High prevalence of undiagnosed diabetes and high risk for diabetes using HbA1c criteria in middle-aged patients undergoing cataract surgery

Prediction of type 2 diabetes mellitus using hematological factors based on machine learning approaches: a cohort study analysis

Type 2 Diabetes Mellitus (T2DM) is a significant public health problem globally. The diagnosis and management of diabetes are critical to reduce the diabetes complications including cardiovascular disease and cancer. This study was designed to assess the potential association between T2DM and routinely measured hematological parameters. This study was a subsample of 9000 adults aged 35-65 years recruited as part of Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study. Machine learning techniques including logistic regression (LR), decision tree (DT) and bootstrap forest (BF) algorithms were applied to analyze data. All data analyses were performed using SPSS version 22 and SAS JMP Pro version 13 at a significant level of 0.05. Based on the performance indices, the BF model gave high accuracy, precision, specificity, and AUC. Previous studies suggested the positive relationship of triglyceride-glucose (TyG) index with T2DM, so we considered the association of TyG index with hematological factors. We found this association was aligned with their results regarding T2DM, except MCHC. The most effective factors in the BF model were age and WBC (white blood cell). The BF model represented a better performance to predict T2DM. Our model provides valuable information to predict T2DM like age and WBC.

Improving the accuracy of revised cardiac risk index with HbA1C: Hemoglobin ratio (HH ratio) - A retrospective cohort study

Background

The current Lee's Revised cardiac risk index (RCRI) was created in 1999. Validation studies have found RCRI to be only moderately discriminant. The "Diabetes Mellitus on insulin" component of the score does not accurately reflect the severity of the disease. A previously studied HbA1C:Hemoglobin ratio shows an improved association with outcomes than individual components alone.

Study design

A retrospective cohort study was performed in diabetic patients undergoing non-cardiac surgery. Ethics approval was obtained. The study compares the predictive value of RCRI and substitution of the "DM on insulin" component with HH ratio for 30- and 90-day mortality, and postoperative acute myocardial injury (AMI) and acute kidney injury (AKI).

Results

A total of 20,099 adult patients were included in the final analysis. The incidence of 30- and 90-day mortality was at 4.2 and 6.5%, respectively. Substitution of HH ratio in RCRI resulted in 687 more patients being in the moderate to high-risk category. The substituted HH-RCRI score had better prediction for 30-day (AUC 0.66 vs. 0.69, p < 0.001) and 90-day mortality (AUC 0.67 vs. 0.70, p < 0.001), and postoperative AMI (AUC 0.69 vs. 0.71, p < 0.001) and AKI (AUC 0.57 vs. 0.62, p < 0.001).

Conclusion

Although currently not an universal practice, substitution of "DM on insulin" with HbA1C:Hemoglobin ratio in RCRI score improves the accuracy of the RCRI risk prediction model in diabetic patients going for non-cardiac surgery.

Eye disorders other than diabetic retinopathy in patients with diabetes

AIM

While diabetic retinopathy is the most specific complication of chronic hyperglycaemia, numerous other ocular conditions also can involve the eyes of people with diabetes. Cataract, glaucoma, age-related macular degeneration, retinal vascular occlusion, and acute ischaemic optic neuropathy combine to impair vision in people with diabetes, especially when they are old. This report provides a critical analysis and an overview of the current knowledge of the main ocular disorders (excluding diabetic retinopathy) and their association in patients with diabetes.

METHODS

A literature search strategy was conducted for all English-language literature with a systematic review of key references until 2021.

RESULTS

Patients with diabetes have a high-to-moderate increased risk for most of the usual ocular disorders we reviewed with the exception of age-related macular degeneration. Exposure to chronic hyperglycaemia promotes the development of many eye disorders while acute glucose changes are involved in refractive disorders, diabetic papillopathy and acute cataract.

CONCLUSION

Diabetes, beyond diabetic retinopathy, increases the risk of numerous eye disorders leading to low vision with implications for daily diabetes management. Even in the absence of clearly demonstrated benefit from glucose control in all eye conditions, achieving good glycaemic control and adherence to diabetes treatment will likely help avoid an additional risk of visual impairment in people with diabetes. In perspective, interesting findings suggesting a preventive effect of metformin use on age-related macular degeneration occurrence justify further studies.

A prospective observational prevalence study of elevated HbA1c among elective surgical patients

Type 2 Diabetes Mellitus (DM) is a chronic disease with high prevalence worldwide. Using glycated haemoglobin (HbA1c) as a surrogate for potential pre-DM and DM conditions, our primary objective was to determine the HbA1c epidemiology in non-cardiac elective surgical patients in Singapore. Our secondary aim was to identify risk factors associated with elevated HbA1c. We conducted a prospective, observational single-centre study in adult patients. HbA1c screening was performed. Patient demographics and comorbidities were recorded. Patients were divided into those with HbA1C ≤ 6.0% and HbA1C ≥ 6.1%. Regression analyses were performed to identify associated factors. Subgroup analysis was performed comparing patients with HbA1C ≥ 6.1% and HbA1C ≥ 8.0%. Of the 875 patients recruited, 182 (20.8%) had HbA1c ≥ 6.1%, of which 32 (3.7%) had HbA1c ≥ 8%. HbA1C ≥ 6.1% was associated with Indian ethnicity [1.07 (1.01–1.13), p = 0.023], BMI > 27.5 [1.07 (1.02–1.11), p = 0.002], higher preoperative random serum glucose [1.03 (1.02–1.04), p < 0.001], pre-existing diagnosis of DM [1.85 (1.75–1.96), p < 0.001] and prediabetes [1.44 (1.24–1.67), p < 0.001], and peripheral vascular disease [1.30 (1.10–1.54), p = 0.002]. HbA1c ≥ 8% had an additional association with age > 60 years [0.96 (0.93–0.99), p = 0.017]. The prevalence of elevated HbA1c is high among the surgical population. Targeted preoperative HbA1c screening for at-risk elective surgical patients reduces cost, allowing focused use of healthcare resources.

Comparison of Endothelial Cell Density, Morphological Changes and Central Corneal Thickness after Phacoemulsification between Diabetic and Non-Diabetic Patients

Background:

Corneal endothelial tissues are susceptible to mechanical trauma from ultrasound energy during phacoemulsification. Several studies have reported various results of phacoemulsification effect on corneal endothelial cells between diabetic and non-diabetic patients.

Purpose:

To compare endothelial density, hexagonality, Coefficient of Variance (CV) and Central Corneal Thickness (CCT) changes between diabetic and non-diabetic patients at four weeks after phacoemulsification.

Methods:

Specular microscopy examinations prior to phacoemulsification and at four-weeks after phacoemulsification were performed on diabetic and non-diabetic groups with cataract. Later, patients in the diabetic group were divided based on their HbA1c level. The changes in endothelial density, the percentage of hexagonality, CV and CCT were evaluated.

Results:

At a four-weeks follow up, there were no statistical differences in endothelial cells density, CV and CCT changes between diabetic and non-diabetic groups. Mean (SD) of hexagonality percentage at four weeks of follow-up was lower (p-value=0.001) in diabetic group [(14.6) 41.7%] compared to non-diabetic group [(14.5) 50.1%]. There were no differences in endothelial cells density, hexagonality, CV and CCT values between the diabetic group with HbA1c level <7.5% and HbA1c level ≥7.5% at 4-weeks after phacoemulsification.

Conclusion:

There were no statistically significant differences in the endothelial loss, reduction of CV and CCT changes between the diabetic and non-diabetic group at four-weeks follow up after phacoemulsification. Diabetic group showed greater hexagonality decrease compared to non-diabetic group at four weeks after phacoemulsification. Different HbA1c levels did not affect the changes in endothelial density, the percentage of hexagonality, CV and CCT after phacoemulsification.

Prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy: The DIabetes and CATaract study

BACKGROUND

The purpose of this study is to determine the prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy.

METHODS

It is a prospective, multicenter, cross-sectional study. Thirteen ophthalmic units equally distributed across the Italian territory have been involved in the study. For a period of 3 months, all subjects undergoing phacoemulsification received an Optical Coherence Tompgraphy (OCT) scan and were screened for the anamnestic presence of diabetes. In addition, five selected units collected blood samples from all their patients to measure glycated hemoglobin (HbA1c) levels and detect the presence of occult diabetes (HbA1c > 6.5%). In diabetic patients, levels of retinopathy were measured and diabetic macular edema was considered significant (clinically significant macular edema) when foveal thickness was above 30% of normal levels.

RESULTS

A total number of 3657 subjects have been screened. Among them, 20.4% were diabetics. Prevalence of diabetes was significantly higher in males (24.7%) than in females (17%). Levels of HbA1c were tested in a representative sample of 1216 consecutive subjects, and occult diabetes was diagnosed in 4.8% of cases. No significant differences were observed between age groups or different geographic areas. Among diabetic patients, diabetic macular edema of any kind was present in 27.5% (clinically significant macular edema (6.6%)). No significant differences were seen in the prevalence of diabetic macular edema between males and females or between age groups. Among the 745 diabetic patients, no signs of retinopathy were seen in 537 subjects (76.3%), while 101 patients (14.3%) had nonproliferative retinopathy, 13 (1.7%) had nontreated proliferative diabetic retinopathy, and 53 (7.5%) had laser-treated retinopathy. In the entire sample of 3657 subjects, a normal macula was present in 90.9% of cases, diabetic macular edema of any kind in 5.4%, and other maculopathies in 3.4%.

CONCLUSION

In this large cohort study on patients undergoing cataract surgery, more than one-fourth were diabetics and more than one-fourth of these had diabetic macular edema. These high prevalences suggest the opportunity to plan an adequate preoperative assessment in all patients in order to reduce the risk of postoperative development or worsening of a sight-threatening complication such as chronic diabetic macular edema.

Hematological profile associated with type 2 diabetes mellitus

BACKGROUND

Hematological changes affecting blood cells and the coagulation factors are shown to be associated with diabetes mellitus. We investigated some of the hematological risk factors implicated in the development of type 2 diabetes mellitus.

METHODS

The study conducted in western Algeria on a sample of 1852 subjects, 1059 with type 2 diabetes and 793 witnesses, were evaluated for peripheral blood parameters using hematology analyzer. All the informations related to the disease were collected from the patients and recorded using predesigned questionnaire.

RESULTS

The logistic model retained, the mean corpuscular hemoglobin concentration reveals that subjects with concentration over the normal ratio (>36 g/dl) have an exposure risk six and half times higher than subjects with normal concentration (OR = 6.59; 95% CI = 2.51-17.31, P = 0.000). As regards to the platelets blood ratio, subjects with a ratio lower are five times more exposed to type 2 diabetes compared to subjects with a normal ratio (OR = 5.01; 95% CI = 1.78-14.13, P < 0.002). Our logistic model also retained basophils ratio (OR = 2.18; 95% CI = 1.35-3.53, P < 0.001) and sedimentation rate at one hour (OR = 7.83; 95% CI = 3.39-18.06, P = 0.000).

CONCLUSIONS

Hematological profile associated with type 2 diabetes mellitus retained the mean corpuscular hemoglobin concentration over the normal ratio, lower platelets blood ratio, basophils ratio and sedimentation rate at one hour.

Predictive factors of visual outcome of Malaysian cataract patients: a retrospective study

AIM

To explore the associations between various characteristics of Malaysian cataract patients and their management, and their post-operative visual outcomes, to inform relevant bodies to reduce cataract-related blindness.

METHODS

We conducted a descriptive secondary data analysis of cataract surgery patients in Melaka Hospital, from 2007 to 2014 using the National Eye Database (NED). Patient-related factors (demographic features, systemic and ocular comorbidities) and management-related factors (surgical duration, type of surgery, type of lens) were analysed for their association with visual outcome (acuity).

RESULTS

Most patients were Malays (48.23%) and Chinese (38.55%) aged 60-79y (range 0-100y). Hypertension (58.61%) and diabetes (44.89%) were major systemic comorbidities. Glaucoma (6.71%) and diabetic retinopathy (10.12%) were the main ocular comorbidities. Other comorbidities were age-related macular degeneration, pterygium, corneal opacities, macula diseases, vitreous haemorrhage, retinal detachment and pseudoexfoliation (0.70%-1.60%). Preoperatively 7150 (55.03%) eyes presented with poor vision. Uncomplicated phacoemulsification performed quickly with foldable lenses gave good results.

CONCLUSION

Primary care physicians should initiate early detection to prevent late presentation of cataracts causing poor vision and should discuss the risks and benefits of cataract surgery while emphasizing the role of pre-existing comorbidities which may affect the visual outcomes. For good results, phacoemulsification should be done within 30min, without complications, using foldable posterior chamber intraocular lens.