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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Association of age at diagnosis of diabetes with subsequent risk of age-related ocular diseases and vision acuity
Si-Ting Ye, Xian-Wen Shang, Yu Huang, Susan Zhu, Zhuo-Ting Zhu, Xue-Li Zhang, Wei Wang, Shu-Lin Tang, Zong-Yuan Ge, Xiao-Hong Yang, Ming-Guang He
Si-Ting Ye, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Si-Ting Ye, Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Xian-Wen Shang, Yu Huang, Zhuo-Ting Zhu, Xue-Li Zhang, Shu-Lin Tang, Xiao-Hong Yang, Ming-Guang He, Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Xian-Wen Shang, Yu Huang, Zhuo-Ting Zhu, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Susan Zhu, Austin Hospital, University of Melbourne, Melbourne 3084, Victoria, Australia
Wei Wang, Ming-Guang He, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
Zong-Yuan Ge, Monash e-Research Center, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Center, Monash University, Melbourne 3080, Victoria, Australia
Ming-Guang He, Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, Melbourne 3002, Victoria, Australia
Co-first authors: Si-Ting Ye and Xian-Wen Shang.
Co-corresponding authors: Xiao-Hong Yang and Ming-Guang He.
Author contributions: Shang XW, Yang XH, and He MG conceived the study; Shang XW did the literature search and analysed the data; Ye ST, Shang XW, Huang Y, Zhu S, Zhu ZT, and He MG contributed to key data interpretation; Ye ST and Shang XW wrote the manuscript; Ye ST, Shang XW, Huang Y, Zhu S, Zhu ZT, Zhang XL, Wang W, Tang SL, Ge ZY, Yang XH, and He MG critically revised the manuscript. Ye ST is a clinician who identified the clinical problem, provided clinical background, and facilitated the discussion. Shang XW is a statistician who conducted the analysis. Additionally, Ye ST and Shang XW collaborated on drafting the manuscript. Therefore, Ye ST and Shang XW made equal contributions to this work and are co-first authors. He MG provided the funding and the data source, while Yang XH established the research team for this project. They jointly supervised this work. Therefore, they are both considered co-corresponding authors.
Supported by National Natural Science Foundation of China, No. 32200545; The GDPH Supporting Fund for Talent Program, No. KJ012020633 and KJ012019530; Science and Technology Research Project of Guangdong Provincial Hospital of Chinese Medicine, No. YN2022GK04.
Institutional review board statement: The UK Biobank Study’s ethical approval had been granted by the National Information Governance Board for Health and Social Care and the NHS North West Multicenter Research Ethics Committee. The data used in this study is available in the UK Biobank database under the application number of 62443.
Informed consent statement: All participants provided informed consent through electronic signature at the baseline assessment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare that are relevant to the content of this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ming-Guang He, MD, PhD, Professor, Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshaner Road, Guangzhou 510080, Guangdong Province, China. mingguang_he@yahoo.com
Received: November 19, 2023
Peer-review started: November 19, 2023
First decision: December 8, 2023
Revised: December 19, 2023
Accepted: February 27, 2024
Article in press: February 27, 2024
Published online: April 15, 2024
BACKGROUND
The importance of age on the development of ocular conditions has been reported by numerous studies. Diabetes may have different associations with different stages of ocular conditions, and the duration of diabetes may affect the development of diabetic eye disease. While there is a dose-response relationship between the age at diagnosis of diabetes and the risk of cardiovascular disease and mortality, whether the age at diagnosis of diabetes is associated with incident ocular conditions remains to be explored. It is unclear which types of diabetes are more predictive of ocular conditions.
AIM
To examine associations between the age of diabetes diagnosis and the incidence of cataract, glaucoma, age-related macular degeneration (AMD), and vision acuity.
METHODS
Our analysis was using the UK Biobank. The cohort included 8709 diabetic participants and 17418 controls for ocular condition analysis, and 6689 diabetic participants and 13378 controls for vision analysis. Ocular diseases were identified using inpatient records until January 2021. Vision acuity was assessed using a chart.
RESULTS
During a median follow-up of 11.0 years, 3874, 665, and 616 new cases of cataract, glaucoma, and AMD, respectively, were identified. A stronger association between diabetes and incident ocular conditions was observed where diabetes was diagnosed at a younger age. Individuals with type 2 diabetes (T2D) diagnosed at < 45 years [HR (95%CI): 2.71 (1.49-4.93)], 45-49 years [2.57 (1.17-5.65)], 50-54 years [1.85 (1.13-3.04)], or 50-59 years of age [1.53 (1.00-2.34)] had a higher risk of AMD independent of glycated haemoglobin. T2D diagnosed < 45 years [HR (95%CI): 2.18 (1.71-2.79)], 45-49 years [1.54 (1.19-2.01)], 50-54 years [1.60 (1.31-1.96)], or 55-59 years of age [1.21 (1.02-1.43)] was associated with an increased cataract risk. T2D diagnosed < 45 years of age only was associated with an increased risk of glaucoma [HR (95%CI): 1.76 (1.00-3.12)]. HRs (95%CIs) for AMD, cataract, and glaucoma associated with type 1 diabetes (T1D) were 4.12 (1.99-8.53), 2.95 (2.17-4.02), and 2.40 (1.09-5.31), respectively. In multivariable-adjusted analysis, individuals with T2D diagnosed < 45 years of age [β 95%CI: 0.025 (0.009,0.040)] had a larger increase in LogMAR. The β (95%CI) for LogMAR associated with T1D was 0.044 (0.014, 0.073).
CONCLUSION
The younger age at the diagnosis of diabetes is associated with a larger relative risk of incident ocular diseases and greater vision loss.
Core Tip: This is the first prospective cohort study to examine the association of age at the diagnosis of diabetes with main ocular conditions. Our findings suggest the age at the diagnosis of diabetes plays an important role in the association between diabetes and incident cataract, glaucoma, and age-related macular disease as well as vision. A younger age at the diagnosis of diabetes was associated with larger excessive relative risk for ocular conditions and larger vision loss. Type 1 diabetes appears to have potentially more harmful effects.
