Siraj Ul Haq, Michael Myung-Sup Han, Waseem Ansari, Felipe Conti, Fabiana Queiroga de Paula Araujo Silva, Rishi P Singh; Baseline Systemic Demographic Characteristics of Patients With Diabetic Macular Edema Undergoing Initiation of Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3594.
Purpose : Clinical studies have demonstrated that baseline visual acuity (VA) can result in a varying response to anti-VEGF treatment. However, little is known about the initial presentation of diabetic macular edema (DME) in routine clinical practice with regard to patient demographics, medication use, and systemic comorbidities. The aim of the current study is to report these findings of patients presenting with DME who received anti-VEGF in routine clinical practice.
Methods : A retrospective study was performed at a single institution from April 2012-December 2016. Inclusion criteria were age ≥18, diagnosis of Type 1 or 2 diabetes, foveal-involving retinal edema secondary to diabetes and initiation of anti-VEGF therapy. Exclusion criteria were any cause of macular edema not related to diabetes, and any intraocular surgery within 3 months of presentation of DME. Patient demographics, relevant medical history, and lab values were evaluated. Relationships between categorical variables were assessed using Pearson chi-square tests, while continuous variables were assessed using T-tests.
Results : For the entire cohort, 638 patients were enrolled. The average age was 63.1(±11.6) years. There were 95.6% type II and 4.4% type I diabetics with an average HbA1c of 8.1% (5.1-14.5%). Insulin was used in 67%, biguanides in 43%, sulfonylureas in 32.8%, DDP4 inhibitors in 11.8%, thiazolidinediones in 3.9%, and D-phenylalanine derivatives in 0.94%. Hypertension was present in 78.4% of patients, cardiac comorbidities in 29.3%, peripheral vascular disease in 16.5% and renal insufficiency in 22.6%.
Patients were divided into two visual acuity groups: ETDRS <70 (Snellen 20/50 or worse, n=326) and ETDRS ≥70 (Snellen 20/40 or better, n=312). Patients with ETDRS <70 were older (p=0.016) and more likely to have a history of hypertension (p=0.034). This group was less likely to use biguanides (48.7% vs 37.7%, p=0.005), had lower HDL values (45.8 vs 50.0, p=0.028), and higher creatinine levels (1.7 vs 1.4, p=0.047).
Conclusions : Patients with DME who received anti-VEGF treatment in routine clinical practice are mostly type II diabetics, insulin dependent, with an average HbA1c above target values. Patients within the lower vision cohort demonstrated key differences with regards to their baseline demographics, systemic laboratory values, and medication utilization.