Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
Invest Ophthalmol Vis Sci. 2023 Jul 3;64(10):10. doi: 10.1167/iovs.64.10.10.
The purpose of this study was to identify diabetes-related risk factors for exudative age-related macular degeneration (AMD).
This was a nationwide population-based cohort study using authorized clinical data provided by the Korean National Health Insurance Service. A total of 1,768,018 participants with diabetes over 50 years of age participated in the Korean National Health Screening Program between 2009 and 2012. Data on covariates, including age, sex, income level, systemic comorbidities, behavioral factors, and diabetes-related parameters, including duration of diabetes, use of insulin for diabetes control, number of oral hypoglycemic agents used, and accompanying vision-threatening diabetic retinopathy, were collected from health screening results and claims data. Patients were followed up until December 2018. Incident cases of exudative AMD were identified using registered diagnostic codes from the claims data. The prospective association of diabetes-related parameters with incident exudative AMD was investigated using the multivariable-adjusted Cox proportional hazard model.
During an average follow-up period of 5.93 years, 7331 patients were newly diagnosed with exudative AMD. Compared to those who had diabetes for less than 5 years, individuals with diabetes for 5 years or more had a greater risk of future exudative AMD development, with a hazard ratio (95% confidence interval) of 1.13 (1.07-1.18) in the fully adjusted model. Use of insulin for diabetes control and the presence of vision-threatening diabetic retinopathy were also associated with an increased risk of exudative AMD with a hazard ratio (95% confidence interval) of 1.16 (1.07-1.25) and 1.40 (1.23-1.61), respectively.
A longer duration of diabetes, administration of insulin for diabetes control, and comorbid vision-threatening diabetic retinopathy were associated with an increased risk of developing exudative AMD.
本研究旨在确定与糖尿病相关的渗出性年龄相关性黄斑变性（AMD）风险因素。
这是一项全国性基于人群的队列研究，使用韩国国家健康保险服务提供的授权临床数据。共有 1768018 名年龄在 50 岁以上的糖尿病患者参加了 2009 年至 2012 年的韩国国家健康筛查计划。从健康筛查结果和索赔数据中收集了协变量数据，包括年龄、性别、收入水平、系统性合并症、行为因素以及与糖尿病相关的参数，包括糖尿病的持续时间、用于糖尿病控制的胰岛素使用、使用的口服降糖药数量以及伴有威胁视力的糖尿病性视网膜病变。患者随访至 2018 年 12 月。使用索赔数据中登记的诊断代码确定渗出性 AMD 的新发病例。使用多变量调整的 Cox 比例风险模型研究糖尿病相关参数与新发渗出性 AMD 的前瞻性关联。
在平均 5.93 年的随访期间，有 7331 名患者被新诊断为渗出性 AMD。与糖尿病病程不足 5 年的患者相比，病程 5 年或以上的患者未来发生渗出性 AMD 的风险更高，在完全调整模型中，风险比（95%置信区间）为 1.13（1.07-1.18）。糖尿病控制中使用胰岛素和存在威胁视力的糖尿病性视网膜病变也与渗出性 AMD 的风险增加相关，风险比（95%置信区间）分别为 1.16（1.07-1.25）和 1.40（1.23-1.61）。
糖尿病病程较长、糖尿病控制中使用胰岛素以及合并威胁视力的糖尿病性视网膜病变与发生渗出性 AMD 的风险增加相关。
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