Impact of Anemia on the Risk of Diabetic Macular Edema: A TriNetX Analysis

Document Type

Conference Proceeding

Publication Date

6-2025

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : To investigate the association between varying levels of anemia and the risk of developing diabetic macular edema (DME) in patients with type 1 and type 2 diabetes who are DME-naive.

Methods : This retrospective cohort study utilized the TriNetX United States (US) Collaborative Network, a federated health research platform providing access to de-identified electronic medical records (EMRs) from over 60 healthcare organizations across the US. Inclusion criteria consisted of patients with type 1 or type 2 diabetes who were DME-naive at diagnosis, had hemoglobin (Hb) levels recorded within 6 months of diagnosis, and at least one ophthalmology visit within the year following diagnosis. Patients were categorized into five cohorts based on Hb levels: Control (Hb ≥ 13.5 g/dL), Hb 11.5–13.4 g/dL, Hb 10–11.4 g/dL, Hb 8.5–9.9 g/dL, and Hb < 8.5 g/dL. Exclusion criteria included patients with severe types of anemia linked to specific underlying conditions, such as aplastic anemia, hemolytic anemia, and bone marrow failure syndromes. Propensity score matching (1:1) was conducted to balance cohorts for demographics (age, gender, race, ethnicity) and comorbidities, including hyperlipidemia, hypertension, chronic kidney disease, cardiovascular diseases (heart failure, ischemic heart disease), overweight/obesity, and tobacco use. Time-to-event analysis was performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the development of DME.

Results : Cohort sizes post-PSM were as follows: Hb 11.5–13.4 g/dL (55,703), Hb 10–11.4 g/dL (25,928), Hb 8.5–9.9 g/dL (12,357), and Hb < 8.5 g/dL (5,511). Compared to the control group (Hb ≥ 13.5 g/dL), the risk of DME progressively increased with decreasing hemoglobin levels. Patients with Hb 11.5–13.4 g/dL had a 40% increased risk of developing DME (HR: 1.40, 95% CI: 1.33–1.47). The risk rose to nearly double in those with Hb 10–11.4 g/dL (HR: 1.92, 95% CI: 1.79–2.05). Patients with Hb 8.5–9.9 g/dL exhibited an over twofold increased risk (HR: 2.23, 95% CI: 2.04–2.44), while those with Hb < 8.5 g/dL had the highest risk (HR: 2.29, 95% CI: 2.01–2.61).

Conclusions : Lower hemoglobin levels appear to be linked with an increased risk of developing DME within 1 year. These findings highlight the potential importance of anemia management in reducing DME risk in diabetic patients and underscore the need for further research to better understand this association.

Volume

66

Issue

8

First Page

3303

Comments

Association for Research in Vision and Ophthalmology ARVO Annual Meeting, May 4-8, 2025, Salt Lake City, UT

Last Page

3303

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