Loss Of Gland In Eyelids May Be A Biomarker For Elevated Blood Glucose In Diabetes

In patients with diabetes, loss of the gland that helps lubricate the eye may be a sign of elevated blood glucose levels, according to research accepted for presentation at ENDO 2020, the Endocrine Society’s annual meeting. The study will be published in a special supplemental section of the Journal of the Endocrine Society.

Meibomian glands in the eyelid play a role in tear film production and tear film stabilization.

“In this small study, we found that loss of meibomian glands occurred more frequently with elevated hemoglobin A1c, perhaps due to microischemia, or damage to the small blood vessels, of the eyelids,” said co-author Gloria Wu, MD, adjunct faculty at the University of California, San Francisco in San Francisco, Calif. “Loss of meibomian glands may suggest the need for A1c testing to track average blood glucose levels during the past two to three months and additional monitoring in individuals with diabetes.”

Individuals with diabetes often complain of dry eye and eye pain. Infrared images of the eyelid may help characterize dry eye in individuals with diabetes, and new infrared photography techniques have recently enabled meibomian glands to be easily photographed.

To study meibomian gland loss in patients with diabetes as well as dry eye, Wu and her colleagues conducted a retrospective electronic health record chart review of patients with type 2 diabetes and of patients who did not have diabetes and were diagnosed with “dry eye” between 2017 and 2019. The participants were between the ages of 18 and 90, and those with diabetes had A1c levels higher than 5.7%. The researchers analyzed participants’ A1c levels and reviewed their infrared eyelid photos.

For each participant, the researchers averaged the percentage of the meibomian glands that were lost in both eyes. Of the 60 patients with diabetes, 35 of 37 with A1c levels higher than 6.6% had more than 40% loss of the meibomian glands. In comparison, 12 of 23 diabetes patients who had more controlled A1c levels of less than 6.5% had lost less of the meibomian glands.

Of the 60 control patients, 41 of 50 patients with A1c levels lower than 5.5% had minimal loss of the meibomian glands. Seven of 10 control patients with A1c levels higher than 5.6% had greater loss of the meibomian glands.

“It can be useful to check the eyelids of individuals with diabetes who complain of dry eye,” Wu said. “It is important for people with diabetes and their family members to consider that dry eye and painful ‘sand in the eyes’ feelings may mean they should check their blood sugar and see an ophthalmologist about their eye health, including their eyelids.”

Certain smartphones have cameras capable of capturing images to gauge eyelid health, including the Samsung Galaxy 10S and iPhone models 10, Xs and 11, Wu said.

“We used an infrared camera in this study, but patients can examine their own eyelids, using selfie and black-and-white settings on their smartphone,” she said. “This technique gives patients and health care workers, including those in community and rural health clinics, one more way to control diabetes.”

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