Is there a link between dry eye disease and diabetes mellitus? A systematic review and meta-analysis

Keratoconjunctivitis sicca, or the dry eye disease (DED) is prevalent multifactorial disorder of the tears and ocular surface, which has lately been interested scholars, particularly in establishing its link with diabetes mellitus (DM). This study aimed to evaluate the association between DM and DED through a comprehensive systematic review and meta-analysis of existing published articles, and thus understand the attributed risks for DED development in diabetic patients.

Four databases, PubMed, Cochrane Library (CENTRAL), Web of Science, and Google Scholar, were electronically searched for relevant publications. Peer-reviewed articles in English language reporting on DED prevalence among diabetic population published over the last 10 years were considered. A random effect model with odds ratio (OR) and risk ratio (RR) and respective confidence intervals were used in our statistical analysis to determine pooled effect sizes.

This study included 23 studies with 5566 participants. Diabetic individuals had a significantly higher prevalence of dry eye disease (DED) than non-diabetics (OR: 2.30 [95 % CI: 1.54-3.43]; RR: 1.69 [95 % CI: 1.28-2.25]). Older age (>50 years), longer diabetes duration (>10 years), and poor glycemic control (HbA1c >7 %) were associated with increased DED risk. Gender-based findings varied, with slightly higher odds in males, though not statistically significant. High heterogeneity (I² = 72 %) was observed, but sensitivity analyses confirmed result stability. Minimal publication bias was detected. Mechanisms linking diabetes to DED included oxidative stress, inflammation, and neuropathy-related tear dysfunction.

Our study confirmed a significant association between DM and DED prevalence and severity, and diabetic patients exhibit higher DED risks. These risks are pronounced in older adults, particularly those diagnosed with T2DM.". Hence, early detection and management of DED in diabetic population is a priority to enhance patient's quality of life.