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Short-Term Effect of Metabolic Control on Diabetic Macular Edema and Serum Cytokine Levels in Diabetic Patients with Unregulated Blood Glucose

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First Author: E.Tinkir Kayitmazbatir TURKEY

Co Author(s):    G. Bitirgen   G. Satirtav   I. Kilinc   M. Kulaksizoglu   B. Savut   H. Kerimoglu     

Abstract Details

Purpose:

To evaluate the short-term effect of metabolic control on diabetic macular edema (DME) and to assess the relation between HbA1c, serum cytokine levels and macular response to treatment in diabetic patients with unregulated blood glucose.

Setting:

This prospective study was undertaken at the Department of Ophthalmology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.

Methods:

Forty-three subjects with type 2 diabetes mellitus, having HbA1c levels greater than 7% (53 mmol/mol) and having DME detected by optical coherence tomography were included in the study. Patients were grouped according to the best corrected visual acuity (BCVA); Group 1 worse than 0,10 LogMAR, and Group 2 equal or better than 0,10 LogMAR. Group 1 was treated with 3 doses of intravitreal ranibizumab injections at monthly intervals and Group 2 was followed without local treatment. Serum cytokine levels (IL-1β, IL-6, IL-8, TNF-α, MCP-1, VEGF) of all patients were analyzed with ELISA at baseline and at 3 months.

Results:

A statistically significant decrease in HbA1c levels was observed in both groups of patients after 3 months follow-up period with improved metabolic control. Macular thickness was significantly decreased in Group 1 and did not change in Group 2 at the end of 3 months. Changes in serum cytokine levels in both groups during follow-up period were not correlated with HbA1c change. Serum vascular endothelial growth factor (VEGF) levels were significantly increased in both groups despite the decrease in HbA1c.

Conclusions:

It is possible to lower HbA1c levels by metabolic control, but metabolic control alone has limited value in the treatment of DME at 3 months period. The therapeutic effect of anti-VEGF treatment on DME supports the role of local cytokine milieu in pathophysiology rather than the systemic cytokine levels.

Financial Disclosure:

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