Type 2 diabetes patients with high fasting blood glucose and waist circumference are more likely to develop diabetic retinopathy.¹

A year-long cross-sectional study conducted in a tertiary hospital examined the association between fasting blood glucose, waist circumference and diabetic retinopathy. A total of 213 individuals, aged  ≥45 years (mean age 60 years), with type 2 diabetes (mean duration 10 years), were enrolled for the study conducted from July 2021 to July 2022. The study group had a male preponderance (~60%).. Persons who had been diagnosed within the preceding 3 years were not included in the study. Similarly, patients with type 1 diabetes, impaired glucose tolerance, maturity-onset diabetes of the young (MODY) and latent autoimmune diabetes in adults (LADA) were also not included. The presence of ≥1 retinal microaneurysms or retinal blot hemorrhages, with or without any additional abnormalities, were considered as diabetic retinopathy.

The mean weight of the study participants was 61.6 kg. The mean BMI was 23.6. Nearly 25% were overweight and about 14% were found to be hypertensive.

Results showed the prevalence of diabetic retinopathy to be nearly 68%. The mean fasting glucose in study subjects with diabetic retinopathy was 203.36 mg/dL, whereas it was 187.93 mg/dL in those without diabetic retinopathy. This difference had statistical significance (p = 0.032). A significant difference was also noted for waist circumference between the two groups. The mean waist circumference in participants with diabetic retinopathy was 39.72, while it was 37.64 among those who did not have diabetic retinopathy (p = 0.009).

Diabetic retinopathy is a long-term microvascular and sight-threatening complication of diabetes. This study has demonstrated a high prevalence of diabetic retinopathy in almost two-thirds of the study population. It also found a significant association of high fasting blood glucose and increasing waist circumference, indicative of central obesity, with diabetic retinopathy. The optimal cut-off levels for waist circumference for Asian Indians is 78 cm for men and 72 cm for women. And men with waist circumference 90 cm and 80 cm for women need to be evaluated for cardiometabolic risk factors.² Hence, fasting blood glucose and waist circumference may be considered as surrogate markers of diabetic retinopathy, particularly in resource-constrained settings. Clinicians taking care of diabetes patients should refer such individuals for evaluation and monitoring for diabetic retinopathy.

References

1. Ranganathan R, et al. High fasting blood sugar and increased waist circumference as risk factors for diabetic retinopathy in type 2 diabetes patients older than 45 years. Cureus. 2022 Aug. 23;14(8):e28291. doi:10.7759/cureus.28291.
2. Misra A, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009 Feb;57:163-70.