Jeffrey S. Eisenberg

Only one in four diabetic patients participating in the Malay Eye Study achieved optimal glycemic control and one in eight achieved optimal blood pressure controls, and these numbers were even lower in individuals with diabetic retinopathy, according to a report in the September 2010 issue of Archives of Ophthalmology.

Olivia S. Huang, B.Sc, of the University of New South Wales, in Kensington, Australia, and her colleagues measured glycemic and blood pressure control among a population-based sample of patients with diabetes and, specifically, those patients with diabetic retinopathy.

Previous studies have predicted that the prevalence of diabetes in Asia will increase from 240 million in 2007 to 380 million in 2025.

The cross-sectional study is based on a population of 3,280 Malay adults aged 40-80 years in Singapore from 2004 to 2006. The researchers identified 768 patients with diabetes, which they defined as non-fasting glucose level of 200 mg/dL or greater, use of diabetic medication, or physician diagnosis. Nearly 1 in 10 had severe diabetic retinopathy.

Overall, the mean glycated hemoglobin (HbA1c) level was 8.0% (range of 4.5%-15.1%) with only 26.9% having an optimal HbA1c level, defined as less than 7%. This number dropped to 17.4% among participants with diabetic retinopathy.

HbA1c of greater than 8% was present in 49.1% of the overall sample, but rose to 61.9% of patients with diabetic retinopathy. Patients who had HbA1c levels greater than 8% were more likely to have diabetic retinopathy vs. those with an HbA1c lower than 8%.

Factors associated with higher odds of suboptimal glycemic control included higher serum cholesterol levels, being previously undiagnosed with diabetes, being treated with oral hypoglycemic agents, and having diabetic retinopathy, the researchers found. Older age, however, was associated with decreased odds of suboptimal control.

Mean systolic and diastolic blood pressure levels were 154.6 mm Hg and 79.2 mm Hg, respectively. Only 13.4% of the overall patients and 10.3% of diabetic patients had optimal blood pressure, defined as 130/80 mm Hg or lower, were achieved in 13.4% patients. In those with diabetic retinopathy, the number dropped to 10.3% (Arch. Ophthalmol. 2010;128:1185-90 [doi:10.1001/archophthalmol. 2010.168]).

Patients with systolic pressure greater than 150 mm Hg were more likely to have diabetic retinopathy than were those with 150 mm Hg or less. A total of 57.3% of the overall sample had optimal diastolic blood pressure levels.

Factors associated with higher odds of suboptimal blood pressure included older age, higher total serum cholesterol levels, higher body mass index, diabetic retinopathy, and posterior subcapsular cataract. Patients who had a previous acute myocardial infarction were less likely to have suboptimal blood pressure control.

Other socioeconomic factors, namely education and income, as well as ocular and systemic factors were not significantly associated with suboptimal blood pressure or glycemic control, the researchers said.

“Our findings present a challenge to health-care policy makers and professionals regarding effective implementation of diabetes care in Asia,” the researchers wrote. Specifically, they need to devise strategies to improve awareness and implement evidence-based guidelines in order to reduce diabetic complications, they added.

Strengths of the study include the population-based sample, masked external grading of retinal photographs with higher proportions of gradable photographs, and standardized measurement of HbA1c and blood pressure, the investigators said. A limitation, they added, was a definition of diabetes based on random blood glucose levels instead of oral glucose tolerance tests.

The authors have no financial disclosures. The study was supported by grants from the National Medical Research Council and Biomedical Research Council and by the Ministry of Health, all in Singapore.

Only one in four diabetic patients participating in the Malay Eye Study achieved optimal glycemic control and one in eight achieved optimal blood pressure controls, and these numbers were even lower in individuals with diabetic retinopathy, according to a report in the September 2010 issue of Archives of Ophthalmology.

Olivia S. Huang, B.Sc, of the University of New South Wales, in Kensington, Australia, and her colleagues measured glycemic and blood pressure control among a population-based sample of patients with diabetes and, specifically, those patients with diabetic retinopathy.

Previous studies have predicted that the prevalence of diabetes in Asia will increase from 240 million in 2007 to 380 million in 2025.

The cross-sectional study is based on a population of 3,280 Malay adults aged 40-80 years in Singapore from 2004 to 2006. The researchers identified 768 patients with diabetes, which they defined as non-fasting glucose level of 200 mg/dL or greater, use of diabetic medication, or physician diagnosis. Nearly 1 in 10 had severe diabetic retinopathy.

Overall, the mean glycated hemoglobin (HbA1c) level was 8.0% (range of 4.5%-15.1%) with only 26.9% having an optimal HbA1c level, defined as less than 7%. This number dropped to 17.4% among participants with diabetic retinopathy.

HbA1c of greater than 8% was present in 49.1% of the overall sample, but rose to 61.9% of patients with diabetic retinopathy. Patients who had HbA1c levels greater than 8% were more likely to have diabetic retinopathy vs. those with an HbA1c lower than 8%.

Factors associated with higher odds of suboptimal glycemic control included higher serum cholesterol levels, being previously undiagnosed with diabetes, being treated with oral hypoglycemic agents, and having diabetic retinopathy, the researchers found. Older age, however, was associated with decreased odds of suboptimal control.

Mean systolic and diastolic blood pressure levels were 154.6 mm Hg and 79.2 mm Hg, respectively. Only 13.4% of the overall patients and 10.3% of diabetic patients had optimal blood pressure, defined as 130/80 mm Hg or lower, were achieved in 13.4% patients. In those with diabetic retinopathy, the number dropped to 10.3% (Arch. Ophthalmol. 2010;128:1185-90 [doi:10.1001/archophthalmol. 2010.168]).

Patients with systolic pressure greater than 150 mm Hg were more likely to have diabetic retinopathy than were those with 150 mm Hg or less. A total of 57.3% of the overall sample had optimal diastolic blood pressure levels.

Factors associated with higher odds of suboptimal blood pressure included older age, higher total serum cholesterol levels, higher body mass index, diabetic retinopathy, and posterior subcapsular cataract. Patients who had a previous acute myocardial infarction were less likely to have suboptimal blood pressure control.

Other socioeconomic factors, namely education and income, as well as ocular and systemic factors were not significantly associated with suboptimal blood pressure or glycemic control, the researchers said.

“Our findings present a challenge to health-care policy makers and professionals regarding effective implementation of diabetes care in Asia,” the researchers wrote. Specifically, they need to devise strategies to improve awareness and implement evidence-based guidelines in order to reduce diabetic complications, they added.

Strengths of the study include the population-based sample, masked external grading of retinal photographs with higher proportions of gradable photographs, and standardized measurement of HbA1c and blood pressure, the investigators said. A limitation, they added, was a definition of diabetes based on random blood glucose levels instead of oral glucose tolerance tests.

The authors have no financial disclosures. The study was supported by grants from the National Medical Research Council and Biomedical Research Council and by the Ministry of Health, all in Singapore.

Only one in four diabetic patients participating in the Malay Eye Study achieved optimal glycemic control and one in eight achieved optimal blood pressure controls, and these numbers were even lower in individuals with diabetic retinopathy, according to a report in the September 2010 issue of Archives of Ophthalmology.

Olivia S. Huang, B.Sc, of the University of New South Wales, in Kensington, Australia, and her colleagues measured glycemic and blood pressure control among a population-based sample of patients with diabetes and, specifically, those patients with diabetic retinopathy.

Previous studies have predicted that the prevalence of diabetes in Asia will increase from 240 million in 2007 to 380 million in 2025.

The cross-sectional study is based on a population of 3,280 Malay adults aged 40-80 years in Singapore from 2004 to 2006. The researchers identified 768 patients with diabetes, which they defined as non-fasting glucose level of 200 mg/dL or greater, use of diabetic medication, or physician diagnosis. Nearly 1 in 10 had severe diabetic retinopathy.

Overall, the mean glycated hemoglobin (HbA1c) level was 8.0% (range of 4.5%-15.1%) with only 26.9% having an optimal HbA1c level, defined as less than 7%. This number dropped to 17.4% among participants with diabetic retinopathy.

HbA1c of greater than 8% was present in 49.1% of the overall sample, but rose to 61.9% of patients with diabetic retinopathy. Patients who had HbA1c levels greater than 8% were more likely to have diabetic retinopathy vs. those with an HbA1c lower than 8%.

Factors associated with higher odds of suboptimal glycemic control included higher serum cholesterol levels, being previously undiagnosed with diabetes, being treated with oral hypoglycemic agents, and having diabetic retinopathy, the researchers found. Older age, however, was associated with decreased odds of suboptimal control.

Mean systolic and diastolic blood pressure levels were 154.6 mm Hg and 79.2 mm Hg, respectively. Only 13.4% of the overall patients and 10.3% of diabetic patients had optimal blood pressure, defined as 130/80 mm Hg or lower, were achieved in 13.4% patients. In those with diabetic retinopathy, the number dropped to 10.3% (Arch. Ophthalmol. 2010;128:1185-90 [doi:10.1001/archophthalmol. 2010.168]).

Patients with systolic pressure greater than 150 mm Hg were more likely to have diabetic retinopathy than were those with 150 mm Hg or less. A total of 57.3% of the overall sample had optimal diastolic blood pressure levels.

Factors associated with higher odds of suboptimal blood pressure included older age, higher total serum cholesterol levels, higher body mass index, diabetic retinopathy, and posterior subcapsular cataract. Patients who had a previous acute myocardial infarction were less likely to have suboptimal blood pressure control.

Other socioeconomic factors, namely education and income, as well as ocular and systemic factors were not significantly associated with suboptimal blood pressure or glycemic control, the researchers said.

“Our findings present a challenge to health-care policy makers and professionals regarding effective implementation of diabetes care in Asia,” the researchers wrote. Specifically, they need to devise strategies to improve awareness and implement evidence-based guidelines in order to reduce diabetic complications, they added.

Strengths of the study include the population-based sample, masked external grading of retinal photographs with higher proportions of gradable photographs, and standardized measurement of HbA1c and blood pressure, the investigators said. A limitation, they added, was a definition of diabetes based on random blood glucose levels instead of oral glucose tolerance tests.

The authors have no financial disclosures. The study was supported by grants from the National Medical Research Council and Biomedical Research Council and by the Ministry of Health, all in Singapore.

Major Finding: Higher BMI is not associated with a higher risk of POAG, and in women, it was associated with a 6% risk reduction in normal-tension glaucoma.

Data Source: Prospective cohort study of 78,777 women in the Nurses Health Study and 41,352 men in the Health Professionals Follow-Up Study, from which 980 cases of POAG were identified.

Disclosures: The investigators reported no conflicts of interest. The study was funded by grants from the National Institutes of Health.

Higher body mass index is not associated with a higher risk of primary open-angle glaucoma, and in women, it may be associated with a reduced incidence of normal-tension glaucoma, a study has shown.

Even so, clinicians and patients must be cautious about these findings until further research substantiates them and clarifies the related biologic mechanisms, cautioned lead researcher Dr. Louis R. Pasquale of the department of ophthalmology, Harvard Medical School, and the Massachusetts Eye and Ear Infirmary, both in Boston, and his colleagues.

The findings are based on data from a prospective cohort study of 78,777 women in the Nurses Health Study and 41,352 men in the Health Professionals Follow-Up Study. Researchers followed participants in the NHS from 1980 through 2004 and participants in the HPFS from 1986 through 2004 (Ophthalmology 2010 [doi:10.1016/j.ophtha.2009.12.017]).

Eligible patients were aged 40 years and older, did not have primary open-angle glaucoma (POAG) at baseline, and underwent eye examinations during follow-up.

Participants in both studies completed questionnaires with information about anthropometric measures, potential confounders, and ophthalmic status. Also, researchers evaluated medical records, including visual field data, from participants who self-reported glaucoma.

For statistical analysis, they divided the incident cases by person-years accrued for each category of anthropometric measure, controlled for known risk factors for POAG, and determined the relationship between anthropometric measures and POAG subtype, namely high tension (more than 21 mm Hg) and low tension (21 mm Hg or less).

The researchers identified 980 cases of POAG during follow-up. Overall, they found no associations between cumulatively averaged BMI and either POAG subtype, and no association between height and the risk for POAG. In women, however, they found that every unit increase in BMI was associated with a 6% reduction in the risk for normal-tension glaucoma.

“Although the inverse association between weight residuals and normal-tension POAG among women may be the result of chance, it is reasonable to entertain [biologic] mechanisms that may support such an association,” the researchers reported. “Perhaps some measure linked to adiposity or lean mass that is under sex hormonal influences may protect against the development of POAG. It is possible that higher circulating estrogen levels in postmenopausal women with higher BMI bind to estrogen receptors expressed on retinal ganglion cells to mediate neuroprotection.”

By determining how anthropometric measures influence a patient's risk of developing POAG, the researchers wrote, they may one day unlock important clues regarding disease pathogenesis.

Major Finding: Higher BMI is not associated with a higher risk of POAG, and in women, it was associated with a 6% risk reduction in normal-tension glaucoma.

Data Source: Prospective cohort study of 78,777 women in the Nurses Health Study and 41,352 men in the Health Professionals Follow-Up Study, from which 980 cases of POAG were identified.

Disclosures: The investigators reported no conflicts of interest. The study was funded by grants from the National Institutes of Health.

Higher body mass index is not associated with a higher risk of primary open-angle glaucoma, and in women, it may be associated with a reduced incidence of normal-tension glaucoma, a study has shown.

Even so, clinicians and patients must be cautious about these findings until further research substantiates them and clarifies the related biologic mechanisms, cautioned lead researcher Dr. Louis R. Pasquale of the department of ophthalmology, Harvard Medical School, and the Massachusetts Eye and Ear Infirmary, both in Boston, and his colleagues.

The findings are based on data from a prospective cohort study of 78,777 women in the Nurses Health Study and 41,352 men in the Health Professionals Follow-Up Study. Researchers followed participants in the NHS from 1980 through 2004 and participants in the HPFS from 1986 through 2004 (Ophthalmology 2010 [doi:10.1016/j.ophtha.2009.12.017]).

Eligible patients were aged 40 years and older, did not have primary open-angle glaucoma (POAG) at baseline, and underwent eye examinations during follow-up.

Participants in both studies completed questionnaires with information about anthropometric measures, potential confounders, and ophthalmic status. Also, researchers evaluated medical records, including visual field data, from participants who self-reported glaucoma.

For statistical analysis, they divided the incident cases by person-years accrued for each category of anthropometric measure, controlled for known risk factors for POAG, and determined the relationship between anthropometric measures and POAG subtype, namely high tension (more than 21 mm Hg) and low tension (21 mm Hg or less).

The researchers identified 980 cases of POAG during follow-up. Overall, they found no associations between cumulatively averaged BMI and either POAG subtype, and no association between height and the risk for POAG. In women, however, they found that every unit increase in BMI was associated with a 6% reduction in the risk for normal-tension glaucoma.

“Although the inverse association between weight residuals and normal-tension POAG among women may be the result of chance, it is reasonable to entertain [biologic] mechanisms that may support such an association,” the researchers reported. “Perhaps some measure linked to adiposity or lean mass that is under sex hormonal influences may protect against the development of POAG. It is possible that higher circulating estrogen levels in postmenopausal women with higher BMI bind to estrogen receptors expressed on retinal ganglion cells to mediate neuroprotection.”

By determining how anthropometric measures influence a patient's risk of developing POAG, the researchers wrote, they may one day unlock important clues regarding disease pathogenesis.

Major Finding: Higher BMI is not associated with a higher risk of POAG, and in women, it was associated with a 6% risk reduction in normal-tension glaucoma.

Data Source: Prospective cohort study of 78,777 women in the Nurses Health Study and 41,352 men in the Health Professionals Follow-Up Study, from which 980 cases of POAG were identified.

Disclosures: The investigators reported no conflicts of interest. The study was funded by grants from the National Institutes of Health.

Higher body mass index is not associated with a higher risk of primary open-angle glaucoma, and in women, it may be associated with a reduced incidence of normal-tension glaucoma, a study has shown.

Even so, clinicians and patients must be cautious about these findings until further research substantiates them and clarifies the related biologic mechanisms, cautioned lead researcher Dr. Louis R. Pasquale of the department of ophthalmology, Harvard Medical School, and the Massachusetts Eye and Ear Infirmary, both in Boston, and his colleagues.

The findings are based on data from a prospective cohort study of 78,777 women in the Nurses Health Study and 41,352 men in the Health Professionals Follow-Up Study. Researchers followed participants in the NHS from 1980 through 2004 and participants in the HPFS from 1986 through 2004 (Ophthalmology 2010 [doi:10.1016/j.ophtha.2009.12.017]).

Eligible patients were aged 40 years and older, did not have primary open-angle glaucoma (POAG) at baseline, and underwent eye examinations during follow-up.

Participants in both studies completed questionnaires with information about anthropometric measures, potential confounders, and ophthalmic status. Also, researchers evaluated medical records, including visual field data, from participants who self-reported glaucoma.

For statistical analysis, they divided the incident cases by person-years accrued for each category of anthropometric measure, controlled for known risk factors for POAG, and determined the relationship between anthropometric measures and POAG subtype, namely high tension (more than 21 mm Hg) and low tension (21 mm Hg or less).

The researchers identified 980 cases of POAG during follow-up. Overall, they found no associations between cumulatively averaged BMI and either POAG subtype, and no association between height and the risk for POAG. In women, however, they found that every unit increase in BMI was associated with a 6% reduction in the risk for normal-tension glaucoma.

“Although the inverse association between weight residuals and normal-tension POAG among women may be the result of chance, it is reasonable to entertain [biologic] mechanisms that may support such an association,” the researchers reported. “Perhaps some measure linked to adiposity or lean mass that is under sex hormonal influences may protect against the development of POAG. It is possible that higher circulating estrogen levels in postmenopausal women with higher BMI bind to estrogen receptors expressed on retinal ganglion cells to mediate neuroprotection.”

By determining how anthropometric measures influence a patient's risk of developing POAG, the researchers wrote, they may one day unlock important clues regarding disease pathogenesis.