Pan Li-Yen, Kuo Yu-Kai, Chen Tien-Hsing, Sun Chi-Chin
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Front Med (Lausanne). 2022 Aug 23;9:980714. doi: 10.3389/fmed.2022.980714. eCollection 2022.
To investigate the risk and protective factors of dry eye disease (DED) in patients with type II diabetes mellitus (DM).
A retrospective cohort study using Chang- Gung research database collecting data from 2005 to 2020.
Patients with type II DM were included, and those with previous ocular diseases were excluded. Ten thousand twenty nine developed DED (DED group), and 142,491 didn't (non-DED group). The possible risk and protective factors were compared and analyzed using the logistic regression model.
A majority of the DED group were female with significantly higher initial and average glycated hemoglobin levels, and higher incidence of diabetic neuropathy and retinopathy. In conditional logistic regression model, advanced age was a risk factor. After adjusting for sex, age, and DM duration; average glycated hemoglobin level, diabetic neuropathy, retinopathy, and nephropathy with eGFR 30 ~ 59 and intravitreal injection, vitrectomy, pan-retinal photocoagulation, and cataract surgery were contributing factors of DED. Considering antihyperglycemic agents, DPP4 inhibitor, SGLT2 inhibitor, GLP-1 agonist, and insulin monotherapy and dual medications combining any two of the aforementioned agents were protective factors against DED compared with metformin alone. In the monotherapy group, SLGT2 inhibitor had the lowest odds ratio, followed by GLP1 agonist, DPP4 inhibitor, and insulin.
DED in patients with DM is associated with female sex, advanced age, poor diabetic control, microvascular complications and receiving ocular procedures. GLP-1 agonist, SGLT-2 inhibitor, DPP4 inhibitor, and insulin are superior to metformin alone in preventing DM-related DED. A prospective randomized control trial is warranted to clarify our results.
探讨2型糖尿病（DM）患者患干眼症（DED）的风险及保护因素。
一项回顾性队列研究，使用长庚研究数据库收集2005年至2020年的数据。
纳入2型糖尿病患者，排除既往有眼部疾病的患者。10029例发生干眼症（干眼症组），142491例未发生（非干眼症组）。采用逻辑回归模型对可能的风险和保护因素进行比较和分析。
干眼症组大多数为女性，初始和平均糖化血红蛋白水平显著更高，糖尿病神经病变和视网膜病变的发生率更高。在条件逻辑回归模型中，高龄是一个风险因素。在调整性别、年龄和糖尿病病程后；平均糖化血红蛋白水平、糖尿病神经病变、视网膜病变、估算肾小球滤过率为30~59的肾病以及玻璃体内注射、玻璃体切除术、全视网膜光凝和白内障手术是干眼症的促成因素。考虑到降糖药物，与单独使用二甲双胍相比，二肽基肽酶4抑制剂（DPP4抑制剂）、钠-葡萄糖协同转运蛋白2抑制剂（SGLT2抑制剂）、胰高血糖素样肽-1激动剂（GLP-1激动剂）以及胰岛素单药治疗和将上述任何两种药物联合使用的双药治疗是预防干眼症的保护因素。在单药治疗组中，SGLT2抑制剂的比值比最低，其次是GLP1激动剂、DPP4抑制剂和胰岛素。
糖尿病患者的干眼症与女性、高龄、糖尿病控制不佳、微血管并发症以及接受眼科手术有关。GLP-1激动剂、SGLT-2抑制剂、DPP4抑制剂和胰岛素在预防糖尿病相关干眼症方面优于单独使用二甲双胍。有必要进行一项前瞻性随机对照试验以阐明我们的结果。
