The aim of this study was to establish diabetic retinopathy correlation with several risk factors. A prospective study including 256 type II diabetic patients who referred to diabetes’s clinic was designed. All patients underwent physical & retina examination and then completed questionnaire including duration of DM, cardiovascular disease, stroke, chronic kidney disease, smoking, and kind of treatment, blood pressure, BMI, abdominal & hip circumference. Results of HbA1C, total cholesterol, HDL & LDL cholesterol, TG, FBS, creatinine, 24-h urine microalbumin were recorded. Data were analyzed by SPSS version 17 with K2, independent samples T, and logistic regression. Of 256 types II diabetic patients 81 & 175 were men and women respectively. Mean age of subject was 54 ± 10.27. Prevalence of diabetic retinopathy was 22.3% & macula edema 0.5% & PDR 6% & NPDR 14%; diabetic retinopathy was associated with duration of DM & BMI (P = 0, P = 0.43 respectively). Mean of FBS 191 ± 83 vs. 165.7 ± 74.5 (P = 0.03), HbA1c 9.1 ± 2 vs. 8.5 ± 1.9 (P = 0.02), 24-h urine microalbumin 181.2 ± 404.7 vs. 60.2 ± 236 (P = 0.03), Systolic blood pressure 124.3 ± 21.3 vs. 118.5 ± 17.8 (p = 0.04) differed between diabetic patients with or without diabetic retinopathy. There were no significant difference between subject with & without diabetic retinopathy in total cholesterol LDL, HDL, TG, Cr, Diastolic BP, types of treatment, cardiovascular disease, chronic kidney disease, stroke & smoking. This study showed prevalence of diabetic retinopathy was high and it associated with duration of DM, BMI, FBS, HbA1C, 24-h urine albumin, and systolic blood pressure.
The prevalence of diabetes is increasing worldwide [
In addition, controlling blood sugar levels, presence or absence of hypertension, smoking, neuropathy, dys- lipidemia and pregnancy are other effective risk factors [
The presence of diabetic retinopathy is an indicator for increasing morbidity and mortality (including cardiovascular complications [
Screening for diabetic retinopathy is important, because the large number of patients had no symptoms with progression of retinopathy to the macular edema (ME) and or proliferative diabetic retinopathy (PDR). On the other hand, the effect of laser photocoagulation in preventing vision loss from proliferative retinopathy and macular edema has been marked in the randomized trials. Early prevention of retinopathy is more important than the treatment of established retinopathy. In this study we determine the prevalence of retinopathy. In the study, we determined the prevalence of retinopathy and its risk factors among patients with diabetes mellitus that referred to diabetes clinic in Golestan Hospital.
In this descriptive analytical study 256 patients were evaluated. The study protocol adhered to the tenets of the Declaration of Helsinki. Informed consent was provided by all the participants. This research project has been approved by ethical committee of University of Medical sciences.
In this study, 256 patients referred to the diabetic clinic in hospital of during the 2009, which diagnosis of diabetes in them was done based on criteria ADA 2003, were examined. At the initial visit, the data sheet were completed about the duration of their disease, previous history of cardiovascular disease, stroke, chronic kidney disease, smoking history, family history of diabetes and diabetic retinopathy, and the type of treatment used during illness, and the data was recorded.
Then, the patients’ blood pressure, BMI, and abdominal, hip circumference ratio were measured. Level glycosylated hemoglobin was measured using reader II NYCO card II by UV method. Also, serum cholesterol, triglycerides, creatinine and fasting blood glucose levels were measured by enzymatic colorimetric test; and serum level of HDL was measured by direct methods, antibody enzyme method; Low-Density Lipoprotein (LDL) was calculated Fridwald’s Formula; and 24-hour urine microalbumin was measured by immunoturbidometric method; 24-hour urine microalbumin using kits of Pars Azmoon Co. was done by autoanalyzer BT 3000. Diabetes duration was considered the period from diagnosis of diabetes mellitus by study onset.
Patients were evaluated by an ophthalmologist who had no information about metabolic control of the patients. Retinal examination was performed by an ophthalmologist using direct and indirect through dilated pupils with ophthalmoscope of TOPCON and by Slit-Lamp TOPCON, along with 90 +VOLKE lens. Data were analyzed using SPSS v.17.
In the study, 256 patients with diabetes attending the diabetes clinic of Golestan hospital of Ahvaz in 2010 were studied of which 81 were male (31.7%) and 175 females (68.3%).
Patients aged 15 - 87 years in the study with an average of 54 ± 10.27. Duration of diagnosed diabetes was 1 - 384 months with an average 93.39 ± 78.6. Prevalence of diabetic retinopathy was 22.3%, the most common prevalence age was 51 - 70 years (81% of cases). Prevalence of cataract was 30.5%. 23.4% of patients were with cardiovascular disease; 4.7% of patients were with chronic kidney disease; 3% of patients had cerebrovascular events; 13.7% of the patients were smokers; and 65.6 percent had a family history of diabetes.
Furthermore, 60% of patients were with albuminuria BP ≥ 125.75; and 55.3% of patients were without albuminuria BP ≥ 130/80.
Levels of fasting blood glucose, 24-hour urinary albuminuria, glycosylated hemoglobin (HbA1C), duration of diabetes and systolic blood pressure were differed among patients with and without retinopathy (
The blood pressure 60% of patients with albuminuria group and 55.3% of patients in the group without albuminuria were higher than goals of blood pressure control.
Diabetic retinopathy associated with Duration of diabetes and BMI, OR = 0.98 (95% CI: 0.98 - 0.99) P value = 0.0001, OR = 0.93 (95% CI: 0.86 - 0.99) and P value = 0.043 respectively (
There were not significant difference between subject with & without diabetic retinopathy in total cholesterol LDL, HDL, TG, Cr, Diastolic BP, types of treatment, cardiovascular disease, chronic kidney disease, stroke & smoking.
95% CI | P.V | SD | Mean | Number | Diabetic Retinopathy | |
---|---|---|---|---|---|---|
−10.6 - 14.8 | 0.75 | 46.6 | 183.9 | 57 | Yes | Chol |
42 | 181.8 | 199 | No | |||
−3.98 - 19.86 | 0.19 | 41.4 | 104 | 57 | Yes | LDL |
33.8 | 96.1 | 199 | No | |||
−4.25 - 2.36 | 0.57 | 10.9 | 47.3 | 57 | Yes | HDL |
11.26 | 48.2 | 199 | No | |||
−68.1 - 5.39 | 0.09 | 86.12 | 161.6 | 57 | Yes | TG |
133 | 193 | 199 | No | |||
−0.03 - 0.11 | 0.31 | 0.3 | 0.98 | 57 | Yes | Cr |
0.2 | 0.94 | 199 | No | |||
2.76 - 4804 | 0.03 | 83.33 | 191.1 | 57 | Yes | FBS |
74.4 | 165.8 | 199 | No | |||
8.82 - 233.2 | 0.03 | 404.7 | 181.3 | 57 | Yes | 24 Urine alb |
238.9 | 60.3 | 199 | No | |||
−0.49 - 2.29 | 0.2 | 4.94 | 28.95 | 57 | Yes | BMI |
4.65 | 28.05 | 199 | No | |||
0.29 - 11.21 | 0.04 | 21.28 | 124.3 | 57 | Yes | SBP |
17.8 | 118.5 | 199 | No | |||
0.81 - 5.8 | 0.14 | 11.6 | 77.9 | 57 | Yes | DBP |
11 | 75.4 | 199 | No | |||
51.5 - 101.8 | 0.0004 | 88.38 | 153 | 57 | Yes | Duration of DM |
66.68 | 76.32 | 199 | No | |||
0.09 - 1.25 | 0.02 | 2.07 | 9.14 | 57 | Yes | HbA1C |
1.92 | 8.47 | 199 | No |
*P < 0.05 significant.
P.V | 95% Confidence Interval | Odd Ratio | Risk Factors |
---|---|---|---|
0.0001 | 0.98 - 0.99 | 0.98 | Duration of D.M |
0.043 | 0.86 - 0.99 | 0.93 | BMI |
0.29 | 0.43 - 1.28 | 0.74 | Insulin or Tablets |
0.32 | 0.25 - 1.56 | 0.63 | Cardiovascular Disease |
0.43 | 0.26 - 21.1 | 2.37 | Chronic Kidney Disease |
0.07 | 0.9 - 7.57 | 2.61 | Smoking |
0.46 | 0.02 - 5.11 | 0.38 | Stroke |
*P < 0.05 significant.
*Corresponding author.
In current study, the prevalence of diabetic retinopathy in the patients with known diabetes was 22.3%, which was more than a prevalence of retinopathy of 17.6% in India, based on Cures’s study, and less than a prevalence of the 25.7% of retinopathy in the Chinese-Americans residents in America [
In current study, long duration of diabetes and high BMI were established risk factors for diabetic retinopathy which was similar to a study done in Singapore among patients with diabetes mellitus [
Other risk factors for retinopathy were high levels of glycosylated hemoglobin, (HbA1C) and fasting blood glucose and systolic blood pressure and 24-hour urinary albuminuria. Similar results about of glycosylated hemoglobin and systolic blood pressure were shown in the study of Singapore [
We could not find associations between diabetic retinopathy and total cholesterol, TG, HDL, LDL, insulin therapy (similar to Los Angeles Study) but Singapore study showed effects of total cholesterol in diabetic retinopathy. Our study could find any association between diabetic retinopathy creatinine. The study in Singapore showed a relationship between sight-threatening retinopathies with previous history of stroke, cardiovascular disease and chronic kidney disease. Additionally, a prospective multi-center study [
This evidence suggests that the risk of occurrence of diabetic retinopathy is associated with modifiable and non-modifiable factors that can be reduced by controlling its modifiable factors such as high blood sugar, high blood pressure and the risk reduction of microalbuminuria and weight loss in patients with diabetes.
This paper issued from Drs. Ferdos Zaman thesis register number D/130. Financial support was provided by Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences.
The authors declare that they have no competing interests.