Risk and Protective Factors for Ocular Surface Disease in Patients with Type 2 Diabetic Mellitus: A Retrospective Cohort Study

Purpose: Identify the risk and protective factors for ocular surface disease (OSD) in patients with type 2 diabetes mellitus (T2DM). Methods: This retrospective cohort study used the Chang Gung Research Database (2005-2020) for patients with T2DM. A total of 161,001 patients were included, of which 915 had OSD and 160,086 did not. The OSD group was further divided into recurrent corneal erosion (RCE) (n = 92) and corneal ulcer (n = 371) groups after excluding those with overlapping diagnoses. The risk and protective factors were also analyzed. Results: After age and gender matching, the OSD group had a considerably higher baseline and mean HbA1c and a higher incidence of dry eye disease (DED), diabetic neuropathy, retinopathy, and ocular procedures. After adjusting for gender, age, and diabetes mellitus (DM) duration, we found that DED, higher mean HbA1c, diabetic neuropathy, trans pars plana vitrectomy (TPPV) and cataract surgery were the contributing factors for OSD. Antihyperglycemic agents, especially sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 agonists, considerably protect against OSD. DED and TPPV were risk factors for corneal ulcers but not for RCE; however, DM medication had the same effect on corneal ulcers and RCE. Conclusions: Poor diabetic control, diabetic neuropathy, and ocular procedures are the risk factors for OSD. Antihyperglycemic agents, except metformin, can prevent OSD in patients with T2DM. Additionally, DED and TPPV are risk factors for corneal ulcers but not for RCE. A prospective randomized controlled trial is required to confirm our results.