Is a History of Diabetes Mellitus (DM) Protective Against Developing Primary Open-Angle Glaucoma?

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1 Is a History of Diabetes Mellitus (DM) Protective Against Developing Primary Open-Angle Glaucoma? (Presenter name goes here) (Presenter Institutional Affiliation goes here) The Ocular Hypertension Treatment Study Group (OHTS) National Eye Institute, National Center for Minority Health and Health Disparities, NIH grants EY09307, EY09341, EY02687, Unrestricted Grant from Research to Prevent Blindness, Merck Research Laboratories and Pfizer, Inc.

2 2002 OHTS Prediction Model Gordon, et. al., Archives of Ophthal,2002;120: History of DM at baseline appeared to be protective against developing POAG DM classification of Participant at baseline n Percent POAG MV hazard ratio 95% CI Yes 191 3% 0.37 No 1,427 8% (0.13, 0.90)

3 Significant Baseline Predictive Factors from Multivariate Proportional Hazard Models Hazard Ratio (95% CI) Age (decade) Diabetes Mellitus IOP (per mmhg) CCT (per 40 µm decrease) PSD (per 0.2 db increase) Horizontal C/D Ratio (per 0.1 increase) Vertical C/D Ratio (per 0.1 increase) 1.22 (1.01, 1.49) 0.37 (0.15, 0.90) 1.10 (1.04, 1.17) 1.71 (1.40, 2.09) 1.27 (1.06, 1.52) 1.27 (1.14, 1.40) 1.32 (1.19, 1.47)

4 2002 OHTS Prediction Model DM finding was unexpected and contradicted most of the literature on risk factors for POAG Methodological issues in OHTS might account for this finding

5 Methodological Issues OHTS entry criteria excluded diabetic individuals with any retinopathy possibly resulting in an atypical sample of DM patients Under and Over Ascertainment of Diabetes History Patients were asked Has a doctor ever told you that you have...diabetes, or sugar in the blood? Patients who answered Yes were classified as having a history of DM Self-report was not corroborated by chart review, blood tests or medication use

6 Methods Additional data on DM diagnosis and treatment were collected by self-report beginning February The original prediction model was rerun refreshing only the DM information No blood tests or chart reviews were performed

7 Methods Pts. were classified using 3 different definitions of DM history High sensitivity and low specificity Moderate sensitivity and moderate specificity Low sensitivity and high specificity

8 Definition of DM History High sensitivity and low specificity Has a doctor ever told you that you have DM or sugar in the blood? 409 pts responded yes at baseline or follow-up compared to 191 pts at baseline. All 191 pts from baseline interview responded yes at one or more f/up visits 1,227 pts. responded no

9 Result: High Sensitivity and Low Specificity DM classification of Participant n Percent POAG MV hazard ratio 95% CI Yes 409 6% 0.76 No 1,227 8% (0.48, 1.20)

10 Definition of DM History Moderate sensitivity and moderate specificity Has a doctor or health professional recommended a special diet to lower your blood sugar 277 pts. responded yes 1,036 pts. responded no

11 Result: Diet Moderate Sensitivity and Moderate Specificity DM classification of Participant n Percent POAG MV hazard ratio 95% CI Yes 277 6% 0.73 No 1,036 9% (0.43, 1.24)

12 Definition of DM History Low sensitivity and high specificity Are you currently taking insulin or diabetic pills to lower your blood sugar 256 pts. responded yes 1,057 pts. responded no

13 Result: Insulin or Pills Low Sensitivity and High Specificity DM classification of Participant n Percent POAG MV hazard ratio 95% CI Yes 256 7% No 1,057 9% 0.84 (0.51, 1.39)

14 Conclusion In univariate and multivariate analyses, a history of DM was not associated with the development of POAG for any of the 3 definitions tested.

15 Conclusion Difference in result from the 2002 prediction model reflects more complete ascertainment of DM Results of re-analyses are consistent with previous studies which reported that DM either increased the risk of developing POAG or had no effect

16 OHTS Clinical Centers Bascom Palmer Eye Institute Eye Consultants of Atlanta Eye Physicians and Surgeons Cullen Eye Institute Devers Eye Institute Emory Eye Institute Henry Ford Hospitals Johns Hopkins University Krieger Eye Institute Howard University University of Maryland University of California, Los Angeles Charles Drew University Kellogg Eye Center Kresge Eye Institute Great Lakes Eye Institute University of Louisville Mayo Clinic New York Eye & Ear Infirmary Ohio State University Ophthalmic Surgeons & Consultants Pennsylvania College of Optometry MCP/Hahnemann University Scheie Eye Institute Keystone Eye Associates University of California, Davis University of California, San Diego University of California, San Francisco University Suburban Health Center University of Ophthalmic Consultants Washington Eye Physicians & Surgeons Eye Associates of Washington, DC Washington University, St. Louis

17 OHTS Resource Centers Study Chairman s Office & Coordinating Center Washington University St. Louis, MO Optic Disc Reading Center Bascom Palmer Eye Institute University of Miami Miami, FL Visual Field Reading Center University of California, Davis Sacramento, CA