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The Effect of Serum HbA1c Level on Intravitreal Anti-VEGF Treatment for Diabetic Macular Edema

Year 2019, Volume: 3 Issue: 2, 79 - 83, 31.08.2019

Abstract

Aim: To investigate the effect of serum glycosylated hemoglobin A1C (HbA1c) on treatment success in patients receiving intravitrealvascular endothelial growth factor inhibitor (anti-VEGF) treatment for diabetic macular edema (DME).

Material and Methods: The study included only one eye of patients who received anti-VEGF therapy for the first time and whohad checked blood HbA1c levels in the last two weeks. Patients with vitreomacular interface pathology and vitreous or premacularhemorrhage were excluded from the study. The affected eyes of the patients, the best corrected visual acuity (BCVA) with Snellen chart,dilated fundus examination findings, fundus fluorescein angiography, central macular thickness (SMK) measurements (pre-treatmentand 1 month after treatment) obtained by optical coherence tomography (OCT), and used type of anti -VEGF agents were recorded.Patients were divided into two groups as HbA1c level <9.0 mg / dl (group 1, 23 eyes) and ≥9.0 mg / dl (group 2, 34 eyes). 

Results: There were 54 patients, of them 54.4% were female included in the study. The mean age of the patients was 61.1 ± 11.9 years. Twenty-one eyes (54.4%) were received ranibizumab as intravitreal anti-VEGF injection and remained 26 (45.6%) eyes were received aflibercept. The mean HbA1c level of the patients was 9.35 ± 1.8 [6.5-13.6] mg / dl, while there was no difference between the male and female patients (p = 0,570). The two groups were not statistically different in terms of age, gender, eye laterality and anti-VEGF agents used (p> 0.05). While the decrease in SMC after the treatment was 164 μ in group 1, it was 138 μ in group 2 (p = 0.714). The increase in BCVA was 0.23 in group 1 and 0.12 in group 2 (p = 0.001).

Conclusion: Our study revealed that serum HbA1c level did not have a significant effect on anatomical success at the first month of intravitreal anti-VEGF treatment, whereas low HbA1c level was associated with increased functional success.

References

  • 1. Kitano S, Sakamoto T, Goto R, Fukushima A, Vataire AL, Hikichi Y. The impact of anti-vascular endothelial growth factor agents on visual impairment/blindness prevention in patients with diabetic macular edema and on associated patient and caregiver burden in Japan. J Med Econ 2019;22:254-265.
  • 2. Acan D, Calan M, Er D, Arkan T, Kocak N, Bayraktar F, Kaynak S. The prevalence and systemic risk factors of diabetic macular edema: a cross-sectional study from Turkey. BMC Ophthalmol 2018;18:91.
  • 3. Hemmingsen B, Lund SS, Gluud C, Vaag A, Almdal T, Hemmingsen C, Wetterslev J. Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. BMJ 2011;343:d6898.
  • 4. Wang PH, Lau J, Chalmers TC. Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes. Lancet 1993;341:1306-9.
  • 5. Klein R, Palta M, Allen C, Shen G, Han DP, D'Alessio DJ. Incidence of retinopathy and associated risk factors from time of diagnosis of insulin-dependent diabetes. Arch Ophthalmol 1997;115:351-6.
  • 6. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837-53.
  • 7. Calugaru D, Calugaru M. Anti-VEGF Treatment for Diabetic Macular Edema in a Real-World Clinical Setting. Am J Ophthalmol 2018;196:208-209.
  • 8. Wells JA, Glassman AR, Ayala AR, Jampol LM, Bressler NM, Bressler SB, et al. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema: Two-Year Results from a Comparative Effectiveness Randomized Clinical Trial. Ophthalmology 2016;123:1351-9.
  • 9. Antonetti DA, Barber AJ, Bronson SK, Freeman WM, Gardner TW, Jefferson LS, et al. Diabetic retinopathy: seeing beyond glucose-induced microvascular disease. Diabetes 2006;55:2401-11.
  • 10. Wangsa-Wirawan ND, Linsenmeier RA. Retinal oxygen: fundamental and clinical aspects. Arch Ophthalmol 2003;121:547-57.
  • 11. Dodo Y, Murakami T, Suzuma K, Yoshitake S, Yoshitake T, Ishihara K, Fujimoto M, Miwa Y, Tsujikawa A. Diabetic Neuroglial Changes in the Superficial and Deep Nonperfused Areas on Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2017;58:5870-5879.
  • 12. Hudson BI, Schmidt AM. RAGE: a novel target for drug intervention in diabetic vascular disease. Pharm Res 2004;21:1079-86.
  • 13. Aiello LP. The potential role of PKC beta in diabetic retinopathy and macular edema. Surv Ophthalmol 2002;47 Suppl 2:S263-9.
  • 14. Caldwell RB, Bartoli M, Behzadian MA, El-Remessy AE, Al-Shabrawey M, Platt DH, Liou GI, Caldwell RW. Vascular endothelial growth factor and diabetic retinopathy: role of oxidative stress. Curr Drug Targets 2005;6:511-24.
  • 15. Funatsu H, Yamashita H, Noma H, Mimura T, Yamashita T, Hori S. Increased levels of vascular endothelial growth factor and interleukin-6 in the aqueous humor of diabetics with macular edema. Am J Ophthalmol 2002;133:70-7.
  • 16. Murakami T, Frey T, Lin C, Antonetti DA. Protein kinase cbeta phosphorylates occludin regulating tight junction trafficking in vascular endothelial growth factor-induced permeability in vivo. Diabetes 2012;61:1573-83.
  • 17. Schmid KE, Neumaier-Ammerer B, Stolba U, Binder S. Effect of grid laser photocoagulation in diffuse diabetic macular edema in correlation to glycosylated haemoglobin (HbA1c). Graefes Arch Clin Exp Ophthalmol 2006;244:1446-52.
  • 18. Shalchi Z, Okada M, Bruynseels A, Palethorpe D, Yusuf A, Hussain R, et al. Effect of glycosylated hemoglobin on response to ranibizumab therapy in diabetic macular edema: real-world outcomes in 312 patients. Can J Ophthalmol 2018;53:415-419.

Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi

Year 2019, Volume: 3 Issue: 2, 79 - 83, 31.08.2019

Abstract

Amaç: Diyabetik maküla ödemi (DMÖ) tedavisi için intravitreal vasküler endotelyal büyüme faktör inhibitörü (anti-VEGF) tedavisi alan hastalarda enjeksiyon esnasında serum glikolize hemoglobin A1c (HbA1c) düzeyinin tedavi başarısına etkisini incelemektir.

Gereç ve Yöntemler: Çalışmaya ilk kez DMÖ nedenli anti-VEGF tedavisi alan ve HbA1c düzeyi son 2 hafta içinde çalışılmış hastaların sadece tek gözleri alındı. Daha önce makülaya lazer yapılan, son 3 ay içinde göz cerrahisi geçiren, vitreomaküler ara yüzey patolojisi olan ve vitreus ya da premaküler hemorajisi olan olgular dahil edilmedi. Hastaların etkilenen gözleri, Snellen eşeli ile en iyi düzeltilmiş görme keskinlikleri (EİDGK), dilate fundus muayene bulguları, fundus floresein anjiyografileri, tedavi öncesi ve tedaviden 1 ay sonraki optik koherens tomografi (OKT) ile elde edilen santral maküla kalınlığı (SMK) ve uygulanan anti-VEGF türü kaydedildi. Hastalar HbA1c düzeyi <9,0 mg/dl (grup 1, 23 göz) ve ≥9,0 mg/dl (grup 2, 34 göz) olarak iki gruba ayrılarak analiz edildi.

Bulgular: Çalışmaya 31’i (%54,4) kadın olmak üzere 57 birey dahil edildi. Hastaların yaş ortalaması 61,1±11,9 idi. İntravitreal anti- VEGF olarak 31 göze (%54,4) ranibizumab, 26 (%45,6) göze ise aflibercept uygulandı. Hastaların ortalama HbA1c düzeyi 9,35±1,8 [6,5- 13,6] mg/dl iken kadın ve erkek hastalar arasında fark yoktu (p=0,570). İki grup yaş, cinsiyet, göz ve uygulanan anti-VEGF açısından istatistiksel olarak farklı değildi (p>0,05). Tedavi sonrası SMK azalması grup 1’de 164 μ iken grup 2’de 138 μ idi (p=0,714). Tedavi ile EİDGK artışı grup 1’de 0,23 ve grup 2’de 0,12 idi (p=0,001).

Sonuç: Çalışmamıza göre serum HbA1c düzeyi intravitreal anti-VEGF tedavisinin ilk bir ayında anatomik başarı üzerine bariz bir etki oluşturmazken HbA1c düzeyinin düşük olması fonksiyonel başarıda artış ile ilişkili bulunmuştur.

References

  • 1. Kitano S, Sakamoto T, Goto R, Fukushima A, Vataire AL, Hikichi Y. The impact of anti-vascular endothelial growth factor agents on visual impairment/blindness prevention in patients with diabetic macular edema and on associated patient and caregiver burden in Japan. J Med Econ 2019;22:254-265.
  • 2. Acan D, Calan M, Er D, Arkan T, Kocak N, Bayraktar F, Kaynak S. The prevalence and systemic risk factors of diabetic macular edema: a cross-sectional study from Turkey. BMC Ophthalmol 2018;18:91.
  • 3. Hemmingsen B, Lund SS, Gluud C, Vaag A, Almdal T, Hemmingsen C, Wetterslev J. Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. BMJ 2011;343:d6898.
  • 4. Wang PH, Lau J, Chalmers TC. Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes. Lancet 1993;341:1306-9.
  • 5. Klein R, Palta M, Allen C, Shen G, Han DP, D'Alessio DJ. Incidence of retinopathy and associated risk factors from time of diagnosis of insulin-dependent diabetes. Arch Ophthalmol 1997;115:351-6.
  • 6. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837-53.
  • 7. Calugaru D, Calugaru M. Anti-VEGF Treatment for Diabetic Macular Edema in a Real-World Clinical Setting. Am J Ophthalmol 2018;196:208-209.
  • 8. Wells JA, Glassman AR, Ayala AR, Jampol LM, Bressler NM, Bressler SB, et al. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema: Two-Year Results from a Comparative Effectiveness Randomized Clinical Trial. Ophthalmology 2016;123:1351-9.
  • 9. Antonetti DA, Barber AJ, Bronson SK, Freeman WM, Gardner TW, Jefferson LS, et al. Diabetic retinopathy: seeing beyond glucose-induced microvascular disease. Diabetes 2006;55:2401-11.
  • 10. Wangsa-Wirawan ND, Linsenmeier RA. Retinal oxygen: fundamental and clinical aspects. Arch Ophthalmol 2003;121:547-57.
  • 11. Dodo Y, Murakami T, Suzuma K, Yoshitake S, Yoshitake T, Ishihara K, Fujimoto M, Miwa Y, Tsujikawa A. Diabetic Neuroglial Changes in the Superficial and Deep Nonperfused Areas on Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2017;58:5870-5879.
  • 12. Hudson BI, Schmidt AM. RAGE: a novel target for drug intervention in diabetic vascular disease. Pharm Res 2004;21:1079-86.
  • 13. Aiello LP. The potential role of PKC beta in diabetic retinopathy and macular edema. Surv Ophthalmol 2002;47 Suppl 2:S263-9.
  • 14. Caldwell RB, Bartoli M, Behzadian MA, El-Remessy AE, Al-Shabrawey M, Platt DH, Liou GI, Caldwell RW. Vascular endothelial growth factor and diabetic retinopathy: role of oxidative stress. Curr Drug Targets 2005;6:511-24.
  • 15. Funatsu H, Yamashita H, Noma H, Mimura T, Yamashita T, Hori S. Increased levels of vascular endothelial growth factor and interleukin-6 in the aqueous humor of diabetics with macular edema. Am J Ophthalmol 2002;133:70-7.
  • 16. Murakami T, Frey T, Lin C, Antonetti DA. Protein kinase cbeta phosphorylates occludin regulating tight junction trafficking in vascular endothelial growth factor-induced permeability in vivo. Diabetes 2012;61:1573-83.
  • 17. Schmid KE, Neumaier-Ammerer B, Stolba U, Binder S. Effect of grid laser photocoagulation in diffuse diabetic macular edema in correlation to glycosylated haemoglobin (HbA1c). Graefes Arch Clin Exp Ophthalmol 2006;244:1446-52.
  • 18. Shalchi Z, Okada M, Bruynseels A, Palethorpe D, Yusuf A, Hussain R, et al. Effect of glycosylated hemoglobin on response to ranibizumab therapy in diabetic macular edema: real-world outcomes in 312 patients. Can J Ophthalmol 2018;53:415-419.
There are 18 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Sait Alim 0000-0003-1237-4264

Ayşe Kevser Demir This is me 0000-0002-9993-5265

Publication Date August 31, 2019
Acceptance Date August 31, 2019
Published in Issue Year 2019 Volume: 3 Issue: 2

Cite

APA Alim, S., & Demir, A. K. (2019). Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi. Turkish Journal of Diabetes and Obesity, 3(2), 79-83.
AMA Alim S, Demir AK. Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi. Turk J Diab Obes. August 2019;3(2):79-83.
Chicago Alim, Sait, and Ayşe Kevser Demir. “Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi”. Turkish Journal of Diabetes and Obesity 3, no. 2 (August 2019): 79-83.
EndNote Alim S, Demir AK (August 1, 2019) Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi. Turkish Journal of Diabetes and Obesity 3 2 79–83.
IEEE S. Alim and A. K. Demir, “Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi”, Turk J Diab Obes, vol. 3, no. 2, pp. 79–83, 2019.
ISNAD Alim, Sait - Demir, Ayşe Kevser. “Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi”. Turkish Journal of Diabetes and Obesity 3/2 (August 2019), 79-83.
JAMA Alim S, Demir AK. Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi. Turk J Diab Obes. 2019;3:79–83.
MLA Alim, Sait and Ayşe Kevser Demir. “Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi”. Turkish Journal of Diabetes and Obesity, vol. 3, no. 2, 2019, pp. 79-83.
Vancouver Alim S, Demir AK. Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi. Turk J Diab Obes. 2019;3(2):79-83.

Turkish Journal of Diabetes and Obesity (Turk J Diab Obes) is a scientific publication of Zonguldak Bulent Ecevit University Obesity and Diabetes Research and Application Center.

This is a refereed journal, which is published in printed and electronic forms. It aims at achieving free knowledge to the related national and international organizations and individuals.

This journal is published annually three times (in April, August and December).

The publication language of the journal is Turkish and English.