The relationship between glycemic status and the risk of third, fourth, and sixth cranial nerve palsy: a nationwide population-based study (2009-2018)

Abstract

Abstract Abstract: The incidence of diabetes is increasing globally and prediabetes is clinically important. However, the relationship between diabetic duration and ocular motor cranial nerve palsy (CNP) was not evaluated in large scale study and studies on ocular motor CNP in pre-diabetes are sparse.Backgroud/Objectives: This study aimed to assess the association between glycemic status and the incidence of ocular motor CNP.Subjects/Methods: This is a retrospective nationwide population-based cohort study using National Health Insurance Service (NHIS) of South Korea data from 2009. Health checkup data of 4,067,842 individuals aged between 20 and 90 years between January 1, 2009, and December 31, 2018, were analyzed. The subjects were classified based on glycemic status as nondiabetes, impaired fasting glucose (IFG), newly detected diabetes, diabetes duration <5 years, and diabetes duration ≥5 years. The primary end point of this study was incidence of CNP. Hazard ratio (HR) and 95% confidence interval (CI) of CNP were estimated using Cox proportional hazards regression analysis. Model 3 adjusted age, sex, smoking status, alcohol consumption, physical activity of individuals and body mass index in the analysis. Results: We identified 5,835 incident CNP cases and 4,062,007 control cases during the follow-up period (average, 6.3 years). In the adjusted model 3, the adjusted HR for the IFG group was 1.104 (95% CI 1.035 - 1.177), for the newly detected diabetes group was 1.793 (95% CI 1.6 - 2.009), for the diabetes duration <5 years group was 1.959 (95% CI 1.768 - 2.169) and for the diabetes duration ≥5 years group was 2.606 (95% CI 2.38 - 2.854). Using the Kaplan-Meier curve, the log-rank test showed increase in the incidence of CNP according to the duration of diabetes (p < 0.001).Conclusions: Our population-based large-scale cohort study suggests that both IFG and diabetes significantly increased the risk of the development of ocular motor CNP compared to the normal glycemic status.