Association between Glucose

JOURNAL Levels and

READING Intraocular Pressure: Pre- and
Postprandial Analysis in
SUPERVISOR: Diabetic and Nondiabetic Patients
dr. Siti Farida ITSW, Sp.M (K)

Komang Septian Trisna Jaya – H1A012028

DEPARTMENT OF OPTHALMOLOGY - WEST NUSA TENGGARA PROVINCIAL HOSPITAL

2017
Outline Presentation

Journal Journal
Introduction Methods Results Discussion Conclusions
identity Analyses
Journal Identity

AUTHORS Luis GuilhermeMilesi Pimentel, Carolina P. B. Gracitelli, Leticia

Sant’Ana Cardoso da Silva, Aline Katia Siqueira Souza, and Tiago
Santos Prata.

TITLE Association between Glucose Levels and Intraocular

Pressure: Pre- and Postprandial Analysis in Diabetic and
Nondiabetic Patients

Hindawi Publishing Corporation, Journal of Ophthalmology

PUBLISHER Volume 2015, Article ID 832058
http://dx.doi.org/10.1155/2015/832058
Background

Glaucoma
optic neuropathy characterized by progressive degeneration of retinal
ganglion cells (RGCs) and their axons, resulting in changes in the
appearance of the optic disc and visual field loss

Glaucoma is a multi-factorial Disease

elevated intraocular pressure (IOP) remains its major known risk
factor
Background

IOP can be influenced by different systemic factors

Atherosclerotic BMI HYPERTENSION Diabetic

Diseases
Background

 Although diabetes is associated with higher IOP values in most

studies, the underlying mechanisms are still unclear.
 It is not known whether variations in glucose levels could lead to
IOP changes in diabetic and nondiabetic individuals.

This Research
determine the relationship between glucose levels variation and IOP
fluctuation in diabetic and nondiabetic patients.
Methods

Prospective observational study

Approved by the Institutional Review Board of the Federan University of
Sao Paulo
According to the tenets of the Declaration of Helsinki

written informed consent was obtained from all participants.

Patients

37 patients

31%
69%
17 nondiabetic 20 diabetic

All participants underwent a complete ophthalmological

examination including review of medical history, best-
corrected visual acuity, slit-lamp biomicroscopy, IOP
measurement, gonioscopy, dilated funduscopic examination,
and refraction
Exclusion criteria
 glaucoma diagnosis or ocular hypertension
 corneal opacity or irregularities that could alter the
ophthalmological examination
 refractive error greater than ±5D spherical or cylindrical greater than
±3D
 and central corneal thickness (based on ultrasound pachymetry)
above 600 microns or below 450 microns
Diabetes was defined
according to self reported
physician diagnosis, and all
diabetic patients were
under medical treatment
Healthy subjects were recruited
from the general population or
from spouses and relatives of
diabetic patients. They were
defined as self-reported history
of normal glucose level in the
past two years.
Methods

Capillary Glucose Testing

1
baseline measurements
glucose (fasting for
exactly 8 hours, i.e., after
overnight fasting)
2 postprandial
measurements glucose
(exactly 2 hours after the
meal, i.e., after lunch time)

The measurement of capillary glucose

was performed by collecting blood from
the patient’s finger, pierced through
the skin by a lancet and checked with
an automated device.
Methods

Intraocular Pressure Assessment

IOP was measured in both eyes (i.e.,

fasting for exactly 8 hours and exactly
2 hours after lunch time) of each
patient by Goldmann tonometry
applanation
Methods

Statistical Analysis

 Descriptive statistics included mean and standard deviation values

for normally distributed variables.
 Paired 𝑡-test was used for comparison of IOP values between each
time point (baseline and postprandial).
 The association between changes in glucose levels and IOP variation
was investigated using univariable and multivariable regression
analyses.
 All statistical analyses were performed with commercially available
software (Stata, version 13; StataCorp LP, College Station, TX, USA).
The 𝛼 level (type I error) was set at 0.05
Results
Results

 Postprandial glucose levels were significantly higher than

baseline measurements in both diabetic (mean increase of
62mg/dL; 𝑃 = 0.005) and nondiabetic patients (mean increase of
31.5mg/dL; 𝑃 = 0.015).

Postprandial IOP was significantly higher

than baseline IOP in diabetic (17.8 ± 0.80
versus 15.5 ± 0.55mmHg; 𝑃 <0.001) and
nondiabetic patients (15.9 ± 0.77 versus 14.3
± 0.72mmHg; 𝑃 = 0.006).
Results

 the magnitude of glucose level change remained significantly

associated with IOP variation (𝑃 < 0.001)
Results

 In addition, there was a

strong correlation
between the IOP
variation in right eye
and IOP variation in the
left eye (𝑅2= 0.826).
Discussion
Barbados Eye Study
Documented that the presence of diabetes, among
other factors such as systolic blood pressure and
age, was positively correlated with higher IOP
values
Blue Mountain Eye Study
exploring the relationship between diabetes and
open-angle glaucoma, the authors found that
glaucoma prevalence was higher in diabetic
patients compared to those without diabetes
Larsen et al
found lower IOP values during
severe hypoglycemia
Traisman et al
assessing IOP in patients with
blood glucose values under and
above 200mg/dL, observed
higher IOP values in those with
glucose levels above 200mg/dL
(mean difference of 1.3mmHg)
Discussion

 none of these studies sought to determine the association

between the magnitude of glucose levels variation and IOP
change in diabetic and nondiabetic patients.
 In this research, found a mean IOP increase of 2.3 and
1.6mmHg in diabetic and nondiabetic patients, respectively,
during the postprandial period.
Discussion

Effect glucose levels on IOP

Several hypotheses

Genetic Factors Autonomic dysfunction Gradient Osmotic change

Leads to fluid shifts into the

intraocular space
Discussion

 Glycemic levels variation may influence IOP change and is

therefore relevant for diagnosis and treatment
management, in diabetic or non diabetic patients.
 Clinicians should consider the patient’s glycemic status and
glucose level variations concurrently with IOP values
assessment in certain cases, especially in diabetic patients
using, for example, peripheral capillary blood as a screening
for glucose level variations
Discussion

Limitations of the present study

it is limited by its small The study did not correlate the
1 4
sample size duration of diabetes and IOP
glucose levels were assessed
2 5 peripheral capillary blood is used for the
solely twice (baseline and
glucose analysis. However, different
postprandial)
studies showed evidences that
peripheral capillary blood and venous
3 the investigation of other
(antecubital fossa) blood samples could
systemic comorbidities by
be comparable and can have similar
means of questionnaire may
influence after meal
have been insufficient.
Discussion

 In addition, further studies should be done to evaluate the

causative relationship between glucose levels and IOP
variation.
 however, IOP variation could have been affected by different
factors other than glucose levels.
 Therefore, longitudinal studies should help us to better
understand the connection between these two variations.
Conclusion
There is a significant association between blood glucose levels and IOP values,
especially in diabetic patients. Postprandial IOP seems to be significantly higher in
these patients compared to baseline values, revealing a strong association with the
magnitude of glucose level increase. This fact should be considered while assessing
IOP values and fluctuation especially in diabetic patients.
 Topic Information Explanation

Title and Abstract a. Describes objectives, a. Yes, the abstracts of the journal have clerly defined
methods, research results and objectives, methods, and research results and conclusions.
conclusions b. The information presented in the abstract is clear and
b. Provide an informative and complete summary and in accordance with the results
balanced summary of what is obtained in the study.
done and what is found
Background Explain the scientific and rational Yes, on the background explain why this research needs to be done
background why research needs to because some systemic factors can affect intraocular pressure
be done (IOP), one of them is diabetic. It is not yet known whether
variations in glucose levels can cause changes in IOP in
individuals with diabetes and nondiabetes.
Aim Determine the specific aim, Yes, this journal suggests that the aim of the study was to evaluate
including the proposed hypothesis the relationship between glucose levels and increased intraocular
pressure (IOP) in diabetic and nondiabetic patients.
Population Describe how the population is No, this study does not explain the population used in the study.
determined
 Topic Information Explanation

Research subject Criteria of research subjects The study explains the subjects used are patients who come
to undergo complete ophthalmological examination
(including IOP examination), with clear explanation about
exclusion criteria. In addition, the journal also explains how
to determine the population of diabetes and nondiabetes.

Sample Size Explain the minimum sample No, this journal does not mention clerly the criteria for
determination criteria needed to determining the sample size, the sampling method.
generate research strength as
well as sampling technique.

Research procedure Describes in detail and Yes, the research described research procedures that start
systematic research procedures from the determination of subjects, variables and data
(data collection techniques) analysis.

Research design Explain the research design No, this study does not clerly explain the research design
undertaken.
 Topic Information Explanation

Data analysis techniques Data analysis techniques used to compare Yes, in this research the data obtained are done by some data analysis ie
the results of research paired t-test, nonparametric test for the variable which is not normal
distribution, and regression analysis.

Research time Explain the time of the research No, this study does not explain the timing of the research conducted.

Outcome research For outcome of research result The results of the research are described descriptively and in the form of
tables and curves.
Interpretation Interpretation of the results Interpretation of results in this study was also compared with previous studies
that have related topics.
Generalizability What results can be generalized in the The results of this study can be generalized in the community although it still
community needs further research to improve the research limitations.

Overall evidence General interpretation of results in the This research has been good enough to describe the results descriptively,
context of research tables and curves. This study also compares with other research results that
have relevance to the topic. This study can also show a significant
relationship between blood glucose levels and IOP values, especially in
diabetic patients.
Strength

1. The title of the journal is interesting enough to make the reader interested to
read the journal.
2. The title and abstract provide a clear and informative description of the
research for the reader.
3. The background and objectives of the study are clerly defined for the reader.
4. Journal explain clear research procedures.
5. This journal provides information about the relationship between glucose levels
with the value of IOP so that it can add knowledge to pay more attention to
patients who come to do eye examination with history of diabetic.
6. In the journal is presented advantages and disadvantages of research, so that it
can be used as a reference in further research.
Weakness

1. This journal does not mention how to determine the sampling and sampling
method.
2. This journal explains the presence of confounding factors such as age,
heredity, and gender in their influence on IOP, but is not explained more in the
discussion.
3. In the results of the study also show the correlation between the variation of
IOP in the right eye and the variation of IOP in the left eye, but not described
more detail in the discussion.
4. More sample is required so that it adds more discussion.
5. Some of the sources used in the study have a published year which is
considered less up-to-date, i.e. under the year 2000.
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