Intensive Glycemic Management Is Associated With Reduced Retinal Structure Abnormalities on Ocular Coherence Tomography in the DCCT/EDIC Study

Authors

Barbara Blodi, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison.
Thomas W. Gardner, Kellogg Eye Institute, University of Michigan, Ann Arbor, MI.
Xiaoyu Gao, Biostatistics Center, The George Washington University, Rockville, MD.
Jennifer K. Sun, Department of Ophthalmology, Joslin Diabetes Center, Boston, MA.
Gayle M. Lorenzi, University of California San Diego, La Jolla, CA.
Lisa C. de Koo, Eye Institute at Harborview, University of Washington, Seattle, WA.
Arup Das, University of New Mexico, Albuquerque, NM.
Neil H. White, Pediatrics, Washington University in St. Louis, St. Louis, MO.
Rose A. Gubitosi-Klug, Rainbow Babies and Children's Hospital, Cleveland, OH.
Lloyd P. Aiello, Department of Ophthalmology, Joslin Diabetes Center, Boston, MA.
Ionut Bebu, Biostatistics Center, The George Washington University, Rockville, MD.

Document Type

Journal Article

Publication Date

3-29-2024

Journal

Diabetes care

DOI

10.2337/dc23-2408

Abstract

OBJECTIVE: To investigate quantitative and qualitative changes in retinal structure using optical coherence tomography (OCT) and their associations with systemic or other risk factors in individuals with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: In the Epidemiology of Diabetes Interventions and Complications (EDIC) study, OCT images were obtained during study years 25-28 (2019-2022) in 937 participants; 54% and 46% were from the original intensive (INT) and conventional (CONV) glycemic management treatment groups, respectively. RESULTS: Average age for participants was 61 years old, diabetes duration 39 years, and HbA1c 7.6%. Participants originally in the CONV group were more likely to have disorganization of retinal inner layers (DRIL) (CONV 27.3% vs. INT 18.7%; P = 0.0003), intraretinal fluid (CONV 24.4% vs. INT 19.2%; P = 0.0222), and intraretinal cysts (CONV 20.8% vs. INT 16.6%; P = 0.0471). In multivariable models, sex, age, smoking, mean updated systolic blood pressure, and history of "clinically significant" macular edema (CSME) and of anti-VEGF treatment were independently associated with changes in central subfield thickness, while HbA1c, BMI, and history of CSME and of ocular surgery were associated with DRIL. Visual acuity (VA) decline was associated with significant thinning of all retinal subfields except for the central and inner nasal subfields. CONCLUSIONS: Early intensive glycemic management in T1D is associated with a decreased risk of DRIL. This important morphological abnormality was associated with a history of macular edema, a history of ocular surgery, and worse VA. This study reveals benefits of intensive glycemic management on the retina beyond features detected by fundus photographs and ophthalmoscopy.

APA Citation

Blodi, Barbara; Gardner, Thomas W.; Gao, Xiaoyu; Sun, Jennifer K.; Lorenzi, Gayle M.; de Koo, Lisa C.; Das, Arup; White, Neil H.; Gubitosi-Klug, Rose A.; Aiello, Lloyd P.; and Bebu, Ionut, "Intensive Glycemic Management Is Associated With Reduced Retinal Structure Abnormalities on Ocular Coherence Tomography in the DCCT/EDIC Study" (2024). GW Authored Works. Paper 4465.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4465

Department

Biostatistics and Bioinformatics