Association of the glucose metabolism continuum (fasting plasma glucose/HbA1c) with tear-film stability and secretion: ocular surface evidence across non-diabetes, prediabetes, and diabetes - Report - MDSpire
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Association of the glucose metabolism continuum (fasting plasma glucose/HbA1c) with tear-film stability and secretion: ocular surface evidence across non-diabetes, prediabetes, and diabetes
Glycemic Spectrum Correlates with Tear Film Stability and Dry Eye Disease Risk
Overview
This cross-sectional study of 300 adults across non-diabetic, prediabetic, and diabetic strata found that higher glycemic levels are associated with reduced tear film stability (NIBUT), decreased tear secretion (Schirmer I), and increased odds of dry eye disease (DED). Both HbA1c and fasting plasma glucose showed consistent dose-response relationships with ocular surface inflammation and tear film abnormalities.
Background
Dry eye disease (DED) is a multifactorial disorder characterized by tear film instability and ocular surface inflammation, impacting quality of life and productivity. Dysglycemia, spanning from non-diabetes through prediabetes to diabetes, is prevalent and may contribute to ocular surface dysfunction via mechanisms such as tear hyperosmolarity, inflammation, and neuropathy. Prior studies have established associations between diabetes and DED, but evidence across the full glycemic spectrum, especially in prediabetes, remains limited. This study aimed to clarify these associations using standardized ocular surface assessments and continuous glycemic modeling.
Data Highlights
Glycemic Stratum
Mean NIBUT (s)
Mean Schirmer I (mm)
DED Prevalence (%)
Non-diabetes
11.8
13.8
24.0
Prediabetes
10.5
12.1
34.0
Diabetes
9.2
10.4
51.0
Key Findings
Mean NIBUT decreased progressively from non-diabetes (11.8 s) to prediabetes (10.5 s) to diabetes (9.2 s), with adjusted differences of −1.20 s and −2.50 s versus non-diabetes (p ≤ 0.006).
Schirmer I values similarly declined across strata: 13.8 mm (non-diabetes), 12.1 mm (prediabetes), and 10.4 mm (diabetes), with adjusted differences of −1.60 mm and −3.10 mm (p ≤ 0.006).
Each 1% increase in HbA1c was associated with a 0.72 s decrease in NIBUT, a 1.15 mm decrease in Schirmer I, and a 31% increase in odds of DED (all p < 0.001), with no significant non-linearity.
DED prevalence rose from 24.0% in non-diabetes to 34.0% in prediabetes (adjusted OR 1.60, p = 0.049) and 51.0% in diabetes (adjusted OR 2.90, p = 0.001).
Osmolarity abnormalities and MMP-9 positivity, markers of ocular surface inflammation, increased across glycemic strata and with higher HbA1c, remaining significant after multiple testing correction.
Findings were consistent when fasting plasma glucose was used instead of HbA1c as the glycemic metric.
Clinical Implications
Clinicians should be aware that even prediabetic glycemic levels are associated with measurable impairments in tear film stability and secretion, as well as increased dry eye disease risk and ocular surface inflammation. Early identification and management of ocular surface abnormalities in patients with dysglycemia may help mitigate symptom burden. These findings support integrating ocular surface evaluation into the care of patients across the glycemic spectrum.
Conclusion
Higher glycemic status, including prediabetes, correlates with reduced tear film stability, decreased tear secretion, and increased dry eye disease prevalence and inflammation. Longitudinal studies are warranted to determine causality and clinical relevance of these associations.
Related Resources & Content
Study Authors/First People’s Hospital of Wuyi County/2025 -- Link Between Glucose Metabolism Spectrum and Tear Film Stability
