Risk Factors Associated With Cataract Surgery in Patients With T2D

Cataract surgery.
Cataract surgery.
People with type 2 diabetes are at significantly higher risk for cataract surgery, especially people in younger age groups, and factors including serum lipid levels, hypoglycemia, and ethnicity are able to predict likelihood of undergoing surgery.

According to study results published in Diabetes Care, people with type 2 diabetes (T2D), especially in younger age groups, are at significantly higher risk for cataract surgery than people without diabetes, and factors including serum lipid levels, hypoglycemia, and ethnicity can predict the likelihood of these individuals undergoing surgery.

Researchers conducted this community-based study to compare the incidence rate of intraocular lens implantation for cataracts in people with and without T2D and assess for associated risk factors. For every 1 participant with T2D (n = 1183; average age at entry, 62.8), the researchers included 4 comparison residents without diabetes (n = 5133; average age at entry, 63.4), matched for age, sex, and zip code.

During 6949 person-years of follow-up from baseline, 311 patients (26.3%) with T2D were hospitalized for their first intraocular lens implantation (incidence rate ratio, 44.76/1000 person-years). During 31,136 person-years of follow-up, 928 comparison participants without diabetes (18.1%) had their first cataract surgery (incidence rate, 29.81/1000 person-years). In addition, 475 people in the matched cohort were diagnosed with T2D during follow-up; 180 of these participants had cataract surgery before or at the time of diagnosis.

The crude incidence rate ratio for cataract surgery in participants with T2D vs matched participants without diabetes was 1.50 (P <.001). The ratio decreased as age increased, with participants in the 45- to 54-year-old group being much more likely to have cataract surgery vs participants in the 75- to 84-year-old group (incidence rate ratio, 7.12 vs 1.32, respectively).

After risk analysis, the researchers reported several factors that predicted participants with T2D who were more likely to undergo cataract surgery, including age (P <.001), T2D duration (P <.001), serum high-density lipoprotein cholesterol (P <.001), serum triglycerides (P <.001), a severe hypoglycemic episode in the past year (P <.001), and Asian (P <.005) and southern European ethnicity (P ≤.025).

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Limitations to this study included possible data recording errors and an inability to determine cataract type in certain instances due to reliance on hospital coding.

The researchers were able to conclude that “type 2 diabetes increases the risk [for] cataract surgery, particularly in younger people, a subgroup in which multifaceted cataract-prevention strategies could be of substantial benefit.”

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Drinkwater JJ, Davis TME, Turner AW, Bruce DG, Davis WA. Incidence and determinants of intraocular lens implantation in type 2 diabetes: The Fremantle Diabetes Study Phase II. Diabetes Care. 2018;dc181556.