Association Between Diabetic Macular Edema and Cardiovascular Events in Type 2 Diabetes Patients: A Multicenter Observational Study.
Diabetic macular edema (DME) is the main cause of visual loss associated with diabetes but any association between DME and cardiovascular events is unclear.This study aims to describe the possible association between DME and cardiovascular events in a multicenter cross-sectional study of patients with type 2 diabetes.Two thousand eight hundred seven patients with type 2 diabetes were recruited from diabetes and nephrology clinical institutional centers participating in the DIAB 2 NEPHROGENE study focusing on diabetic complications. DME (presence/absence) and diabetic retinopathy (DR) classification were based on ophthalmological report and/or on 30° color retinal photographs. DR was defined as absent, nonproliferative (background, moderate, or severe) or proliferative. Cardiovascular events were stroke, myocardial infarction, and lower limb amputation.Details regarding associations between DME and cardiovascular events were evaluated.The study included 2807 patients with type 2 diabetes, of whom 355 (12.6%) had DME. DME was significantly and independently associated with patient age, known duration of diabetes, HbA1c, systolic blood pressure, and DR stage. Only the prior history of lower limb amputation was strongly associated with DME in univariate and multivariate analyses, whereas no association was found with regard to myocardial infarction or stroke. Moreover, both major (n = 32) and minor lower limb (n = 96) amputations were similarly associated with DME, with respective odds ratio of 3.7 (95% confidence interval [CI], 1.77-7.74; P = 0.0012) and of 4.29 (95% CI, 2.79-6.61; P < 0.001).DME is strongly and independently associated with lower limb amputation in type 2 diabetic patients.
From the Department of ophthalmology, University Hospital of Poitiers, France (NL, OL, JG, M-FR, MB); University of Poitiers, UFR Médecine et Pharmacie, France (NL, RM); U1084, Inserm, Poitiers, France (NL); Centre d'investigation clinique, University of Poitiers, Poitiers, France (SR, P-JS, SH); CIC1402, Inserm, France (SR, P-JS, SH); Centre d'investigation clinique, University Hospital of Poitiers, Poitiers, France (SR, P-JS, SH); Endocrinology and Diabetology Department, pole DUNE, University Hospital of Poitiers, Poitiers, France (EG, XP, RM, SH); Department of Nephrology-immunology, University Hospital of Tours, François Rabelais University, Tours, France (JMH); Diabetology Department, Rangueuil Hospital, University Hospital of Toulouse, France (PG); Endocrinology Department Hospital of Sud Francilien, Corbeil Essonnes, France (DD); UMRS1138, Inserm, Paris, France (RR); University Paris 7 Denis Diderot, UMRS1138, Paris, France (RR); Diabetology, endocrinology and Nutrition Department, Groupe Hospitalier Bichat Claude Bernard, Assistance Public-Hopitaux de Paris (AP-HP), Paris, France (RR); Diabetology Department Bégin Armed Forces Hospital, Saint Mandé, France (OD); U1082, Inserm, Poitiers, France (SH).
Nicolas
N
Leveziel
Stéphanie
S
Ragot
Elise
E
Gand
Olivier
O
Lichtwitz
Jean Michel
JM
Halimi
Julien
J
Gozlan
Pierre
P
Gourdy
Marie-Françoise
MF
Robert
Dured
D
Dardari
Michèle
M
Boissonnot
Ronan
R
Roussel
Xavier
X
Piguel
Olivier
O
Dupuy
Florence
F
Torremocha
Pierre-Jean
PJ
Saulnier
Richard
R
Maréchaud
Samy
S
Hadjadj
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology; D004596:Electroretinography / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D035002:Lower Extremity; D008269:Macular Edema / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*
D006442:Glycated Hemoglobin