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

Abstract

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.