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Pathophysiology/Complications
Original research
Visual impairment and mortality in patients with type 2 diabetes
  1. Volkert Siersma1,
  2. Rasmus Køster-Rasmussen RKR1,
  3. Christine Bruun1,
  4. Niels de Fine Olivarius MD, BS1,
  5. Audun Brunes2
  1. 1 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  2. 2 Section for Trauma, Catastrophes and Forced Migration–Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
  1. Correspondence to Dr Audun Brunes; audun.brunes{at}nkvts.no

Abstract

Objective To evaluate whether visual acuity impairment was an independent predictor of mortality in patients with type 2 diabetes.

Research design and methods This is a 19-year follow-up of a cohort of 1241 patients newly diagnosed with type 2 diabetes and aged 40 years or over. Visual acuity was assessed by practicing ophthalmologists both at diabetes diagnosis and after 6 years. The logarithmic value of the visual acuity (logMAR) was the exposure. Multivariable Cox regression models were adjusted for multiple potential confounders including cardiovascular disease, and censored for potential mediators, that is, fractures/trauma. Primary outcomes were from national registers: all-cause mortality and diabetes-related mortality.

Results Visual impairment at diabetes diagnosis was robustly associated with subsequent 6-year all-cause mortality. Per 1 unit reduced logMAR acuity the incidence rate of all-cause mortality increased with 51% (adjusted HR: 1.51; 95% CI 1.12 to 2.03) and of fractures/trauma with 59% (HR: 1.59; 95% CI 1.18 to 2.15), but visual acuity was not associated with diabetes-related mortality. After censoring for fractures/trauma, visual acuity was still an independent risk factor for all-cause mortality (HR: 1.68; 95% CI 1.23 to 2.30). In contrast, visual acuity 6 years after diabetes diagnosis was not associated with the subsequent 13 years’ incidence of any of the outcomes, as an apparent association with all-cause mortality and diabetes-related mortality was explained by confounding from comorbidity.

Conclusions Visual acuity measured by ophthalmologists in patients newly diagnosed with type 2 diabetes was an independent predictor of mortality in the short term.

  • vision impairment
  • mortality
  • type 2 diabetes

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2018-000638

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    Footnotes

    • Contributors VS, AB and NdFO developed the research question and wrote the protocol for this follow-up study. NdFO was responsible for the original study design and data collection. NdFO and VS were responsible for data collection from the registries. VS performed the statistical analyses. All authors made substantial contributions to the analysis and interpretation of data. The paper was written by VS, AB, RKR and CB, and revised by NdFO critically for important intellectual content. NdFO obtained funding and is the guarantor of the study. All authors have approved the final version of the manuscript.

    • Funding This work was supported by grants from The Danish Medical Research Council, The Danish Research Foundation for General Practice, The Danish Ministry of Health, The Health Insurance Foundation, The Pharmacy Foundation and the Novo Nordisk Farmaka Denmark.

    • Competing interests NdFO reports grants from The Danish Medical Research Council, grants from The Danish Research Foundation for General Practice, grants from The Danish Ministry of Health, grants from The Health Insurance Foundation, grants from The Pharmacy Foundation and grants from the Novo Nordisk Farmaka Denmark, during the conduct of the study.

    • Patient consent for publication Not required.

    • Ethics approval The approval of the study by the Copenhagen and Frederiksberg Research Ethics Committee (V.100.869/87) included that oral informed consent was mandatory for all patients.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

    • Author note Part of the study data are from a clinical trial of diabetes patients (the DCGP Study) while another part is provided by a third party. SAMBA is a unit at Copenhagen University that stores and shares data from epidemiological research in general practice. Anonymized data from the DCGP study can be provided through application to SAMBA by presenting a methodologically sound study protocol and statistical analysis plan. Interested researchers can contact the SAMBA coordination group at tjs657{at}sund.ku.dk with request for DCGP study data.