Diabetes patients with certain risk factors were more likely to also develop dry eye. Photo: Pam Theriot, OD. Click image to enlarge.

Researchers recently found that dry eye disease (DED) in patients with diabetes mellitus (DM) is associated with female sex, older age, poor diabetic control, microvascular complications and ocular procedures. They noted that GLP-1 agonist, SGLT-2 inhibitor, DPP-4 inhibitor and insulin are superior to metformin alone in preventing DM-related DED.

This retrospective cohort study evaluated a large research database of patients with type II DM, excluding those with previous ocular diseases. A total of 10,029 developed DED (DED group), and 142,491 didn't (non-DED group). Potential risk and protective factors were compared and analyzed using a logistic regression model.

A majority of the DED group was female with significantly higher initial and average glycated hemoglobin levels, as well as a higher incidence of diabetic neuropathy and retinopathy. With a conditional logistic regression model, older age was a risk factor. After adjusting for sex, age and DM duration, average glycated hemoglobin level, diabetic neuropathy, retinopathy and nephropathy, intravitreal injection, vitrectomy, panretinal photocoagulation and cataract surgery were contributing factors of DED. Considering antihyperglycemic agents, DPP-4 inhibitor, SGLT-2 inhibitor, GLP-1 agonist and insulin monotherapy and dual medications combining any two of the aforementioned agents were protective factors against DED compared with metformin alone. In the monotherapy group, SLGT-2 inhibitor had the lowest odds ratio, followed by GLP-1 agonist, DPP-4 inhibitor and insulin.

“A prospective randomized control trial is warranted to clarify our results,” the study authors concluded in their paper.

Pan LY, Kuo YK, Chen TH, Sun CC. Dry eye disease in patients with type 2 diabetes mellitus: a retrospective, population-based cohort study in Taiwan. Front Med. August 23, 2022. [Epub ahead of print].