García-Ulloa Ana Cristina, Pérez-Peralta Liliana, Jaime-Casas Salvador, Jiménez-Corona Aida, Rivera-De La Parra David, Graue-Hernández Enrique Octavio, Hernández-Jiménez Sergio
Centro de Atención Integral del Paciente con Diabetes (CAIPaDi) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Instituto de Oftalmología Fundación Conde de Valenciana IAP, Mexico City, Mexico.
Diabetes Metab Syndr Obes. 2024 Jan 16;17:231-238. doi: 10.2147/DMSO.S447658. eCollection 2024.
To evaluate the risk factors associated with diabetic macular edema (DME) in patients with a recent type 2 diabetes mellitus (T2DM) diagnosis.
We conducted a case-control study at a third-level hospital in Mexico City. We enrolled patients ≥18 years old, with T2DM less than five years of diagnosis, without disabling complications, and non-smokers. The control group was patients with diabetic retinopathy and without macular edema (DR-DME). Cases were patients with DR+DME. We measured fasting glucose, creatinine, lipid profile, urinary albumin/creatinine ratio (ACR), and HbA1c. An ophthalmological examination consisted of visual acuity measurement, digital three-field fundus photography with an automatic non-mydriatic camera, slit lamp, and Optical coherence tomography (OCT) examination.
183 and 61 patients with DR-DME and DR+DME, respectively, were included in the analysis. The prevalence of mild DR was higher in the DR-DME group, but the frequencies of moderate and severe retinopathy were higher in the DR+DME group. Patients in the DR-DME group had better vision than those in the DR+DME group. Logistic regression analysis revealed that age (OR, 1.07), HbA1c (OR, 1.19), and Albumin-to-Creatinine Ratio (ACR) > 30 mg/g (OR, 3.37) were associated with an increased possibility of DME compared to DR-DME.
Our study provides insights into the association between risk factors and DME. We found a statistically strong association between HbA1c levels, age, and ACR. Patients with poor metabolic control should undergo an extensive medical examination to screen for DME, which may be related to the chronicity of DM and renal damage.
评估近期诊断为2型糖尿病（T2DM）的患者发生糖尿病性黄斑水肿（DME）的相关危险因素。
我们在墨西哥城的一家三级医院开展了一项病例对照研究。纳入年龄≥18岁、确诊T2DM少于5年、无致残并发症且不吸烟的患者。对照组为患有糖尿病视网膜病变但无黄斑水肿（DR-DME）的患者。病例组为患有DR+DME的患者。我们测量了空腹血糖、肌酐、血脂谱、尿白蛋白/肌酐比值（ACR）和糖化血红蛋白（HbA1c）。眼科检查包括视力测量、使用自动免散瞳相机进行的数字三维眼底摄影、裂隙灯检查和光学相干断层扫描（OCT）检查。
分别有183例和61例DR-DME和DR+DME患者纳入分析。DR-DME组轻度DR的患病率较高，但DR+DME组中度和重度视网膜病变的发生率较高。DR-DME组患者的视力优于DR+DME组患者。逻辑回归分析显示，与DR-DME相比，年龄（比值比[OR]，1.07）、HbA1c（OR，1.19）和白蛋白与肌酐比值（ACR）>30 mg/g（OR，3.37）与发生DME的可能性增加相关。
我们的研究为危险因素与DME之间的关联提供了见解。我们发现HbA1c水平、年龄和ACR之间存在统计学上的强关联。代谢控制不佳的患者应接受全面的医学检查以筛查DME，这可能与糖尿病的慢性病程和肾脏损害有关。
