Association of Ocular Manifestation with Glycemic Control in Patients with Type 2 Diabetes Mellitus

Abstract

Objective: This study aimed to investigate the association between glycemic control, measured by glycated hemoglobin (HbA1c), and the pan ophthalmic burden of ocular disease in patients with Type 2 Diabetes Mellitus (T2DM). We hypothesized that elevated HbA1c levels correlate not only with increased severity of diabetic retinopathy (DR) but also with a higher prevalence of cataract, anterior segment disorders, and glaucomatous signs.

Methods: A hospital based analytical cross sectional study was conducted on 90 adult patients (aged ≥40 years) with T2DM. Participants underwent comprehensive ophthalmic evaluation, including assessment for DR, diabetic macular edema (DME), cataract, anterior segment disorders, and glaucoma suspect status. Glycemic control was categorized as good (HbA1c <7%) or poor (HbA1c ≥7%). A composite Ocular Burden Score (range 0–8) was calculated. Statistical analyses included chi square tests, Spearman’s correlation, and multiple linear regression.

Results: The mean age of participants was 58.4 ± 9.1 years, with a mean diabetes duration of 8.6 ± 4.3 years. The mean HbA1c was 8.2 ± 1.6%; 68.9% were in the poor control group. Any DR was present in 54.4% of patients, significant cataract in 64.4%, anterior segment disorders in 37.8%, and glaucoma suspect status in 17.8%. Poor glycemic control was significantly associated with a higher mean Ocular Burden Score (4.0 ± 1.6 vs. 2.1 ± 1.2, p<0.001), greater prevalence of any DR (66.1% vs. 28.6%, p=0.001), moderate to severe DR (40.3% vs. 7.1%, p=0.001), cataract (33.9% vs. 17.9%, p=0.005), and anterior segment disorders (45.2% vs. 21.4%, p=0.033). HbA1c showed strong positive correlations with Ocular Burden Score (ρ=0.652, p<0.001) and DR grade (ρ=0.584, p<0.001). Multiple regression identified HbA1c as the strongest independent predictor of ocular burden (β=0.632, p<0.001).

Conclusion: Poor glycemic control in T2DM is significantly associated with a greater overall burden of ocular disease, affecting both posterior and anterior segments. These findings underscore the importance of stringent glycemic management and comprehensive ophthalmic screening to mitigate visual morbidity in diabetic patients.