Effect of postprandial hyperglycemia at clinic visits on the incidence of retinopathy in patients with type 2 diabetes: An analysis using real‐world long‐term follow‐up data

• Published in: Journal of diabetes investigation Vol. 11; no. 4; pp. 930 - 937
• Main Authors: Takao, Toshiko, Takahashi, Kazuyuki, Yoshida, Yoko, Kushiyama, Akifumi, Onishi, Yukiko, Tahara, Tazu, Shimmei, Asuka, Kikuchi, Takako, Suka, Machi, Yanagisawa, Hiroyuki, Iwamoto, Yasuhiko, Kasuga, Masato
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.07.2020; John Wiley and Sons Inc; Wiley
• Subjects: Age; Ambulatory Care - statistics & numerical data; Blood glucose; Blood Glucose - analysis; Cholesterol; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetic retinopathy; Diabetic Retinopathy - epidemiology; Diabetic Retinopathy - etiology; Fasting; Female; Follow-Up Studies; Glucose; Glycated Hemoglobin - analysis; Hemoglobin; Humans; Hyperglycemia; Hyperglycemia - blood; Hyperglycemia - complications; Hypoglycemia; Incidence; Lipoproteins; Male; Medical laboratories; Middle Aged; Original; Postprandial hyperglycemia; Postprandial Period; Retinopathy; Retrospective Studies; Risk Factors; Type 2 diabetes; Japan; Diabetic retinopathy; Postprandial hyperglycemia; Type 2 diabetes
• ISSN: 2040-1116; 2040-1124
• DOI: 10.1111/jdi.13194

Aims/Introduction There is little evidence on the role of postprandial glycemia in the incidence of diabetic retinopathy (DR) in a real‐world setting. We aimed to assess the effect of postprandial hyperglycemia at clinic visits on the incidence of DR in patients with type 2 diabetes, and whether its effect differs depending on glycated hemoglobin (HbA1c) values and age. Materials and Methods Intrapersonal mean blood glucose levels at 1–2 h post‐breakfast (1–2h‐PBBG), post‐lunch (1–2 h‐PLBG) and both (1–2h‐PBLBG) during 2 years from the first visit were used as baseline data. This retrospective cohort study enrolled 487, 323 and 406 patients who had 1–2h‐PBLBG, 1–2h‐PBBG and 1–2h‐PLBG measurements, respectively. These three groups were followed from 1999 up through 2017. Results DR occurred in 145, 92 and 126 patients in the 1–2h‐PBLBG, 1–2h‐PBBG and 1–2h‐PLBG groups, respectively. Multivariate Cox regression analysis showed that the mean 1–2h‐PBLBG, 1–2h‐PBBG and 1–2h‐PLBG levels were significant predictors of DR, independent of mean HbA1c. In patients with mean HbA1c <7.0% and those with a baseline age <60 years, the mean 1–2h‐PBLBG, 1–2h‐PBBG and 1–2h‐PLBG levels were significant predictors. Conclusions Postprandial hyperglycemia at clinic visits might predict the incidence of DR, independent of HbA1c. The effect of postprandial hyperglycemia on DR is obvious in patients with well‐controlled HbA1c and in younger patients. Even with the lower HbA1c level, correcting postprandial hyperglycemia is important for preventing DR, especially in middle‐aged adults with type 2 diabetes. The present study shows that postprandial hyperglycemia at clinic visits is associated with the incidence of diabetic retinopathy, independent of glycated hemoglobin levels, in a real‐world setting in patients with type 2 diabetes. The effect of postprandial hyperglycemia on retinopathy is obvious in patients with well‐controlled glycated hemoglobin levels and in patients aged <60 years. Therefore, even with the lower glycated hemoglobin, correcting postprandial hyperglycemia is important for preventing retinopathy, especially in middle‐aged adults with type 2 diabetes.