Elsevier

Ophthalmology

Volume 113, Issue 7, July 2006, Pages 1081-1086
Ophthalmology

Original Article
Prospective Study of Type 2 Diabetes Mellitus and Risk of Primary Open-Angle Glaucoma in Women

Presented in part at: Association for Research in Vision and Ophthalmology meeting, May 2005, Ft. Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2006.01.066Get rights and content

Purpose

To study the relation between type 2 diabetes mellitus (T2DM) and incident primary open-angle glaucoma (POAG) in women.

Design

Prospective cohort analysis.

Participants

Seventy-six thousand three hundred eighteen women enrolled in the Nurses’ Health Study (NHS).

Methods

Women enrolled in the NHS from 1980 to 2000 were observed. Eligible participants were at least 40 years old, did not have POAG at baseline, and reported receiving eye examinations during follow-up. Potential confounders were assessed on biennial questionnaires, and a diagnosis of T2DM was confirmed on a validated supplemental questionnaire. During follow-up, 429 self-reported POAG cases confirmed by medical chart review were identified.

Main Outcome Measures

Multivariable rate ratios (RRs) of POAG and associated 95% confidence intervals (CIs) obtained from proportional hazards models.

Results

After controlling for age, race, hypertension, body mass index, physical activity, alcohol intake, smoking, and family history of glaucoma, T2DM was positively associated with POAG (RR = 1.82 [95% CI = 1.23–2.70]). Nonetheless, the association did not strengthen with longer duration of diabetes: RR = 2.24 (95% CI = 1.31–3.84) for duration < 5 years versus RR = 1.54 (95% CI = 0.90–2.62) for duration ≥ 5 years). In secondary analyses, to evaluate the potential for detection bias we controlled for additional factors such as the number of eye examinations, but T2DM remained positively associated with POAG.

Conclusion

Type 2 diabetes mellitus is associated with an increased risk of POAG in women.

Section snippets

Description of the Cohort at Risk for Primary Open-Angle Glaucoma

The NHS began in 1976 when 121 700 female registered nurses between the ages of 30 and 55 living in 11 U.S. states enrolled in a study of lifestyle habits and chronic diseases. Participants have returned biennial questionnaires on dietary and lifestyle patterns as well as on any newly diagnosed diseases, including diabetes mellitus and glaucoma. The active follow-up rate in the NHS from 1976 through 2000, defined as the number of person-years with responses to biennial questionnaires divided by

Results

In this analysis, 76 318 female nurses contributed 998 292 person-years of follow-up from 1980 to 2000. As shown in Table 1, women with T2DM contributed 3% of total person time. Subjects with T2DM tended to have higher BMI, more hypertension, less physical activity, and less alcohol intake. These differences were controlled for in multivariate analyses.

We identified 429 cases of incident POAG, of whom 30 (7%) had T2DM (Table 2). The age-adjusted RR of POAG among participants with T2DM was 1.53

Discussion

In this large prospective cohort of female nurses, we found that T2DM was associated with an increased risk of POAG. The strengths of our study are its prospective design and 20 years’ follow-up with data on a large number of important potential confounders. Previous cross-sectional studies of the relation between diabetes and POAG have the limitation of possible reverse causation, especially in studies where POAG cases included were those occurring before diabetes was diagnosed.3, 4

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  • Cited by (0)

    Manuscript no. 2005-962.

    The authors have no financial interest related to this article.

    Supported by National Institutes of Health, Bethesda, Maryland (grant nos.: CA 87969, EY09611, EY015473).

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