As the number of people with diabetes rises worldwide, a pair of studies in JAMA Ophthalmology finds that being idle is strongly tied to having diabetic retinopathy (DR), while people fear vision loss as much or more than losing hearing, speech, memory, or a limb.
Paul D. Loprinzo, PhD, of the University of Mississippi, examined data from the National Health and Nutrition Examination Survey (NHANES) and found a connection between sedentary behavior and DR, based on assessments from 2005 and 2006 involving 282 participants with diabetes.1 Those in the study wore an accelerometer to track whether they were moving. The average age of participants was 62.
In a letter to the journal, Loprinzo reports that for every 1 hour daily increase in sedentary behavior, participants increased their odds of having mild or worse DR by 16%. Total physical activity was not associated with DR, which suggests that extended periods with no activity are unhealthy.
“The plausibility of thie positive association between sedentary behavior and diabetic retinopathy may, in part, be a result of the increased cardiovascular risks associated with sedentary behavior, which in turn may increase the risk of DR,” Loprinzi writes. While the association was observed, showing a direct cause-and-effect relationship would require interventional trials, he wrote.
Diabetic macular edema and related eye diseases: the cost burden
About 29 million Americans have diabetes, with the vast majority diagnosed with type 2 diabetes, a condition strongly associated with obesity. Both conditions are rising worldwide, with the most recent estimate from the World Health Organization putting the number with diabetes at 422 million. The most recent estimate of the burden of diabetes in the United States found healthcare and lost productivity cost $245 billion a year.
Changes in diet, lifestyle, and urbanization have all been blamed for this twin epidemic, which is overwhelming health systems around the globe. In the United States, an estimated $1 of every $3 spent in Medicare stems from diabetes.
Diabetic retinopathy and diabetic macular edema are among the worst complications associated with diabetes. A panel convened earlier this year by The American Journal of Managed Care found that many patients with diabetes do not fully understand the risks, and screening falls short of where it should be to prevent progression of eye disease.
This persists despite the fact that patients fear vision loss. A separate survey in the same issue explored patient fears of vision loss relative to other health outcomes. Adrienne W. Scott, MD, of Johns Hopkins University and colleagues examined responses from 2044 US adults, with an average age of 46.2 The group was 48% male, and 11% were uninsured. Among them 63% already wore glasses. The survey found that:
· 88% believed good vision is vital to overall health.
· 47% believed losing vision was the worst possible health outcome.
· Quality of life concerns topped the list of fears associated with vision loss.
However, as experts on the AJMC panel reported, while 66% of respondents were aware of cataracts and 63% knew about glaucoma, 25% were not aware of any eye conditions. Only half were aware of how smoking can cause vision loss, and only half were aware of macular degeneration.
Authors said the findings show vision loss matters to patients, even if they are not precisely aware of conditions that can cause it. “The findings underscore the importance of good eyesight to most and that having good vision is key to one’s overall sense of well-being,” they wrote.
See the full Peer Exchange: Diabetic Complications, a Focus on Diabetic Macular Edema
1. Loprinzi PD. Association of accelerometer-assessed sedentary behavior with diabetic retinopathy in the United States [published online August 4, 2016]. JAMA Opthalmol. 2016; doi:10.1001/jamaophthalmol.2016.2400.
2. Scott AW, Bressler NM, Folkes SF, Wittenborn JS, Jorkasy J. Public attitudes about eye and vision health [published online August 4, 2016]. JAMA Opthalmol. doi:10.1001/jamaophthalmol.2016.2627.