, compared with oral medications. Well glycemic control with longstanding insulin therapy may be beneficial to reduce the risks of postoperative DME in PDR patients. Our investigation calls for large-scale and long-term prospective clinical studies for a full evaluation of the exact role of insulin in the progression of postoperative DME.
研究不同降糖方案与糖尿病性黄斑水肿（DME）术后的关系。
基于回顾性队列研究的二次分析。
本二次分析纳入了 2008 年 1 月至 2012 年 9 月间因增殖性糖尿病视网膜病变（PDR）接受玻璃体切除术（PPV）的 124 只眼。我们发现与口服降糖药物相比，口服降糖药物联合胰岛素治疗与术后 DME 无显著相关性（比值比[OR] = 0.8，95%置信区间[CI]：0.12-5.21，P = 0.8167），仅胰岛素治疗与术后 DME 显著相关（OR = 0.10，95%CI：0.01-0.84，P = 0.0337），校正年龄、性别后。校正年龄、性别、糖尿病病程、糖化血红蛋白（HbA1c）后，结果无明显变化（OR = 0.61，95%CI：0.09-4.26，P = 0.6187；OR = 0.07，95%CI：0.01-0.65，P = 0.0197）。进一步校正年龄、性别、糖尿病病程、HbA1c、高血压、术中视网膜光凝、玻璃体积血、黄斑脱离、纤维血管膜、人工晶状体植入和微切口玻璃体切除术，结果一致（OR = 0.66，95%CI：0.05-9.49，P = 0.7621；OR = 0.06，95%CI：0.00-0.81，P = 0.0342）。在这些调整后的模型中也观察到了相同的趋势（趋势检验的 P 值分别为 0.0254、0.0141 和 0.0311）。
总之，与口服药物相比，我们的二次分析结果提示日本 PDR 患者接受 PPV 手术后，胰岛素治疗与术后 DME 风险降低之间存在显著关联。长期良好的血糖控制可能有利于降低 PDR 患者术后 DME 的风险。我们的研究呼吁进行大规模、长期的前瞻性临床研究，以充分评估胰岛素在术后 DME 进展中的确切作用。
