Título / Title

PROTEINURIA IS AN INDEPENDENT PREDICTOR FOR MACULAR EDEMA IN TYPE 2 DIABETES: RESULTS FROM THE BRAZILIAN DIABETES STUDY

Introdução / Purpose

Importance. Measurement of central retinal thickness by optical coherence tomography (OCT) shows higher diagnostic accuracy for macular edema (ME) than fundus photography alone. The expanding gap between the rising number of type 2 diabetes (T2D) individuals and the availability of OCT devices demands a targeted selection of individuals at higher risk of ME who would benefit the most from early referral. Objective. To appraise if proteinuria should be considered in a targeted referral of T2D individuals to OCT examination.

Material e Método / Methods

Design. Cross-sectional, retrospective analysis of the Brazilian Diabetes Study database. Setting. Eyes from T2D adults were evaluated by fundus photography and OCT exam for ME diagnosis between June/2016 and December/2022. Urinalysis was carried out in the same period to assess proteinuria status. Participants. Data from 1186 eyes were assessed for eligibility, 52 were excluded and 1134 eyes were included in this analysis. Mean age was 57 years; median diabetes duration was 9 years; 59% were male. Main outcomes. Odds ratio (OR) of the association between proteinuria and ME.

Resultados / Results

The prevalence of proteinuria was 22%, and 18.2% of eyes had ME. Proteinuria was related to an increased prevalence of ME (13.2% vs 38.7% for control vs proteinuria, respectively; p < 0.001), with an OR of 3.77 [95% confidence interval (CI): 2.24 to 6.33, p < 0.001), after adjustment for covariates. Proteinuria was independently related to ME in both non-apparent DR [OR: 2.82; 95%CI: 1.34 to 5.93; p=0.003] and non-proliferative DR (OR of 5.94, 95%CI 2.13-16.62, p<0.001). Proteinuria was also related to ME in eyes with preserved visual acuity [OR 4.18, 95%CI: 2.12 to 8.25; p < 0.001). Only half of the ME cases detected by OCT were spotted by fundus photography.

Discussão e Conclusões / Conclusion

In individuals with T2D, proteinuria was independently related to both clinical and subclinical ME. This should be borne in mind of health care providers when referring T2D individuals to OCT examination.

Palavras Chave

Keywords: macular edema; type 2 diabetes; optical coherence tomography

Area

CLINICAL RETINA

Institutions

Universidade Estadual de Campinas - UNICAMP - Campinas - São Paulo - Brasil

Authors

JOAQUIM BARRETO, FERNANDO R. P. CHAVES, VICENTE HIDALGO RODRIGUES FERNANDES, MAURÍCIO ABUJAMRA NASCIMENTO, RODRIGO P. C. LIRA, WILSON NADRUZ, CARLOS EDUARDO LEITE ARIETA, ANDREI CARVALHO SPOSITO