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Impact of treatment cessation on incidence and progression of retinopathy in Japanese patients with type 2 diabetes mellitus: a retrospective cohort study

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Abstract

Aims

This cohort study investigated the association between treatment cessation and incidence/progression of diabetic retinopathy (DR) in Japanese patients with type 2 diabetes mellitus (T2DM).

Materials and methods

Data were extracted from electronic medical records at the University of the Ryukyu Hospital and the Tomishiro Central Hospital of Okinawa, Japan. We enrolled 417 diabetic patients without DR (N = 281) and with nonproliferative DR (N = 136) at the baseline. Treatment cessation was defined as failing to attend outpatient clinics for at least twelve months prior to the baseline. After a median follow-up of 7 years, we compared the incidence/progression rate of DR including nonproliferative and proliferative DR between patients with and without treatment cessation and calculated the odds ratio (OR) in the treatment cessation group using a logistic regression model.

Results

The overall prevalence of treatment cessation was 13% in patients with T2DM. Characteristics of treatment cessation included relative youth (57 ± 11 years vs. 63 ± 12 years, P < 0.01). Treatment cessation was tightly associated with the incidence of DR (OR 4.20 [95% confidence interval [CI] 1.46–12.04, P < 0.01) and also incidence/progression of DR (OR 2.70 [1.28–5.69], P < 0.01), even after adjusting for age, sex, BMI, duration of T2DM, and HbA1c level.

Conclusions

By considering major confounding factors, the present study demonstrates an independent association between treatment cessation and incidence of DR in patients with T2DM, highlighting treatment cessation as an independent risk for DR in T2DM.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

This work was supported in part by Council for Science, Technology and Innovation (CSTI), Cross-Ministerial Strategic Innovation Promotion Program (SIP), “Technologies for Creating Next-Generation Agriculture, Forestry and Fisheries,” New Energy and Industrial Technology Development Organization (NEDO), and Construction of the Okinawa Science & Technology Innovation System. We are also grateful to T. Ikematsu, M. Hirata, and C. Noguchi for excellent secretarial assistance.

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Author notes

  1. Yukiko Shinzato and Yoshiro Nakayama contributed equally to this work.

Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Nakagami, Okinawa, 903-0215, Japan

    Yukiko Shinzato, Yoshiro Nakayama, Shiki Okamoto, Jasmine F. Millman, Tsugumi Uema, Ken-ichiro Honma, Atsuko Tamaki, Moriyuki Uehara, Taiki Teruya, Takamitsu Yabiku, Yohei Ishiki, Ken Yonaha & Hiroaki Masuzaki

  2. Department of Ophthalmology, Tomishiro Central Hospital, 25 Ueda, Tomigusuku, Okinawa, 901-0243, Japan

    Ko-ichiro Arakaki

  3. Department of Diabetes and Life-Style Related Disease Center, Tomishiro Central Hospital, 25 Ueda, Tomigusuku, Okinawa, 901-0243, Japan

    Moritake Higa

  4. Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan

    Hideki Koizumi

  5. Department of Public Health and Hygiene, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan

    Koshi Nakamura

  6. Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan

    Michio Shimabukuro

Authors
  1. Yukiko Shinzato
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  8. Moriyuki Uehara
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  11. Yohei Ishiki
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  18. Hiroaki Masuzaki
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Contributions

All authors contributed to the study’s conception and design. Material preparations were performed by Yoshiro Nakayama, Moritake Higa, Hideki Koizumi, Michio Shimabukuro, and Hiroaki Masuzaki, data collections were performed by Yoshiro Nakayama and Moritake Higa, and analyses were performed by Yukiko Shinzato, Yoshiro Nakayama, Tsugumi Uema, Hideki Koizumi, Michio Shimabukuro, Koshi Nakamura, and Hiroaki Masuzaki. The first draft of the manuscript was written by Yukiko Shinzato, Yoshiro Nakayama, Jasmine F Millman, Michio Shimabukuro, and Hiroaki Masuzaki, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Michio Shimabukuro or Hiroaki Masuzaki.

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None of the authors have any conflicts of interest to disclose.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (The Ethics Committee of University of the Ryukyus for Medical and Health Research Involving Human Subjects (No.765) on February 27, 2015) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

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Shinzato, Y., Nakayama, Y., Okamoto, S. et al. Impact of treatment cessation on incidence and progression of retinopathy in Japanese patients with type 2 diabetes mellitus: a retrospective cohort study. Diabetol Int (2024). https://doi.org/10.1007/s13340-024-00724-7

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