Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Determinants of incident intraocular lens implantation in type 2 diabetes: The Fremantle Diabetes Study Phase 2 (#62)

Jocelyn J Drinkwater 1 , Wendy A Davis 1 , David G Bruce 1 , Timothy M E Davis 1
  1. School of Medicine, University of Western Australia, Fremantle, WA, Australia

People with type 2 diabetes (T2D) are at increased risk of cataracts and subsequent intraocular lens (IOL) implantation but there are few diabetes-specific data relating to the underlying risk factors. The aim was to investigate variables associated with incident IOL implantation in a large community-based sample of Australians with T2D. The Fremantle Diabetes Study Phase II (FDS2) recruited 1,551 T2D participants (mean±SD age 65.7±11.6 years, 51.9% males, median [IQR] diabetes duration 9.0 [3.0-15.8] years) from a postcode-defined population of 157,000 between 2008 and 2011. Detailed biochemical, physical, questionnaire and interview assessments were conducted at entry and then biennially. Cataract and IOL status was obtained through the Western Australian Data Linkage System using relevant ICD codes and hospitalisation for IOL implantation was ascertained to end-June 2013. Cox regression analysis with age as timescale was used to identify predictors of IOL implantation. Participants with a prior IOL implantation at study entry (20.1%, n=322) were excluded. Of the remaining 1,229, 14.1% (n=173) had IOL implantation during 4,120 person-years of follow up. These patients were significantly older (70.2±8.8 vs 61.8±10.7 years, P<0.001) and had longer diabetes duration (13.0[4.0-17.8] vs 6.2[2.0-14.0] years, P<0.001) at study entry than those without any IOL implantation. Independent predictors of incident IOL implantation are shown in the table.

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The multiple predictors of incident IOL implantation included those reported previously for cataract development (glycaemic control, body mass index, hormone replacement and Asian ethnicity (1)). The relationship with relatively high eGFR categories may reflect hyperfiltration, a precursor for rapid decline in renal function leading to chronic renal disease which is itself a risk factor for cataract. Novel predictors comprised severe hypoglycaemia and low HDL cholesterol which have been associated with cataract development in animal studies (2, 3). These findings suggest there are modifiable risk factors for IOL implantation which could be targeted as part of usual care in T2D.

 

  1. Chua J, Koh JY, Tan AG, Zhao W, Lamoureux E, Mitchell P, et al. Ancestry, Socioeconomic Status, and Age-Related Cataract in Asians: The Singapore Epidemiology of Eye Diseases Study. Ophthalmology. 2015;122(11):2169-78.
  2. Tsutsumi K, Inoue Y, Yoshida C. Acceleration of Development of Diabetic Cataract by Hyperlipidemia and Low High-Density Lipoprotein in Rats. Biological & Pharmaceutical Bulletin. 1999;22(1):37-41.
  3. Elanchezhian R, Palsamy P, Madson CJ, Mulhern ML, Lynch DW, Troia AM, et al. Low glucose under hypoxic conditions induces unfolded protein response and produces reactive oxygen species in lens epithelial cells. Cell Death & Disease. 2012;3(4):e301.