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Participation Protocol WESP

Title Participation:
Type 2 diabetes and the risk of glaucoma
Department/division:
Ophthalmology clinics
Name student:
Participation period:
Project supervisor:
Members project team:
Names:

Department:

Short summary of the elective:

This cohort study will be conducted at the Ophthalmology Department, Maastricht. The study aims to
evaluate the association between Diabetes type 2 and the risk of glaucoma. It will also assess the
impacts of glucose lowering-agents on the development of glaucoma. The case-control study involves
3200 participants out of which 1000 patients are the patients of Diabetes mellitus type 2 (T2DM) while
rest of the 3200 are healthy subjects without diabetic problems. Multiple diagnostic tools have been
analyzed to understand the relation of diabetes type 2 and glaucoma, that include Optical Coherence

Tomography around the optic nerve head (OCT), Heidelberg Edge Perimetry (HEP), non-contact
tonometry, and corneal thickness. The present approach will facilitate the understanding of the relation
between diabetes type 2 and glaucoma.
Elaboration of the Project
Background/introduction:
Problem Statement:
This elective cohort study focusses on the links of glaucoma with diabetes type 2. It aims to evaluate
the frequency of glaucoma in diabetic patients in comparison of non-diabetic patients. Through an
analysis of understanding this relation of T2DM and glaucoma the present study will help in designing
all the possible preventive measures to prevent glaucoma among diabetic type 2 patients

Literature Review & Previous findings

Diabetes has been linked with various co-morbidities. Glaucoma is one of the foremost causes of
irreversible blindness across the globe (Zhao et al. 72-78). It is found that the microvascular damage
occurred in glaucoma is an impact of T2DM in that person that further impacts the vascular regulation
of optic and retina nerve. Diabetes also has been found involved in increased intraocular pressure (IOP)
(Tan et al. 1354-1361). Thus, it is necessary to understand the relation of T2DM and glaucoma so that it
can be controlled from developing in diabetic patients.
According to the literature, this association has been very prominent and it has been verified that
diabetic patients are more prone of developing glaucoma in comparison of non-diabetic patients
(Pasquale et al. 1081-1086). A meta-analysis conducted by Zhou and co-researchers analyzed 13
different studied to determine the connection between primary open-angle glaucoma (POAG) and
diabetes mellitus (DM). Among these 13 studies six were case-control studies while seven were

population-cohort studies which led to the conclusion that the diabetic patients are highly susceptible of
developing open-angle glaucoma in comparison of non-diabetic patients (Zhou et al.). Another study
that aimed to investigate the relation also focused to discover whether the diabetic control and the
length of the disease impacts this evident relation. On the basis of extracted finding, the research
concluded that regardless of any factor there is a strong connection between both of the condition
(Halilovic et al.). Based on a Los Angeles Latino Eye Study it is concluded that T2DM and open-angle
glaucoma (OAG) together is the fastest growing problem (Chopra et al. 227-232; Shen et al. 147-155)
This cohort study has as its aims to discover whether the visual field defect found in glaucoma
patients is different between individuals that are diabetic and non-diabetic.

Relevance:
The growing incidence T2DM patients has been a serious issue and to treat and prevent glaucoma as a
cause of blindness in DM-2 it is important to understand this connection of diabetes and glaucoma. It
will facilitate to understand the progression course of glaucoma, its treatment, and developing
preventable measures that will lower the onset of glaucoma among diabetes patients as well as its
progression and symptom severity. Furthermore, it is also necessary to detect whether the disease
duration and presence of glycemic control can impact the glaucoma progression. The visual field defect
in Glaucoma might be different in diabetic and non-diabetic conditions. This study will produce
significant implications for developing effective preventive and screening measures for diabetic
patients.

Research question(s)
The study aims to investigate several research questions that are as follows:
1. Is glaucoma more prevalent in DM-2 compared to individuals without DM-2?
2. What is the impact of diabetes duration over the risk of glaucoma development?

3. Is there any difference between the visual field defect of glaucoma for the diabetic and nondiabetic patients?
Hypotheses:
In this study we propose multiple hypotheses. The duration of diabetes has no connection with
glaucoma severity. Moreover, the pathology of glaucoma in diabetic and non-diabetic patients will be
different because both are diverse conditions.

Research population:
The study will include approximately 3200 participants, out of which 1000 patients with diabetic type 2
(T2DM) and rest are healthy individuals.
Inclusion criteria
The inclusion criteria for the subject selection includes the patients aged 45 years and above.
Participants of the Maastricht study will be included.

Exclusion criteria:
The exclusion criteria of the subject selection in this study are based the absence of a visual field or
IOP measurement.

Methods:
Study design: cross-sectional study
Method of selection:
Only those subjects were included in the study who met inclusion criteria whereas rests of the subjects
were excluded.
Medical Ethical Approval / Animal Ethical Approval (METC / DEC):
Not applicable
Outcomes:

What is being measured?

The primary outcome of this study will be the association between T2DM and its susceptibility towards
developing glaucoma. In this cohort study, a group is diabetic while another group possesses only
healthy patients who do not have diabetes. The outcome will be the presence of glaucoma on the visual
field.
Statistical data analysis:
The data will be analyzed using spss software for statistical analysis. Cross-tabs will be used and the
Chi-square test for statistical significance.
Time schedule and planning:
There will be an introduction meeting at the first day of the internship. After the initial meeting there
will be follow-up and progress meetings with the supervisor every 4 weeks during the duration of the
study. For most of the meetings it is expected that there would be other student and researchers as well.
In the follow-up and progress meetings, I will be presenting my progress on the study in the meeting
and my supervisor would evaluate my performance based on my report. I would also get feedback from
my supervisor based on which there might be some adjustments to the learning objectives and goals.
Meeting schedule:

Meetings
Introduction
Meeting

Progress
Meeting - I

Aim
Timing
1st week
Introduction
Discussion of my role
Instructions from the
department about daily
activity
Fixing the next set of
appointments
Evaluate
study 4th week
progress

Date
October

Describe your
(students)

November

responsibilities
within
project:

Take feedback from the

supervisor on the
progress

As a student
I

will

be

Interpret results along

with the supervisor

responsible

Based on feedback,
results and progress
adjust the goals and
objectives for the
learning activities

management

organizing

Schedule next meeting

with the supervisor
Progress
Interpret the results 8th week
Meeting - II &
with the supervisor
III
Analyze the obtained
Data
Take feedback from the
supervisor
on
the
analysis and results
Evaluate the progress
of the study along with
supervisor
Evaluating the progress
of the study
Based on feedback,
results and progress
adjust the goals and
objectives for the
learning activities

for all overall

of the project
with regards
to analyzing,
and
January

Schedule next meeting

with the supervisor

researching
literature and
scholarly
material
the
topic.

Write the thesis

for
final
submission
and
assessment
Assessment of SCIP Last week 18th March

for
given
The

period of the
study will be
18
before

weeks
the

final
submission.
During

this

period

of

study, I will
be

Final meeting

the

communicating and informing my supervisor about the progress of the study in a professional manner. I
will be able to explain the concept of the glaucoma risk in relation to Diabetes Type 2 to the specialized
evaluation team and also to others. Also I will be working on SPSS for evaluating the results. The
completed results will be used in the final report.

Personal learning objective (smart /CanMEDS) format

Learning objectives

Reason: (How and why I

Plan for learning: (what Evidence of learning:

(WESP): (what I need to

know I need to learn this)

I need to do to learn)

learn)

(how I know Ive

learnt and can show
others I have learnt)

1. As a Medical Expert
I will be able to expand

Through scientific research

I would improve on my

Supervisor feedback

my knowledge into

and working in a scientific

knowledge and skills

would prove to be the

statistics and also perform

environment, I will improve

regarding statistics

evidences for learning.

scientific research.

on my skills that would

through study of books,

benefit me in completing the learning material and

study and also help me in

lectures.

my future career.

2. As a Scholar

I must review the

I intend to gain from the

I will read the articles,

On-time and

information and absorb

research in terms of

related literature and

satisfactory

the knowledge gained

knowledge and

follow instructions and

completion of SCIP

about Glaucoma and

understanding of the topic.

recommendations of my

with acceptable results

supervisor.

and good quality.

Diabetes 2

3. As a Collaborator

I must be a team-player

I will be supporting my

I will be effective team

Successful completion

and effective team

team members and avoid

member, ask for

of the study and

member by completing

conflict and

feedback, get my work

results on time and

my tasks on time.

misunderstanding with other reviewed and incorporate

passing the evaluation

team members.

the feedback into my

with implementing

work for improvement.

supervisor feedback.

4. As a Manager

As a manager I must be

Completing the work on

Record keeping of all

Completion of SCIP

able to effectively manage

time, effective time

activities and agenda. I

on time and supervisor

time between different

management with

will keep a written

feedback will be the

activities.

completing the work on

record.

evidence of my

time for each activity.

success.

5. As a Professional

I will be on time and

Professional approach and

I will complete all

My behavior, adhering

complete all activities as

completing activities as per

activities on time and in a to schedules and

per the pre-decided

schedule is necessary for the professional manner.

completing the SCIP

schedule.

success of the research.

study with positive

attitude, never missing
any class, receiving
positive feedback
from my supervisor
and most importantly
implementing the
feedback and
suggestions.

References :
Chopra, Vikas, et al. "Type 2 diabetes mellitus and the risk of open-angle glaucoma: the
Los Angeles Latino Eye Study." Ophthalmology 115.2 (2008): 227-232.

Halilovic, Emina Alimanovic, et al. "Analysis of the Influence of Type of Diabetes

Mellitus on the Development and Type of Glaucoma." Medical Archives 69.1
(2015): 34.
Pasquale, Louis R., et al. "Prospective study of type 2 diabetes mellitus and risk of
primary open-angle glaucoma in women." Ophthalmology 113.7 (2006): 10811086.
Shen, Ling, et al. "Diabetes Pathology and Risk of Primary Open-Angle Glaucoma:
Evaluating Causal Mechanisms by Using Genetic Information." American journal
of epidemiology 183.2 (2016): 147-155.
Tan, Gavin S., et al. "Diabetes, metabolic abnormalities, and glaucoma: the Singapore
Malay Eye Study." Archives of Ophthalmology 127.10 (2009): 1354-1361.
Zhao, Di, et al. "Diabetes, fasting glucose, and the risk of glaucoma: a meta-analysis."
Ophthalmology 122.1 (2015): 72-78.
Zhou, Minwen, et al. "Diabetes mellitus as a risk factor for open-angle glaucoma: a
systematic review and meta-analysis." PLoS One 9.8 (2014): e102972.