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Study finds no uniform glycemic threshold for diabetic retinopathy

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Based on data from three cross-sectional adult populations, there appears to be no evidence of a "clear and consistent" glycemic threshold for the presence or incidence of diabetic retinopathy, a multinational study suggests.

"The current [fasting plasma glucose] cutoff of 7.0 mmol/L used to diagnose diabetes did not accurately identify people with and without retinopathy. These findings suggest that the criteria for diagnosing diabetes could need reassessment," the authors said.

Tien Y. Wong, MD, and colleagues examined data from three cross-sectional studies to determine the relationship between fasting plasma glucose and retinopathy and to evaluate the accuracy of current fasting plasma glucose thresholds in diagnosing both prevalent and incident retinopathy.

Specifically, the researchers examined data obtained for 3,162 participants in the Blue Mountains Eye Study (BMES, Australia), 2,182 participants in the Australian Diabetes, Obesity and Lifestyle Study (AusDiab, Australia) and 6,079 participants in the Multi-Ethnic Study of Atherosclerosis (MESA, United States).

In all cases, the investigators diagnosed retinopathy using graded multiple retinal photographs and measured plasma glucose concentrations from fasting blood samples.

The overall prevalence of retinopathy was 11.5% in BMES, 9.6% in AusDiab and 15.8% in MESA, according to the study.

"However, we found inconsistent evidence of a uniform glycemic threshold for prevalent and incident retinopathy, with analyses suggesting a continuous relation," the authors said.

The conventional diabetes fasting plasma glucose cutoff of 7.0 mmol/L or higher had sensitivity less than 40% (range, 14.8% to 39.1%) for detecting retinopathy, with specificity between 80.8% and 95.8%, they noted.

The area under receiver operating characteristic curves for fasting plasma glucose and retinopathy was low, ranging between 0.56 for BMES and 0.61 for AusDiab, according to the study, published in the March issue of The Lancet.