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Impact of Type 2 diabetes mellitus and insulin use on progression to glaucoma surgery in primary open angle glaucoma

Eye volume 38, pages 558–564 (2024)Cite this article

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Abstract

Purpose

To investigate outcomes of primary open-angle glaucoma (POAG) patients with and without type 2 diabetes mellitus (T2DM).

Methods

Retrospective observational study using U.S. nationwide healthcare insurance claims database. Patients ≥40 years old with at least one HbA1c within one year of POAG diagnosis were included. Diabetic factors associated with POAG progression requiring glaucoma surgery were evaluated using multivariable Cox proportional hazards regression models adjusted for demographic, diabetic and glaucoma factors. T2DM diagnosis and use of either oral hypoglycaemic agents or insulin therapy were assessed in association with POAG progression requiring glaucoma surgery.

Results

104,515 POAG patients were included, of which 70,315 (67%) had T2DM. The mean age was 68.9 years (Standard deviation 9.2) and 55% were female. Of those with T2DM, 93% were taking medication (65,468); 95% (62,412) taking oral hypoglycaemic agents, and 34% (22,028) were on insulin. In multivariable analyses, patients with T2DM had a higher hazard of requiring glaucoma surgery (Hazard ratio, HR 1.15, 95% CI 1.09–1.21, p < 0.001). Higher mean HbA1c was also a significant predictor of progression requiring glaucoma surgery (HR 1.02, 95% CI 1.01–1.03, p < 0.001). When evaluating only patients who were taking antidiabetic medication, after adjusting for confounders, insulin use was associated with a 1.20 higher hazard of requiring glaucoma surgery compared to oral hypoglycaemic agents (95% CI 1.14–1.27, p < 0.001), but when stratified by HbA1c, this effect was only significant for those with HbA1c > 7.5%.

Conclusions

Higher baseline HbA1c, particularly in patients taking insulin may be associated with higher rates of glaucoma surgery in POAG.

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Fig. 1: Progression to glaucoma surgery according to HbA1c in POAG patients.
Fig. 2: Progression to glaucoma surgery in POAG patients with T2DM Taking insulin compared to those on oral hypoglycaemic agents, stratified by HbA1c levels.

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Data availability

The data that support the findings of this study are available from Clinformatics Data Mart (OptumInsight) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Clinformatics Data Mart (OptumInsight).

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Funding

Departmental support from Research to Prevent Blindness and National Eye Institute P30-026877 (SYW); National Eye Institute K23EY03263501 (SYW).

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Authors and Affiliations

  1. Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA

    Michelle T. Sun, Suzann Pershing, Jeffrey L. Goldberg & Sophia Y. Wang

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Contributions

MTS was responsible for study design, data collection, data analysis and writing the report. SP contributed to study conception, study design, interpretation of results and provided feedback on the manuscript. JLG contributed to study conception, study design, interpretation of results and provided feedback on the manuscript. SYW was responsible for study conception, design and interpretation of results, and contributed to writing the report.

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Correspondence to Sophia Y. Wang.

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Sun, M.T., Pershing, S., Goldberg, J.L. et al. Impact of Type 2 diabetes mellitus and insulin use on progression to glaucoma surgery in primary open angle glaucoma. Eye 38, 558–564 (2024). https://doi.org/10.1038/s41433-023-02734-2

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