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MON-704 Tear Glands and the Diabetic Patient: Is It a Biomarker?

Background: Tear glands in the eyelids, meibomian glands, play a role in tear film production and tear film stabilization. Diabetic patients often complain of dry eye and eye pain. Recently, there are new infrared (820nm) photography techniques to image meibomian glands easily in patients. Purpose:...

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Autores principales: Momen, Donia, Wu, Gloria, Luu, Shannon, Leung, Brian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209450/
http://dx.doi.org/10.1210/jendso/bvaa046.678
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author Momen, Donia
Wu, Gloria
Luu, Shannon
Leung, Brian
author_facet Momen, Donia
Wu, Gloria
Luu, Shannon
Leung, Brian
author_sort Momen, Donia
collection PubMed
description Background: Tear glands in the eyelids, meibomian glands, play a role in tear film production and tear film stabilization. Diabetic patients often complain of dry eye and eye pain. Recently, there are new infrared (820nm) photography techniques to image meibomian glands easily in patients. Purpose: To study meibomian glands in diabetic patients with dry eye. Methods: A retrospective chart review (2017-2019) of Type 2 Diabetes Mellitus (T2DM) patients and non-diabetic patients with the diagnosis of “dry eye” in EHR (eClinicalworks, Westborough, MA) was performed. Infrared eyelid imaging (820 nm wavelength, Heidelberg Spectralis, Heidelberg, Germany) was taken. T2DM: Inclusion criteria: 1) HbA1c of > 5.7% who also had infrared eyelid imaging performed + 4 weeks of their HbA1c lab test results; 2) the percentage loss of meibomian glands for each eye, then averaged, for each patient. Control: Inclusion criteria: 1) non-diabetic patients; 2) HbA1c lab test results; 3) infrared eyelid imaging was performed; 4) percentage loss of meibomian glands was calculated for each eye, then averaged per patient. Exclusion criteria for both T2DM and Controls: younger than the age of 18 years old, older than 90 years old, no glaucoma topical medications, no eyelid surgery, no corneal surgery, no conjunctival surgery. Results: n=120 patients, Avg Age=69.6 years (sd=15.1, range 23-89 years). Diabetic patients: n=60 patients, Male=30, Female=30, Avg Age=65.1 years (sd=11.50, med=65.5, range 36-85 years). Controls: n=60 patients, Male=37, Female=23, Avg Age=54.1 years (sd=16.4, med=56.5, range 23-89 years). Meibomian gland loss: Diabetics=51.54%, Controls=11.29% (p<0.0001, t-test). Of the 60 DM patients: 35/37pts with HbA1c > 6.6% had greater loss of meibomian glands (>40%), compared to 12/23 DM patients with HbA1c < 6.5%, p=0.0001. Discussion: Loss of meibomian glands in diabetic patients have been recently investigated; however, its relationship to HbA1c as a possible biomarker has not been widely discussed in literature. In this small study, loss of meibomian glands occur more frequently with elevated HbA1c, perhaps due to microischemia of the eyelids, thereby resulting in loss of meibomian glands. Conclusion: Loss of meibomian glands may suggest a need for HbA1c testing and further monitoring of the patient’s diabetic condition. Infrared imaging of the eyelid may be useful in characterizing dry eye in diabetic patients.
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spelling pubmed-72094502020-05-13 MON-704 Tear Glands and the Diabetic Patient: Is It a Biomarker? Momen, Donia Wu, Gloria Luu, Shannon Leung, Brian J Endocr Soc Diabetes Mellitus and Glucose Metabolism Background: Tear glands in the eyelids, meibomian glands, play a role in tear film production and tear film stabilization. Diabetic patients often complain of dry eye and eye pain. Recently, there are new infrared (820nm) photography techniques to image meibomian glands easily in patients. Purpose: To study meibomian glands in diabetic patients with dry eye. Methods: A retrospective chart review (2017-2019) of Type 2 Diabetes Mellitus (T2DM) patients and non-diabetic patients with the diagnosis of “dry eye” in EHR (eClinicalworks, Westborough, MA) was performed. Infrared eyelid imaging (820 nm wavelength, Heidelberg Spectralis, Heidelberg, Germany) was taken. T2DM: Inclusion criteria: 1) HbA1c of > 5.7% who also had infrared eyelid imaging performed + 4 weeks of their HbA1c lab test results; 2) the percentage loss of meibomian glands for each eye, then averaged, for each patient. Control: Inclusion criteria: 1) non-diabetic patients; 2) HbA1c lab test results; 3) infrared eyelid imaging was performed; 4) percentage loss of meibomian glands was calculated for each eye, then averaged per patient. Exclusion criteria for both T2DM and Controls: younger than the age of 18 years old, older than 90 years old, no glaucoma topical medications, no eyelid surgery, no corneal surgery, no conjunctival surgery. Results: n=120 patients, Avg Age=69.6 years (sd=15.1, range 23-89 years). Diabetic patients: n=60 patients, Male=30, Female=30, Avg Age=65.1 years (sd=11.50, med=65.5, range 36-85 years). Controls: n=60 patients, Male=37, Female=23, Avg Age=54.1 years (sd=16.4, med=56.5, range 23-89 years). Meibomian gland loss: Diabetics=51.54%, Controls=11.29% (p<0.0001, t-test). Of the 60 DM patients: 35/37pts with HbA1c > 6.6% had greater loss of meibomian glands (>40%), compared to 12/23 DM patients with HbA1c < 6.5%, p=0.0001. Discussion: Loss of meibomian glands in diabetic patients have been recently investigated; however, its relationship to HbA1c as a possible biomarker has not been widely discussed in literature. In this small study, loss of meibomian glands occur more frequently with elevated HbA1c, perhaps due to microischemia of the eyelids, thereby resulting in loss of meibomian glands. Conclusion: Loss of meibomian glands may suggest a need for HbA1c testing and further monitoring of the patient’s diabetic condition. Infrared imaging of the eyelid may be useful in characterizing dry eye in diabetic patients. Oxford University Press 2020-05-08 /pmc/articles/PMC7209450/ http://dx.doi.org/10.1210/jendso/bvaa046.678 Text en © Endocrine Society 2020. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Diabetes Mellitus and Glucose Metabolism
Momen, Donia
Wu, Gloria
Luu, Shannon
Leung, Brian
MON-704 Tear Glands and the Diabetic Patient: Is It a Biomarker?
title MON-704 Tear Glands and the Diabetic Patient: Is It a Biomarker?
title_full MON-704 Tear Glands and the Diabetic Patient: Is It a Biomarker?
title_fullStr MON-704 Tear Glands and the Diabetic Patient: Is It a Biomarker?
title_full_unstemmed MON-704 Tear Glands and the Diabetic Patient: Is It a Biomarker?
title_short MON-704 Tear Glands and the Diabetic Patient: Is It a Biomarker?
title_sort mon-704 tear glands and the diabetic patient: is it a biomarker?
topic Diabetes Mellitus and Glucose Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209450/
http://dx.doi.org/10.1210/jendso/bvaa046.678
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