Meibomian Gland Dysfunction (Dry Eye Disease) and Hyperglycemia: Recent Studies

I recently read that an easy way to begin writing is to ask a question. What an easy way to start a blog post, I thought. Today I would ask, does high blood sugar and insulin resistance cause dry eye? Research greatly suggests the answer is yes. I wonder how many medical professionals see young or (whatever age) people with dry eye and blepharitis and ask if they have had their blood sugar checked. I was being treated for meibomian gland dysfunction, which debilitated me, many years before my Type 1 diabetes diagnosis. Blood sugar was never once discussed.

Despite consuming a typical American diet of pizza, high sugar yogurt, "whole grain" bread for lunch, ice cream, pasta, Gatorade, rice bowls, dried cranberries on a "healthy" salad with a sweet dressing, etc., I had never once in my life had my blood sugar checked. It was never recommended by a medical professional, though I had multiple seemingly "separate" health issues circulating for years. Never once did blood sugar cross my mind or a doctor's mind until I landed in the ER in a state of "profound acidosis" and "rapid decompensation". The CDC has warned for years of an explosion of undiagnosed prediabetes in the U.S. I'm about to say something some may consider radical, but I'll say it nonetheless, because I believe it to be true in the depths of my heart. If we consider the extremely addictive (as addictive if not more addictive than hard narcotics, according to published papers), processed, entirely unnatural and unhealthy diet Americans have considered normal for at least 50 years now, the fact that the people consuming this diet do not have comprehensive blood sugar testing and insulin resistance testing regularly from a young age as "standard of care" is nothing short of genocide. If you think I'm too close to this cause and over-reacting, all I can say is wait to see how the future plays out, truly, because right now it's not looking great. Scour PubMed and other research portals and you will find the co-morbidities of hyperglycemia and insulin resistance to be boundless. I try to cover some on here, but often I don't know where to even begin. It has become our "new normal". Nearly 1 in 3 teens has prediabetes, according to 2023 CDC data. The latest data for adults is from 2021, which is a while ago now, showing 1 in 3 adults have prediabetes. So that number could very well be more dire now. Let me tell you this from someone in the trenches: under no circumstances do you want to be a part of this "new normal". 

I'll get on to posting some studies linking meibomian gland dysfunction, a medical term for dry eye, to hyperglycemia and insulin resistance. If you have dry eye or blepharitis, please consider getting the Insulin Resistance Test Panel at Quest, the oral glucose tolerance test, fasting glucose test, and even an A1c, though, from what I've read, that will only show up as irregular in the late stages of metabolic dysfunction.

The 2025 study Impact of Hyperglycemia on Tear Film and Meibomian Gland Dysfunction: A Cross-Sectional Study found: " Hyperglycemia is linked to impaired tear film stability, meibomian gland function, and DED (dry eye disease) symptoms. Ocular surface disorders in individuals with diabetes may be prevented by effective glycemic control"

One note I'll make on that is once you're full-blown diabetic, it's very hard to achieve the "glycemic control" necessary to eliminate these diseases. Even with an extremely hard-earned boiled egg and steamed broccoli thrice daily A1C of 5.9, I had these symptoms.

The 2015 study Effects of Insulin and High Glucose on Human Meibomian Gland Epithelial Cells states: "Our data show that insulin stimulates, and that high glucose is toxic for, IHMGECs." I don't know what IHMGECs are, but let's agree that high glucose is toxic for many, many things! "These results support our hypothesis that insulin resistance/deficiency and hyperglycemia are deleterious for HMGECs and may help explain why type II diabetes is a risk factor for MGD."

The 2019 paper Correlation between Type 2 diabetes, dry eye and Meibomian gland dysfunction concluded: "MGD (meibomian gland dysfunction) in type 2 diabetic patients is more severe compared with nondiabetic patients. Longer duration of diabetes is associated with major symptoms and changes in MG. Diabetic group showed major changes in lids and tear function, accounting for evaporative dry eye and presenting a high degree of correlation with MG inflammation and obstruction." 

The 2022 study Hyperglycemia Induces Meibomian Gland Dysfunction found: " Long-term diabetes may lead to Meibomian gland dysfunction."

The 2019 paper Diabetes mellitus is associated with dry eye syndrome: a meta-analysis found: "Our meta-analysis suggests that diabetes mellitus has a significant association with the risk of dry eye."

The 2025 paper Is there a link between dry eye disease and diabetes mellitus? A systematic review and meta-analysis states: "Our study confirmed a significant association between diabetes mellitus and DED (dry eye disease) prevalence and severity, and diabetic patients exhibit higher DED risks."

The 2019 study Dry Eye Disease is More Prevalent in Children with Diabetes than in those without Diabetes found: "The prevalence of dry eye disease in the case group was significantly higher than that in the control group...The diabetes duration was significantly higher and the level of corneal sensation was significantly lower in subjects with dry eye disease than in those without dry eye disease. Early screening and close follow-up of dry eye disease in children with diabetes should be strictly implemented, especially in children with a long duration of diabetes and those with peripheral neuropathy."

The 2022 paper Research progress on the pathogenesis of diabetes-related dry eye states: "In recent years, with the further understanding of medical circles on diabetic ocular complications, the ocular surface abnormalities of diabetes has drawn increasing concerns. Nearly 50% of diabetic patients suffer from dry eye symptoms. The main manifestations of diabetes related dry eye were abnormal lacrimal secretion, poor lacrimal stability, decreased corneal sensitivity, persistent corneal epithelial defect and even corneal ulcer, which were mainly related to the changes of structure and function of lacrimal gland, the decrease of goblet cells in conjunctiva, the abnormality of meibomian gland function and the degeneration of corneal nerve caused by diabetes."

 The 2023 study Study of dry eye disease in type 2 diabetes mellitus and its association with diabetic retinopathy in Western India found: "The study highlights a significant correlation between DED and DM, and hence, examination for DED with fundus examination should be an integral part of the assessment of type 2 diabetics."

 The 2013 study Diabetes-associates dry eye syndrome in a new humanized transgenic model of type 1 diabetes found: "Animals developed lacrimal gland disease (classically associated with diabetes in Non Obese Diabetic [NOD] mice and with T1D in humans) as they developed glucose intolerance and diabetes. Animals manifested obvious clinical signs of dry eye syndrome (DES), from corneal erosions to severe keratitis."

The 2017 paper Emphasizing the diagnosis and treatment of diabetes related dry eye states: "Nowadays, diabetes is quickly emerging as one of the biggest health-related catastrophes over the world. Its impact on people's quality of life has been gradually taken seriously. In the past few years, the connection linking dry eye to diabetes has been substantially confirmed by a series of studies. However, many areas remain uncertain due to the complex and diverse pathogeneses of diabetes related dry eye syndrome. Furthermore, the slow progression of dry eye symptoms easily conceals its connection with diabetes, which brings great challenges to timely diagnosis and effective interventions."

There were over 1,000 results on PubMed, so I will leave it there. Please also read my posts on the research between diabetes and demodex, a fairly recently recognized component of ocular disease, if you have an opportunity.