Association of Retinopathy and Insulin Resistance: NHANES 2005-2008

Purpose: In animal models, insulin resistance without severe hyperglycemia is associated with retinopathy; however, corroborating data in humans are lacking. This study aims to investigate the prevalence of retinopathy in a population without diabetes and evaluate the association of insulin resistance and retinopathy within this group. Methods: The study population included 1914 adults age ≥40 without diabetes who were assigned to the morning, fasted group in the National Health and Nutrition Examination Survey 2005–2008, conducted by the Centers for Disease Control. Retinopathy was determined using fundus photos independently graded by a reading center and insulin resistance was determined using the homeostatic model of insulin resistance. Results: Prevalence of retinopathy in those without diabetes was survey design adjusted 9.4% (174/1914). In multivariable analyses, retinopathy was associated with insulin resistance (HOMA-IR OR: 1.09, 95% CI: 1.03, 1.16; p =.0030), male gender (OR: 1.39, 95% CI: 1.04, 1.85; p =.0267), and age (OR: 1.03, 95% CI: 1.01, 1.05; p =.0203). Conclusions: Insulin resistance in the absence of overt hyperglycemia could be an early driver of retinopathy.