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Prediabetes influences the structure of the macula: thinning of the macula in the Northern Finland Birth Cohort
  1. JenniMaria Huru1,2,
  2. Ilmari Leiviskä1,2,
  3. Ville Saarela1,2,
  4. M Johanna Liinamaa1,2
  1. 1 Ophthalmology, Oulu University Hospital, Oulu, Finland
  2. 2 PEDEGO Research Unit and Medical Research Center, Oulu University Faculty of Medicine, Oulu, Finland
  1. Correspondence to Johanna M Liinamaa, Department of Ophthalmology, Oulu University Hospital, Oulu, Finland; johanna.liinamaa{at}


Background/Aim The aim of this study was to evaluate the effect of prediabetes and diabetes on macular thickness and retinal vascular calibres in our population-based cohort (Northern Finland Birth Cohort).

Methods The population of 2005 individuals was divided into diabetes (n=57), prediabetes (n=1638) and normal glucose metabolism (NGM) groups (n=310). Total thickness of the macula was measured using Cirrus HD-OCT 4000. Central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) calibres were measured from the fundus images. The diagnosis of diabetes and prediabetes was made according to WHO 2006 diagnostic standards.

Results Significant macular thinning was observed in subjects with prediabetes (−2.69 μm (95% CI −4.29 to −1.09), p<0.05 and −0.10 mm3 (95% CI −0.16 to −0.04), p<0.05 for macular cube average thickness and cube volume, respectively) and it was greatest in the pericentral area. Macular cube average thickness and macular cube volume decreased significantly by worsening glucose metabolism. Furthermore, CRAE was decreased by increases in 2-hour post-load glucose, glucose area under the curve and increase in Matsuda index (p<0.001, 0.019 and <0.001, respectively). In mediation analysis, macular thickness had significant average causal mediation effect (ACME) on CRVE and CRAE in subjects with prediabetes.

Conclusion We detected significant thinning of the macula in subjects with prediabetes. The diameters of retinal arteries were decreased by impaired glucose metabolism. This study provides a new perspective since it revealed that the early and subtle changes caused by prediabetes as macular thinning had significant ACME on retinal vessels, therefore supporting the neurodegenerative theory of diabetes-induced changes in the retina.

  • Macula
  • Retina

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  • Contributors JMH, VS, JML: planning, conduct and reporting of the work. IL: conducting and reporting of the work.

  • Funding This work was supported by Silmäsäätiö, Mary and Georg Ehrnrooth Foundation, Northern Finland healthcare Support Foundation, Glaukooma Tukisäätiö LUX and Suomen Lääketieteen Säätiö (there are no grant numbers for any of these foundations).

  • Competing interests Non declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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