Introduction: Diabetic retinopathy is the retinal location of diabetic microangiopathy. It is a public health problem and one of the target diseases of the global Vision 2020 initiative. The aim of our study was to determine the epidemiological features and risk factors of diabetic retinopathy in the melanoderma African in Abidjan. Materials and Methods: We carried out a prospective observational study which took place from April to September 2016 and which focused on the diabetic subjects received in consultation in the Ophthalmology Department of Cocody University Hospital. All Patients had had bio-microscopic examination of the fundus with Goldman three-mirror contact lens and optic coherence tomography of the macula and, in some cases, retinal fluorescein angiography. Results: Out of a population of 448 patients, 200 had diabetic retinopathy. That is a prevalence of 45%. The prevalence of macular edema was 6%. The subpopulation of subjects with retinopathy consisted of 61.5% (123) of male patients versus 38.5% (77) of female patients. The mean age of female patients with retinopathy was 42 ± 14.08 years and that of male patients 58 ± 15.07 years. The majority of patients with retinopathy lived in urban areas (73%), and had type II diabetes. The duration of evolution of diabetes was 5 to 10 years in 65% of cases. Obesity, smoking, dyslipidemia and high blood pressure were the main factors of co-morbidity associated with poor glycemic control. Discussion: Diabetic retinopathy had a high prevalence and predominated in males. Maculopathy was represented by macular edema, which is the leading cause of diabetes-related blindness. Conclusion: The prevention of blindness related to diabetes requires regular multidisciplinary follow-up in order to treat retinal damage early.
Diabetic retinopathy is the retinal location of diabetic microangiopathy. It is a public health problem and one of the target diseases of the global “Vision 2020” initiative. Diabetic macular edema is the leading cause of diabetes-related blindness and the leading cause of blindness before the age of 60 in industrialized countries [
We carried out in the Ophthalmology Department of Cocody University Hospital, a prospective observational study that took place from April to September 2016. We included all diabetic patients (Type 1 or Type 2) received in Ophthalmology consultation during the study period. Each patient had had an ophthalmologic examination with a fundus examination with Goldmann three-mirror contact lens after dilatation. An optical coherence tomography of the macula was performed systematically in all patients in search of macular edema. The classification of ALFEDIAM [
The statistical analysis of the data was carried out using the Epi-Info version 3.5.3 software.
Out of a population of 448 diabetic subjects included in the study, 200 of them had diabetic retinopathy that is a prevalence of 45% (
Diabetic retinopathy was observed in 11.27% of cases in type I diabetics and in 88.72% of cases in type II diabetics.
We found 67.5% (135 patients) of non-proliferative diabetic retinopathy and 32.5% (65 patients) of proliferative diabetic retinopathy among the patients with diabetic retinopathy.
Evolutionary stages | Frequencies | Percentages |
---|---|---|
NPDR | 135 | 67.5 |
Minimal | 53 | 26.5 |
Moderate | 54 | 27 |
Severe | 28 | 14 |
PDR | 65 | 32.5 |
incipient | 26 | 13 |
Moderate | 22 | 11 |
Severe | 11 | 5.5 |
Complicated | 06 | 03 |
NPDR: Non-proliferative diabetic retinopathy. PDR: Proliferative diabetic retinopathy.
We did not observe macular ischemia but the prevalence of diabetic macular edema was 5.5% of the subjects (11 patients) with diabetic retinopathy. Seven patients (3.5%) were type I diabetics and four (2%) type II diabetics.
All patients with diabetic macular edema had severe or complicated proliferative diabetic retinopathy.
Macular edema involved 15 eyes of 11 patients and was bilateral in four of them that is 36.36% of patients with macular edema.
The distribution of patients with diabetic retinopathy by gender showed a clear male predominance. Indeed we observed 61.5% (123) of males versus 38.5% (77) of females. That is a sex ratio of 1.59 in favor of men.
Age (years) | Gender | Number | Perrcentages |
---|---|---|---|
20 - 30 | M* | 04 | 2 |
F* | 03 | 1.5 | |
30 - 40 | M | 13 | 6.5 |
F | 11 | 5.5 | |
40 - 50 | M | 49 | 24.5 |
F | 44 | 22 | |
50 - 60 | M | 37 | 18.5 |
F | 12 | 6 | |
>60 | M | 20 | 10 |
F | 07 | 3.5 |
M: male; F: female; the mean age of women was 42 years ± 14.08 (38 - 70 years) and that of men 58 years ± 15.07 (31 - 65 years).
73% of patients lived in urban areas.
We found that 48% of patients with diabetic retinopathy had a university level of education.
The population of patients with diabetic retinopathy was composed of 78% of subjects (n = 156) with type II diabetes and 22% of subjects (n = 44) with type I diabetes.
Patients’ mean fasting glucose level was 1.73 ± 0.83 g/l with extremes ranging from 0.71 to 3.76. Glycated hemoglobin was greater than 6% in 44.5% (89) of patients and less than 6% in 34.5% (21) of patients. In 21% (42) of them, the test was not carried out during the study period for financial reasons.
Diabetes was known for less than 5 years in 7% (n = 14) of patients; it had an age ranging between 5 and 10 years in 65% of cases (n = 130) and greater than 10 years in 28% (n = 56) of cases.
Obesity was the most frequently identified risk factor (56.5%) in patients with diabetic retinopathy. The average body mass index of obese patients was 33.4 ± 2.1 kg/m2.
In hypertensive patients (43%), the mean systolic pressure was 164.5 ± 39.8 mmHg and the mean diastolic pressure was 90.2 ± 19.4 mmHg.
The mean proteinuria of patients with nephropathy (11%) was 2.5 ± 0.70 g/l and serum creatinine was 66 ± 26.1 mg/ l.
The majority of patients (44%) had an annual follow-up with the diabetologist whereas the pace of ophthalmology consultations was greater than 1 year in 53% of them.
In addition, the notion of weekly home fasting blood glucose monitoring using a blood glucose meter was found in 16.5% (n = 33) of patients.
The minimal and moderate stages of NPDR have benefited from a balancing of blood glucose and other co-morbidities. Severe NPDR and early, moderate, severe, and even complicated PDRs have benefited from argon laser pan-retinal photocoagulation in addition to the previous measures. The proper treatment of TRDs has suffered from the lack of a technical platform for vitreoretinal surgery in our context.
Diabetic retinopathy is the main ophthalmological complication of the diabetic patient and is the leading cause of blindness in people under 60 in industrialized countries [
Edematous diabetic Maculopathy is the leading cause of blindness in people under 60 in industrialized countries [
Diabetic retinopathy was more common in males and was predominant in the 40 to 50 age group in both genders (
This type of diabetes is a risk factor for diabetic retinopathy and Maculopathy. In this study, the high prevalence of type II diabetics in patients with retinopathy could be explained by a system of recruitment related to the greater representation of this subpopulation in our sample. These retinal complications of diabetes are more common in type I diabetics [
Whatever the type of diabetes, the glycemic balance and duration of the evolution of the disease are important factors in the incidence of diabetic retinopathy. An average blood glucose level of 1.73 +/− 0.83 g/l and a glycated hemoglobin level greater than 6% in 44.5% of patients showed poor glycemic control in many patients with diabetic retinopathy in our study. The duration and severity of fasting hyperglycemia as well as high glycated hemoglobin (greater than 6%) are major factors in the occurrence and progression of diabetic retinopathy. But there is no threshold for glycated hemoglobin below which this risk vanishes [
The prevalence of diabetic retinopathy also increases with the age of diabetes to reach, in the best cases, a plateau after 15 to 20 years [
In addition to the age of diabetes, and the glycemic balance, the other risk factors for the occurrence or aggravation of diabetic retinopathy were obesity, smoking, dyslipidemia, alcoholism, cataract surgery, sedentary lifestyle, nephropathy and pregnancy (
High blood pressure is very often associated with diabetes. In the diabetic patient, arterial hypertension, whether systolic or diastolic, is a risk factor for the occurrence of diabetic retinopathy. This association would be linear with an increase in risk of 3% to 20% for 10 mmHg increase in systolic blood pressure and 2% to 30% in case of a 10 mmHg increase in diastolic blood pressure [
As for dyslipidemias, despite the discordant results of some studies, it should be remembered that they constitute risk factors for the occurrence and progression of diabetic retinopathy. Hence the importance of standardizing the lipid balance in diabetics [
Diabetic nephropathy is a marker of advanced diabetes. This is a serious micro-vascular complication such as diabetic retinopathy. This explains their frequent correlations [
The occurrence of pregnancy in diabetic women is a risk factor for the onset or aggravation of diabetic retinopathy, particularly since there is pre-existing advanced retinopathy, whether there is arterial hypertension or preeclampsia [
Co-morbidity factors | Frequency | percentage |
---|---|---|
Obesity | 113 | 56.50 |
Smoking | 95 | 47.50 |
High Blood Pressure | 86 | 43.00 |
Dyslipidemia | 83 | 41.50 |
Alcoholism | 51 | 25.50 |
Cataract surgery | 38 | 19.00 |
Sedentary lifestyle | 30 | 15.00 |
Nephropathy | 22 | 11.00 |
Pregnancy | 11 | 5.50 |
Quaterly | Half-yearly | Annual | >1an | |
---|---|---|---|---|
Diabetologist | 7.5% (15) | 17% (34) | 44% (88) | 31.5% (63) |
Ophtalmologist | 5.5% (11) | 12% (24) | 29.5% (59) | 53% (106) |
A history of cataract surgery was found in 19% of our patients with diabetic retinopathy. Cataract surgery is a risk factor for the onset or aggravation of diabetic retinopathy. It is therefore imperative to stabilize diabetes before any cataract surgery in diabetics [
In addition, our study has revealed a poor medical follow-up of diabetic patients with an annual diabetological consultation at most in 75.5% of patients which led to poor ophthalmological follow-up (
So, the poor glycemic balance, and the other co-morbidity factors we studied can explain the early onset of diabetic retinopathy in the study population
At the end of this study, we know that the prevalence of diabetic retinopathy was 45%. It predominated in males and was more prevalent in the 40 to 50 age group. Poor glycemic control, obesity, smoking and high blood pressure were the most common risk factors. They explain an early onset of diabetic retinopathy between 5 and 10 years of age. Reducing diabetes blindness requires an awareness of diabetic patients to better diabetological and ophthalmological follow-up. Sensitization and screening campaigns are to be carried out at least annually to improve the management of diabetes and these complications in Abidjan.
Ophthalmology Department of Cocody University Hospital-Abidjan.
The authors declare no conflicts of interest regarding the publication of this paper.
Kouassi, F.X., Koman, C.E., Kra, A.N.S., Soumahoro, M., Sowagnon, T.Y.C. and N’dohi, R. (2018) Epidemiological Features of Diabetic Retinopathy in Abidjan (Côte d’Ivoire): A Study about 448 Patients. Open Journal of Ophthalmology, 8, 140-149. https://doi.org/10.4236/ojoph.2018.83018