Endocrine Abstracts

Background and Aim: Multiple studies support that chronic glycemic imbalance has deleterious effects on microcirculation. It is the central physiopathological factor in the development of chronic kidney disease (CKD) and several ophthalmologic complications in patients with type 2 diabetes mellitus (T2DM). This study aims to assess the peculiarities of eye complications in patients with diabetes and CKD.

Methods: We conducted a descriptive study including 88 patients suffering from T2DM and CKD who were admitted to the inpatient unit of the Endocrinology department of Hedi Chaker University Hospital between 2019 and 2020. Medical charts were reviewed retrospectively to identify the clinical, biochemical, and ophthalmological findings.

Results: The mean age was 68.7±10.9 years old, with a male predominance (52.3%). A family history of diabetes (84.1%), hypertension (61.4%), and CKD (12.5%) were frequently reported. The average diabetes evolution was 13±9 years. A glycemic imbalance was recorded in 80.2%. The mean A1C was 9.68±2.5% in this population. The leading comorbidities were dyslipidemia (94.0%), hypertension (86.4%), and obesity (35.7%). The mean glomerular filtration rate (GFR) was 32.2±13.81 ml/min. Patients who had reached advanced stages of CKD represent 43.2%. Macroalbuminuria was encountered in 52.2%. The main ophthalmologic conditions were diabetic retinopathy (DR) and cataracts, respectively, observed in 53.3% and 11.1% of cases. Glaucoma and hypertensive retinopathy were also reported in 2.8% of patients. DR was non-proliferative in 29.7%. Intravitreal hemorrhage and maculopathy complicated the course of DR in 2.7% of patients. Panretinal photocoagulation was performed in 27%. Cecity affected 4.3% of our sample.

Discussion: DR represents a vision-threatening complication that may increase the risk of functional impairment and dependence in patients with CKD. Screening for this condition with a specialized annual eye exam is recommended. Optimal control of glycemic profile, blood pressure, and lipid parameters are efficient measures that could prevent the onset and the progression of this disease.

References: 1. Vujosevic, Stela, et al. "Screening for diabetic retinopathy: new perspectives and challenges." The Lancet Diabetes & Endocrinology 8.4 (2020): 337-347. 2. Seewoodhary, Mahesh. "An overview of diabetic retinopathy and other ocular complications of diabetes mellitus." Eye (2020). 3. Feldman-Billard, Sylvie, and Bénédicte Dupas. "Eye disorders other than diabetic retinopathy in patients with diabetes." Diabetes & Metabolism 47.6 (2021): 101279.