Prevalence, Awareness, and Risk Factors of Diabetic Retinopathy among Adults with Known Type 2 Diabetes Mellitus in an Urban Community in China

Barriers to the uptake of eye care services: A cross-sectional survey from rural and urban communities

PURPOSE

To explore the barriers to the uptake of eye care services in urban and rural communities in Papua New Guinea.

METHODS

This was a population-based cross-sectional descriptive study and involved multi-stage sampling. Communities were randomly selected from each of the three clusters of Madang District for free eye care outreaches from June to September 2022. A structured questionnaire was used to collect data from the outreach patients. The study excluded attendees who refused to consent. Responses were rated from 1 (not a barrier) to 10 (a very strong barrier). The p-value significance was set at ≤ 0.05.

RESULTS

The majority of the 972 participants (60.2%) were from rural communities. The mean age of participants was 40.82 ± 13.14 years. Almost two-thirds of the participants (61.4%) never had an eye examination before this study was conducted. All the participants reported that time constraint, insufficient income, good vision in the fellow eye, not considering their eye conditions as serious issues and cultural beliefs were personal barriers to accessing eye care services. Provider-related challenges included long waiting periods at eye clinics and fear of procedure complications. There were differences in barriers with respect to the participants' demographic clusters.

CONCLUSION

There are major personal- and service-related barriers to eye care services in Madang. These barriers could be overcome through strategic human resource development, health education, school screening programs, and establishing eye care centres in the communities to improve the uptake of eye care services in Madang and more widely across the country.

Prevalence of diabetic retinopathy and its risk factors in rural patients with type 2 diabetes referring to Beijing Huairou Hospital, China

BACKGROUND

China has the largest population of diabetic patients worldwide. A diverse population and regional discrepancy in access to health care and diabetes management may lead to unique risk factors for diabetic retinopathy (DR) in different regions of China. This study aimed to evaluate the prevalence and risk factors of DR in rural patients with type 2 diabetes.

METHODS

This hospital-based cross-sectional study recruited a sample of 704 type 2 diabetic patients from rural areas referred to Beijing Huairou Hospital, China, from June 1, 2022, to June 1, 2023. The medical history, demographic information, and results of laboratory examinations of patients were collected and analyzed. The diagnosis of DR were performed by experienced ophthalmologists using mydriatic fundus photography.

RESULTS

Out of all patients, 53.8% were male and 46.2% were female. The mean age of patients and duration of diabetes were 54.9 ± 13.0 and 6.2 ± 4.5 years, respectively. The DR prevalence was 16.8%. The independent risk factors for DR in multivariate analysis were diabetes duration > 10 years (OR = 9.16, 95%CI = 5.49-15.30), fasting plasma glucose ≥ 7.2 mmol/L (OR = 3.25, 95%CI = 1.42-7.42), glycosylated hemoglobin ≥ 7% (OR = 6.49, 95%CI = 2.59-16.23), hypertension (OR = 1.59, 95%CI = 1.05-2.40), hyperlipidemia (OR = 2.16, 95%CI = 1.30-3.59), diabetic nephropathy (OR = 1.95, 95%CI = 1.17-3.23), high uric acid level (OR = 3.57, 95%CI = 1.56-8.15), high albumin to creatinine ratio (OR = 2.48, 95%CI = 1.06-5.82), and insulin treatment (OR = 1.79, 95%CI = 1.12-2.88).

CONCLUSIONS

This study evaluated the DR prevalence and its associated risk factors among type 2 diabetic patients from rural areas in Beijing's Huairou District, China. Paying attention to these risk factors may be useful in screening high-risk diabetic patients for DR and adopting early preventive and therapeutic interventions.

The Patients' Perspective for the Impact of Late Detection of Ocular Diseases on Quality of Life: A Cross-Sectional Study

Background

Late detection of ocular diseases negatively affects patients' quality of life (QoL), encompassing health status, psychological, financial, and social aspects. However, the early detection of eye conditions leads to rapid intervention and avoiding complications, thus preserving the QoL. This study assessed the impact of ocular diseases late detection on patients' QoL at multi-eye clinics based on questionnaire responses.

Methods

We developed an original Arabic-English questionnaire to assess the QoL of patients with ocular diseases referred from primary and secondary healthcare centers to tertiary hospitals. It covered preliminary data, patient perspectives on having lately detected ocular disease and treatment costs, and the impact of late detection on finances, social life, psychology, health status, and awareness of current initiatives. Logistic regression analysis was used to explore the associations between patient perspectives on having ocular diseases detected at a late stage and its impact on different domains. Multivariate logistic regression was applied with impact types of health status, psychological, financial, and social (dependent variables) and age, income levels, and hospital type (independent variables).

Results

Three hundred and eighty-eight responded, with 50% experiencing psychological effects, 27% health issues, 23% social impacts, and 23% financial burdens. Two hundred seventeen patients (56%) reported having ocular condition detected in late stage. Logistic regression analysis showed positive association with health status, social well-being, and financial effects (p < 0.05). Multivariate analysis revealed pronounced effects in patients ≤ 50 years, with income \< 5000 SAR, and those visiting private clinics (p < 0.05). The social impact was greater in patients visiting private hospitals. Ninety percent of all patients emphasized the importance of increasing awareness for better QoL.

Conclusion

Significant associations were found between the late detection of eye diseases and their impact on QoL. Therefore, early detection and increasing patients' awareness of ocular diseases and treatment are essential.

Diabetic retinopathy in China: Epidemiology, screening and treatment trends-A review

Diabetic retinopathy (DR) is the leading cause of vision impairment in the global working-age population. In China, with one-third of the world's diabetes population estimated at 141 million, the blindness prevalence due to DR has increased significantly. The country's geographic variations in socioeconomic status have led to prominent disparities in DR prevalence, screening and management. Reported risk factors for DR in China include the classic ones, such as long diabetes duration, hyperglycaemia, hypertension and rural habitats. There is no national-level DR screening programme in China, but significant pilot efforts are underway for screening innovations. Novel agents with longer durations, noninvasive delivery or multi-target are undergoing clinical trials in China. Although optimised medical insurance policies have enhanced accessibility for expensive therapies like anti-VEGF drugs, further efforts in DR prevention and management in China are required to establish nationwide cost-effective screening programmes, including telemedicine and AI-based solutions, and to improve insurance coverage for related out-of-pocket expenses.

A Pilot Study of Implementing Diabetic Retinopathy Screening in the Oslo Region, Norway: Baseline Results

PURPOSE

to gain insight into the baseline parameters of a population with diabetes mellitus (DM) included in a pilot diabetic retinopathy (DR) screening program at Oslo University Hospital (OUH), Norway.

METHODS

This was a cross-sectional study of a cohort of adult patients (≥18 years) with type 1 or 2 DM (T1D and T2D). We measured the best-corrected visual acuity (BCVA), blood pressure (BP), heart rate (HR), intraocular pressure (IOP), height and weight. We also collected HbA1c, total serum cholesterol and urine-albumin, -creatinine and -albumin-to-creatinine ratio (ACR), as well as socio-demographic parameters, medications and previous screening history. We obtained color fundus photographs, which were graded by two experienced ophthalmologists according to the International Clinical Disease Severity Scale for DR.

RESULTS

The study included 180 eyes of 90 patients: 12 patients (13.3%) had T1D and 78 (86.7%) had T2D. In the T1D group, 5 patients (41.7%) had no DR, and 7 (58.3%) had some degree of DR. In the T2D group, 60 patients (76.9%) had no DR, and 18 (23.1%) had some degree of DR. None of the patients had proliferative DR. Of the 43 patients not newly diagnosed (time of diagnosis > 5 years for T1D and >1 years for T2D), 37.5% of the T1D patients and 5.7% of the T2D patients had previously undergone regular screening. Univariate analyses found for the whole cohort significant associations between DR and age, HbA1c, urine albumin-to-creatinine ratio, body mass index (BMI) and duration of DM. For the T2D group alone, there were significant associations between DR and HbA1c, BMI, urine creatinine, urine albumin-to-creatinine ratio and duration of DM. The analysis also showed three times higher odds for DR in the T1D group than the T2D group.

CONCLUSIONS

This study underscores the need for implementing a systematic DR screening program in the Oslo region, Norway, to better reach out to patients with DM and improve their screening adherence. Timely and proper treatment can prevent or mitigate vision loss and improve the prognosis. A considerable number of patients were referred from general practitioners for not being followed by an ophthalmologist.Among patients not newly diagnosed with DM, 62.8% had never had an eye exam, and the duration of DM for these patients was up to 18 years (median: 8 years).

Risk factor analysis and clinical decision tree model construction for diabetic retinopathy in Western China

BACKGROUND

Diabetic retinopathy (DR) is the driving force of blindness in patients with type 2 diabetes mellitus (T2DM). DR has a high prevalence and lacks effective therapeutic strategies, underscoring the need for early prevention and treatment. Yunnan province, located in the southwest plateau of China, has a high pre-valence of DR and an underdeveloped economy.

AIM

To build a clinical prediction model that will enable early prevention and treatment of DR.

METHODS

In this cross-sectional study, 1654 Han population with T2DM were divided into groups without (n = 826) and with DR (n = 828) based on fundus photography. The DR group was further subdivided into non-proliferative DR (n = 403) and proliferative DR (n = 425) groups. A univariate analysis and logistic regression analysis were conducted and a clinical decision tree model was constructed.

RESULTS

Diabetes duration ≥ 10 years, female sex, standing- or supine systolic blood pressure (SBP) ≥ 140 mmHg, and cholesterol ≥ 6.22 mmol/L were risk factors for DR in logistic regression analysis (odds ratio = 2.118, 1.520, 1.417, 1.881, and 1.591, respectively). A greater severity of chronic kidney disease (CKD) or hemoglobin A 1c increased the risk of DR in patients with T2DM. In the decision tree model, diabetes duration was the primary risk factor affecting the occurrence of DR in patients with T2DM, followed by CKD stage, supine SBP, standing SBP, and body mass index (BMI). DR classification outcomes were obtained by evaluating standing SBP or BMI according to the CKD stage for diabetes duration < 10 years and by evaluating CKD stage according to the supine SBP for diabetes duration ≥ 10 years.

CONCLUSION

Based on the simple and intuitive decision tree model constructed in this study, DR classification outcomes were easily obtained by evaluating diabetes duration, CKD stage, supine or standing SBP, and BMI.

Epidemiology, health policy and public health implications of visual impairment and age-related eye diseases in mainland China

The prevalence of visual impairment (VI) and age-related eye diseases has increased dramatically with the growing aging population in mainland China. However, there is limited comprehensive evidence on the progress of ophthalmic epidemiological research in mainland China to enhance our awareness of the prevention of eye diseases to inform public health policy. Here, we conducted a literature review of the population-based epidemiology of VI and age-related eye diseases in mainland China from the 1st of January 1946 to the 20th of October 2021. No language restrictions were applied. There was significant demographic and geographic variation in the epidemic of VI and age-related eye diseases. There are several factors known to be correlated to VI and age-related eye diseases, including age, gender, family history, lifestyle, biological factors, and environmental exposures; however, evidence relating to genetic predisposition remains unclear. In addition, posterior segment eye diseases, including age-related macular degeneration and diabetic retinopathy, are amongst the major causes of irreversible visual impairments in the senile Chinese population. There remains a significant prevention gap, with only a few individuals showing awareness and achieving optimal medical care with regards to age-related eye diseases. Multiple challenges and obstacles need to be overcome, including the accelerated aging of the Chinese population, the lack of structured care delivery in many underdeveloped regions, and unequal access to care. Despite the progress to date, there are few well-conducted multi-center population-based studies following a single protocol in mainland China, which findings can hopefully provide valuable cues for governmental decision-making and assist in addressing and halting the incidence of VI and age-related eye diseases in China.

Prevalence and risk factors of diabetic retinopathy among Chinese adults with type 2 diabetes in a suburb of Shanghai, China

Background

To investigate the prevalence and risk factors of diabetic retinopathy (DR) in a Chinese population with type 2 diabetes mellitus (T2DM) in a suburb (Qingpu) of Shanghai, China.

Methods

A population-based cross-sectional study. A total of 7462 residents with T2DM in Qingpu were enrolled according to the resident health archives from January 2020 to December 2020. Blood and urine samples of the subjects were collected. Disc- and macula-centred retinal images were taken to assess DR. SPSS was used to analyse and investigate the prevalence and risk factors of DR.

Results

The fundus images of 6380 (85.5%) subjects were of sufficiently good quality for grading. The average (range) age of 6380 subjects was 63.46±7.77 (28–92) years. Six hundred forty-four subjects were diagnosed with DR. The prevalence of DR was 10.1% (95% CI 9.4%-10.8%), with mild, moderate, and severe non-proliferative retinopathy and proliferative retinopathy being 2.1%, 6.3%, 1.3% and 0.4%, respectively. The prevalence of bilateral DR was 6.5%. Higher T2DM duration (OR, 1.057), fasting plasma glucose (OR, 1.063), glycated hemoglobinA1c (OR, 1.269), urea nitrogen (OR, 1.059), and urinary albumin (OR, 1.001) were associated with the higher DR prevalence.

Conclusion

The prevalence of DR among Chinese adults with T2DM in Qingpu was 10.1%, in which non-proliferative DR was more common. Higher fasting plasma glucose and glycated hemoglobinA1c are well-known risk factors of DR, consistent with the findings in our study. Our study didn’t find the risk between lipid indicators and DR. However, several renal function indicators, like higher urea nitrogen and urinary albumin, were risk factors for DR in this study. Appropriate diagnosis and intervention should be taken in time to prevent and control DR development.

Dietary patterns, skeletal muscle mass loss, and cardiovascular risk among elderly men: A preliminary cross-sectional study in Sichuan province

The present study investigated the correlation between dietary patterns (DPs) with skeletal muscle mass (SMM) and cardiovascular risks in Sichuan males aged ≥65-years-old. Three major DPs were extracted by principal component analysis: animal-based and processed food, traditional food, and ovo-lacto vegetarian food, which accounted for 14.83%, 14.36%, and 11.86% of the variance, respectively. Adjusted logistic regression analysis showed that animal-based and processed food DP was positively associated with overweight/obesity(OR: 3.25, 95% CI: 1.94-5.46) and dyslipidemia(OR: 3.53, 95% CI: 2.00-6.22). Traditional DP was negatively associated with overweight/obesity(OR: 0.51, 95% CI: 0.36-0.72), dyslipidemia(OR: 0.50, 95% CI: 0.35-0.75), and high blood pressure(OR: 0.54, 95% CI: 0.38-0.77), but positively associated with decreased SMM (OR: 2.21, 95% CI: 1.36-3.16). Ovo-lacto vegetarian DP was negatively associated with dyslipidemia (OR: 0.56, 95% CI: 0.39-0.81) and hyperuricemia (OR: 0.56, 95% CI: 0.39-0.79), but positively associated with decreased SMM (OR: 1.57, 95% CI: 0.74-2.32). How to choose the best DP to control the cardiovascular risks and fight skeletal muscle loss needs further investigation in the future.

Assessment of Knowledge, Attitude, and Practice Regarding Diabetic Retinopathy in an Urban Population in Northeast China

Objective

This study aimed to assess the knowledge, attitude, and practice (KAP) of diabetic subjects with diabetic retinopathy (DR) and those without DR (NDR) in an urban community in Northeast China, as well as their risk factors in subjects with DR and NDR.

Methods

A community-based survey involving 1,662 subjects was conducted in Fushun, China, between July 2012 and May 2013. The subjects included diabetics with DR (n = 783) and those NDR (n = 879), and questionnaires were completed to collect information about their sociodemographic and healthcare characteristics. A Chi-square test and multiple logistic analyses were performed to analyze the data.

Results

Among the DR group, 21.88% had a good knowledge of DR, 94.15% had a positive attitude, and 68.07% followed good practice, whereas 20.98% of the NDR group had a good knowledge of DR, 94.18% had a positive attitude, and 66.92% followed good practice. There was no significant difference in the KAP of the two groups of subjects. In the NDR group, a good level of knowledge was associated with a high-level of education (OR = 0.1, 0.2; p < 0.05), a good attitude was associated with retirement (OR = 0.2; p < 0.05), and good practice was associated with being female, having a high-level of education, and the type of treatment (OR = 0.5, 0.4, 2.3, 3.1; p < 0.05). In the DR group, good practice was associated with older age and retirement (OR = 0.6, 0.4; p < 0.05).

Conclusions

There was no significant difference between the DR and NDR subjects in the overall levels of KAP, but both groups showed a poor level of knowledge. Age, gender, education, occupation, and type of treatment were the main factors associated with the KAP scores, more risk factors in the NDR group than in the DR group. There is an urgent need for coordinated educational campaigns with a prioritized focus on the northeast region of China, especially NDR group.

Knowledge of ocular complications of diabetes in community-based people with type 2 diabetes: The Fremantle Diabetes Study II

AIMS

To assess knowledge of diabetes-related eye disease in Australians with type 2 diabetes and its associations with diabetic retinopathy (DR), other ocular complications and vision-related quality of life.

METHODS

A random sample from the Fremantle Diabetes Study Phase II cohort (n = 360) was invited to participate. Knowledge was assessed using 10 multiple-choice questions covering how diabetes affects the eyes, frequency of ophthalmic screening, risk factors, prevention, available treatments, and prognosis. DR was assessed from fundus photographs. Multiple linear regression was used to identify independent associates of the knowledge score (KS).

RESULTS

We included 264 participants (mean ± SD age 72.1 ± 9.2 years, 56.8% male, median [IQR] diabetes duration 15.4 [11.1-22.3] years). The mean ± SD KS out of 10 was 5.3 ± 1.8. Most (67%) participants knew diabetes can affect the eye and lead to blindness. Only 13.6% knew that DR screening intervals depend on risk factors. Those with moderate non-proliferative DR (NPDR) or worse had a better knowledge score (B = 1.37,P = 0.008) after adjusting for age (B = -0.03, P = 0.004) and education beyond primary school (B = 1.75, P < 0.001).

CONCLUSIONS

Overall knowledge of diabetes-related ocular complications was suboptimal. Education targeting eye disease may benefit people with type 2 diabetes who are older, less well educated and/or who have no DR/mild NPDR.

Burden of vision loss due to diabetic retinopathy in China from 1990 to 2017: findings from the global burden of disease study

PURPOSE

To conduct a detailed analysis on the burden of vision loss due to diabetic retinopathy (DR) by year, age and gender in China from 1990 to 2017.

METHODS

This is a between-country, retrospective, comparative burden-of-disease study. Prevalence and Years Lived with Disability (YLDs) data caused by DR in China and relative territories were extracted from the Global Burden of Disease (GBD) study 2017 to observe the changing trends of vision loss.

RESULTS

Prevalence and YLDs of DR in China increased significantly from 1990 to 2017. The age-standardized prevalence and YLDs rate witnessed a slowly declining trend recently. Higher prevalence and YLDs were observed in female subjects in the past three decades. Middle-aged and elderly people suffered from a higher burden of DR-induced vision loss. The total age-standardized prevalence rate of China in 1990 (17.68) and 2017 (21.88) was lower than that of other seven neighbouring countries. In 2017, moderate vision loss (MVL) (17.19) accounted for the largest proportion in China. The all-age YLDs of DR showed the second-highest increase (150.26%) while the age-standardized YLDs rate showed the third-highest increase (14.91%) among fifteen common causes of vision impairment (VI) from 1990 to 2017. China ranked 3rd among G20 countries in terms of all-age YLDs while ranked 18th in age-standardized YLDs rate in 2017.

CONCLUSIONS

In the past three decades, the prevalence and YLDs due to DR in China have improved in both genders. This study highlights the importance of prevention for DR, especially for women and the elderly.

Validation of handheld fundus camera with mydriasis for retinal imaging of diabetic retinopathy screening in China: a prospective comparison study

OBJECTIVES

To investigate the clinical validity of using a handheld fundus camera to detect diabetic retinopathy (DR) in China.

DESIGN AND SETTINGS

Prospective comparison study of the handheld fundus camera with a standard validated instrument in detection of DR in hospital and a community screening clinic in Guangdong Province, China.

PARTICIPANTS

Participants aged 18 years and over with diabetes who were able to provide informed consent and agreed to attend the dilated eye examination with handheld tests and a standard desktop camera.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome was the proportion of those with referable DR (R2 and above) identified by the handheld fundus camera (the index test) compared with the standard camera. Secondary outcome was the comparison of proportion of gradable images obtained from each test.

RESULTS

In this study, we examined 304 people (608 eyes) with each of the two cameras under mydriasis. The handheld camera detected 119 eyes (19.5%) with some level of DR, 81 (13.3%) of them were referable, while the standard camera detected 132 eyes (21.7%) with some level of DR and 83 (13.7%) were referable. It seems that the standard camera found more eyes with referable DR, although McNemar's test detected no significant difference between the two cameras.Of the 608 eyes with images obtained by desktop camera, 598 (98.4%) images were of sufficient quality for grading, 12 (1.9%) images were not gradable. By the handheld camera, 590 (97.0%) were gradable and 20 (3.2%) images were not gradable.The two cameras reached high agreement on diagnosis of retinopathy and maculopathy at all the levels of retinopathy.

CONCLUSION

Although it could not take the place of standard desktop camera on clinic fundus examination, the handheld fundus camera showed promising role on preliminary DR screening at primary level in China. To ensure quality images, mydriasis is required.

Knowledge and practices regarding diabetic retinopathy among diabetic patients registered in a chronic disease management system in eastern China

PURPOSE

To investigate the knowledge and practices regarding diabetic retinopathy (DR) among diabetic patients included in a community-based primary health system (CBPHS) in China.

METHODS

Diabetic patients aged 18 years and above registered in the CBPHS in Yueqing city, Zhejiang province were recruited. Information obtained by questionnaire included: demographic and socioeconomic status, knowledge about DR, and ocular and medical history. The primary outcome was whether the participant knew that DM can affect the eyes, defined according to the question: "Do you know diabetes mellitus (DM) can affect eyes? (yes or no)". A knowledge score was calculated based on the responses to seven questions, with 1 point awarded for a correct response and 0 points for an incorrect or uncertain answer.

RESULTS

A total of 1972 diabetic patients were included in the study with an average age of 65.2±10.8 years, 45.7% were male. One thousand two hundred and nineteen patients (61.8%) knew that DM can affect the eyes. Significant differences in age, education, income status, insurance covering eye care, fasting blood glucose, duration of DM, history of hypertension existed between subjects who knew and those who did not know that DM can affect the eyes (P<0.05 for all). The proportion of correct answers to the DR knowledge questions ranged from 33.3% to 61.8%, with an average score of 3.65±2.47. In the multiple regression analysis, the knowledge score was significantly associated with age, education, income, history of hypertension, duration of DM, being told that regular examinations should be performed and concern about vision loss (P <0.01 for all).

CONCLUSIONS

The knowledge toward DR among DM patients were still low within the chronic disease management system in eastern China. Routine ophthalmic screening, health care promotions, and educational programs should be emphasized and implemented for better DR prevention and management.

Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses

Objectives: To estimate the clinical and economic burden of type 2 diabetes (T2D) in established (EST) and emerging markets (EMG).Methods: Three systematic literature reviews were conducted in MEDLINE and Embase to capture all relevant publications reporting 1) the epidemiology of T2D and complications in T2D and 2) the economic burden of T2D and associated complications.Results: In total, 294 studies were included in this analysis. Evidence indicates a high and increasing overall prevalence of T2D globally, ranging up to 23% in EMG markets and 14% in EST markets. Undiagnosed cases were higher in EMG versus EST markets (up to 67% vs 38%), potentially due to a lack of education and disease awareness in certain regions, that could lead to important clinical and economic consequences. Poor glycemic control was associated with the development of several complications (e.g. retinopathy, cardiovascular diseases and nephropathy) that increase the risk of morbidity and mortality. Direct costs were up to 9-fold higher in patients with vs without T2D-related complications.Conclusions: The burden of T2D, related complications and inherent costs are higher in emerging versus established market countries. This review explores potential strategies to reduce costs and enhance outcomes of T2D treatment in developing countries.

Serum Levels of Vitamin D in Diabetic Patients With and Without Retinopathy

Purpose

To evaluate the levels of vitamin D in the serum of diabetic patients with and without diabetic retinopathy (DR).

Methods

Thirty patients with DR and thirty diabetic patients without retinopathy were included in this cross-sectional study. Based on ophthalmic examination, patients with DR were categorized into having non-proliferative retinopathy (NPDR) and proliferative retinopathy (PDR). Patients were tested for fasting blood sugar (FBS), hemoglobin A1C (HbA1C), 25-hydroxy vitamin D (25 (OH) D), and creatinine levels in the serum, and for urine protein. Vitamin D deficiency was defined as a serum 25 (OH) D level < 20 ng/mL.

Results

We found that all diabetic patients had mild vitamin D deficiency (serum 25 (OH) D level = 10–20 ng/mL). The mean serum 25 (OH) D concentration in patients with DR was lower than in those without DR (12.10 ± 14.62 ng/mL vs 15.61 ± 9.40 ng/mL, respectively, P = 0.012). Trace or more proteinuria was frequently present in patients with DR than in those without DR (56% in DR vs 30% in non-DR; P = 0.037). There were no significant differences in the FBS, HbA1C, and serum creatinine levels between patients with or without retinopathy.

Conclusion

The present study demonstrated that patients with DR had lower levels of serum vitamin D compared with those without retinopathy.

Long-Term Tea Consumption Is Associated with Reduced Risk of Diabetic Retinopathy: A Cross-Sectional Survey among Elderly Chinese from Rural Communities

AIM

To investigate the association between variables related to tea consumption (duration, frequency, and type) and the risk of diabetic retinopathy.

METHODS

A rural community-based, cross-sectional survey was conducted in Weitang Town, Suzhou, China. People aged 60 years or above were invited to complete the survey. All eligible patients underwent detailed eye examination. Diabetic retinopathy (DR) was diagnosed and graded based on the retinal fundus imaging. Diabetes was defined as fasting glucose concentrations of ≥7.0 mmol/L or self-reported diagnosis of diabetes. Information about tea consumption such as duration, type, and frequency, together with demographics and lifestyle characteristics, were collected using a face-to-face questionnaire interview. The association between tea consumption and the risk of DR was determined by univariate and multivariate logistic regression analyses.

RESULTS

Among the 5,281 participants, 614 had diabetes mellitus (prevalence of 11.63%). The prevalence rate of DR was 10.38% in the diabetic population and 1.04% in the general population. Compared with non-tea consumers, the crude OR values for DR in subjects with long-term and short-term tea consumption were 0.34 (95%CI = 0.14-0.82, p = 0.016) and 1.64 (95%CI = 0.74-3.64, p = 0.221), respectively. When adjusted for age, gender, and other confounders, consumption of tea for ≥20 years was associated with reduced odds of DR (OR = 0.29, 95%CI = 0.09-0.97, p = 0.044). Thus, long-term tea consumption was significantly associated with a lower risk of DR. There was no statistical significance between frequency or type of tea consumption with DR (p > 0.05).

CONCLUSION

Elderly diabetic Chinese residents who consumed tea for more than twenty years had a lower risk of DR compared to non-tea consumers. The long-term tea consumption may be an independent protective factor for DR. However, further studies are warranted to examine the association.

Rationale, Design, Methodology and Baseline Data of Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT)

Purpose: To describe the rationale, design, methodology and baseline characteristics of Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT), a community-based prospective cohort study in patients with type 2 diabetes mellitus (T2DM) living in northeast China.Methods: Patients with T2DM, aged 30 years and above from communities of Fushun city, Liaoning province, China, were recruited. The presence and severity of the diabetic retinopathy (DR) were determined by a modified Early Treatment Diabetic Retinopathy Study (ETDRS) retinopathy scale of 6 fields fundus photographs. Detailed ocular examinations and questionnaires were collated, in addition to blood and urine sample collection.Results: Of the 2224 subjects eligible for the FS-DIRECT, 2033 (91.4%) participated in the study. The majority of participants were female (58.9%), the average age was 62.1 ± 9.1 years. The overall prevalence rates of DR, non-proliferative DR, proliferative DR, diabetic macular edema, and vision-threatening retinopathy were 44.3%, 40.0%, 4.3%, 15.2%, and 12.3%, respectively. Compared to the patients without DR, patients with DR had lower income, an earlier onset of diabetes, a longer duration of diabetes, higher proportion of insulin use, higher fasting plasma glucose, HbA1c, systolic blood pressure, total cholesterol and high density lipoprotein, as well as a higher level of urine protein (all P < .05).Conclusion: The baseline data of FS-DIRECT showed a high prevalence of DR in a community of northeast China. Further investigation will provide key information about the risk factors, impact, and trends of DR in this region.

Burden of diabetic retinopathy in mainland China: Protocol for an updated systematic review and meta-analysis of prevalence and risk factors to identify prevention policies

BACKGROUND

Diabetic retinopathy (DR) is the leading cause of vision loss in adults of working age. Although existing systematic reviews of the prevalence of DR for mainland China have been reported, but several studies have been newly reported. Further some potential factors for DR are still discrepant and inconclusive. The aim of current research is to identify relevant literature regarding the prevalence of DR and DR-related factors in mainland China. In addition, we will project the number of individuals affected with DR in mainland China in years 2030 and 2050.

METHODS

This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. To identify publications in English or Chinese languages on the prevalence of DR in mainland China, a comprehensive step-by-step search of the PubMed, Embase, Web of Science, VIP Chinese Periodical, and China National Knowledge Infrastructure (CNKI) databases will be performed. Two reviewers will independently review the studies for eligibility according to the predefined inclusion and exclusion criteria. The quality of the included studies will be evaluated according to the National Health Institute Quality Assessment tool and Quality Assessment Manual. A random-effect model (DerSimonian-Laird method) will be used for the meta-analysis. Heterogeneity and publication bias among studies will be estimated by the I statistic and Begg funnel plot, respectively.

RESULTS

This systematic review study will provide an evidence of prevalence, risk factors, and national burden for DR in mainland China.

CONCLUSION

The study will give an explicit evidence to provide preventative measures of DR.PROSPERO registration number: CRD42018094565.

Elevated RBP4 plasma levels were associated with diabetic retinopathy in type 2 diabetes

The retinol-binding protein 4 (RBP4) has been postulated to play a role in glucose homeostasis, insulin resistance, and diabetes mellitus in human and animal studies. The aim of the present study was to evaluate the role of RBP4 in Chinese patients with type 2 diabetes mellitus with and without diabetic retinopathy (DR). Plasma RBP4 concentrations were tested in 287 patients with type 2 diabetes. At baseline, demographic and clinical information including presence of DR and vision-threatening DR (VTDR) was collected. The relationship between RBP4 and DR (VTDR) was investigated using logistic regression. Patients with DR or VTDR had significantly higher plasma levels of RBP4 on admission (P<0.0001). Receiver operating characteristics (ROCs) to predict DR and VDTR demonstrated areas under the curve for RBP4 of 0.79 (95% confidence interval (CI): 0.73–0.85) and 0.90 (95% CI: 0.85–0.94), respectively, which were superior to other factors. For each 1 μg/ml increase in plasma level of RBP4, the unadjusted and adjusted risk of DR would be increased by 8% (with the odds ratio (OR) of 1.08 (95% CI: 1.05–1.13), P<0.001) and 5% (1.05 (1.02–1.11), P=0.001), respectively. It was 12% (with the OR of 1.12 (95% CI: 1.07–1.18), P<0.001) and 9% (1.09 (1.05–1.15), P<0.001) for VTDR. The present study shows that elevated plasma levels of RBP4 were associated with DR and VDTR in Chinese patients with type 2 diabetes, suggesting a possible role of RBP4 in the pathogenesis of DR complications. Lowering RBP4 could be a new strategy for treating type 2 diabetes with DR.

Relationship between serum apolipoproteins levels and retinopathy risk in subjects with type 2 diabetes mellitus

AIMS

Prognostic significance of apolipoproteins in diabetic retinopathy risk has not been well investigated. The aim of this study was to reveal the relationship between the risk of diabetic retinopathy and the levels of several apolipoproteins and their ratios in a 10-year prospective cohort.

METHODS

A total of 1023 diabetic patients without retinopathy were selected from a 10-year hospital-based diabetic cohort. In this cohort, all subjects had type 2 diabetes. Blood samples were obtained, and serum levels of several apolipoproteins were measured. In the follow-up period, diabetic retinopathy was diagnosed by two ophthalmologists through a series of ophthalmologic examinations. A Cox proportional hazard analysis was adopted to determine the relationship between the risk of diabetic retinopathy and the levels of several apolipoproteins and their ratios.

RESULTS

In the follow-up period, 315 diabetic patients were suffered from diabetic retinopathy, and the remaining 708 patients did not. Baseline serum level of apoAI ≥ 7.4 μmol/L was related to the decreased risk of diabetic retinopathy (HR 0.86, 95% CI 0.70-0.99). Baseline levels of apoCIII ≥ 6.3 μmol/L, apoE ≥ 1.1 μmol/L, apoCIII-to-apoAI ratio ≥ 0.9 and apoE-to-apoAI ratio ≥ 0.2 were associated with the increased risk of this complication (HR 1.25, 95% CI 1.04-1.49; HR 1.23, 95% CI 1.03-1.47; HR 1.34, 95% CI 1.11-1.60; HR 1.21, 95% CI 1.01-1.46).

CONCLUSION

Elevated level of apoAI might be a protective factor for diabetic retinopathy. Increased levels of apoCIII, apoE, apoCIII-to-apoAI and apoE-to-apoAI ratios might be risk factors for this complication.

Diabetic retinopathy and health-related quality of life among Chinese with known type 2 diabetes mellitus

PURPOSE

We aim to describe the impact of diabetic retinopathy (DR) on health-related quality of life (HRQOL) among community-dwelling Chinese adults who had been previously diagnosed with type 2 diabetes mellitus (T2DM).

METHODS

A community-based survey including 913 patients with T2DM was conducted in Suzhou, China. Retinopathy lesions were graded according to the Airlie House classification system of the Early Treatment Diabetic Retinopathy Study. The HRQOL was measured by the Chinese version of the EuroQol Group's five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). A Gamma distribution with log link was incorporated into linear regression models to assess the associations between DR and EQ-5D-5L health utility score.

RESULTS

The mean EQ-5D-5L index scores were 0.971 ± 0.082 among individuals with unilateral DR and 0.970 ± 0.145 among those with bilateral DR, which were lower compared with those without DR (0.986 ± 0.045, P = 0.02). In multivariate analysis adjusting for confounders, people with bilateral DR reported lower the EQ-5D index scores compared with those without DR. The presence of DR was significantly associated with problems in usual activities (odds ratio [OR] = 0.16, P = 0.02, comparing participants with unilateral vs. no DR; OR = 0.11; P = 0.01, comparing participants with bilateral vs. no DR). No significant variations in EQ-5D-5L index scores as well as different domains of health problems between individuals with unilateral and bilateral DR were observed (P > 0.05).

CONCLUSION

Chinese T2DM patients with bilateral DR tend to report lower HRQOL scores compared with those without DR, especially in health problems associated with usual activities.

The Beijing Desheng Diabetic Eye Study: rationale, design, methodology and baseline data

AIM

To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study (BDDES), and to determine the prevalence of diabetic retinopathy (DR) and possible risk factors in patients with type 2 diabetes mellitus (T2DM) in an urban community of Beijing, China.

METHODS

Community-based prospective cohort study of persons diagnosed with T2DM aged 30y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic dispositions.

RESULTS

A total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male (P=0.031), lower income level (P=0.011), lower education background (P=0.022), longer duration of diabetes (P=0.001), younger age at diabetic onset (P=0.001), higher systolic blood pressure (P=0.007), higher glycosylated hemoglobin A1c levels (P=0.001), high albuminuria (P=0.03), and use of insulin (P<0.001). For vision-threatening DR, four factors were significant: younger age at diabetic onset (P<0.001), higher systolic blood pressure (P=0.042), high albuminuria (P<0.001), and use of insulin (P<0.001).

CONCLUSION

The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.

Diabetic Retinopathy in the Asia-Pacific

Diabetic retinopathy (DR), the most common complication of diabetes mellitus, is the leading cause of new cases of blindness in middle-aged and elderly in the Asia-Pacific. It has been estimated that 51% of all those with blindness due to DR globally (n = 424,400) and 56% of those with visual impairment due to DR (2.1 million) come from the Asia-Pacific. Prevalence of DR among those with diabetes ranged from 10% in India to 43% in Indonesia within the Asia-Pacific. Awareness of DR among persons with diabetes ranged from 28% to 84%. Most common modifiable risk factors for DR in the Asia-Pacific were hyperglycemia, blood pressure, dyslipidemia, and obesity. Implementation of systematic screening programs for DR and advancement in telemedicine screening methods have increased patient coverage and cost-effectiveness, though there are still numerous factors impeding screening uptake in the low-middle income regions of the Asia-Pacific. Management and treatment of DR in the Asia-Pacific is mainly limited to traditional laser retinopexy, but it is suboptimal despite new clinical approaches such as use of intravitreal anti.vascular endothelial growth factor and steroids due to limited resources. Further research and data are required to structure a more cost-effective public healthcare program and more awareness-building initiatives to increase the effectiveness of DR screening programs.

Combined effect of glycemic and blood pressure control on diabetic retinopathy among Chinese with type-2 diabetes mellitus

BACKGROUND

To explore the associations of glycemic and blood pressure (BP) control with diabetic retinopathy (DR), with special focus on whether different combinations of categories of these two interventions are additive.

METHODS

A community-based survey including 913 patients with known type-2 diabetes mellitus (T2DM) was conducted in Suzhou, China. Retinal photographs were graded for the presence of DR using the Airlie House classification system. BP and blood hemoglobin A1c (HbA1C) levels were measured by standardized protocols. Binary logistic regression models were established to examine the associations of risk factors with DR.

RESULTS

The overall prevalence of any DR was 18.0% [95% confidence interval (95% CI) 15.5-20.6%] in this population. Stratified by conventional control thresholds, lower levels of either systolic blood pressure (SBP, < 140 mmHg) or HbA1C (< 7.0%) were not significantly associated with decreased susceptibility to DR, while patients simultaneously with lower HbA1C and SBP levels demonstrated 43% reduced likelihood of developing DR [adjusted odds ratio (OR) = 0.57, 95% CI 0.33-0.99, P = 0.045)], comparing with those with both higher levels of HbA1C (≥ 7.0%) and SBP (≥ 140 mmHg). Meanwhile, the group achieved intensive HbA1C (< 6.5%) and SBP (< 120 mmHg) control goals were found to have the smallest OR, but failed in yielding statistical significance (P = 0.10).

CONCLUSIONS

In this community-based DR screening study of Chinese adults with T2DM, combination but not individual of lower SBP (< 140 mmHg) and HbA1C (< 7.0%) levels, were suggested to be associated with a significantly reduced likelihood of having DR.

Assessment of visual morbidity amongst diabetic retinopathy at tertiary eye care center, Nepal: a cross-sectional descriptive study

BACKGROUND

Diabetic retinopathy (DR) is one of the leading causes of preventable blindness in low and middle income countries. In Nepal, there are less studies regarding DR and they too are limited around Kathmandu valley. This study was done to assess visual morbidity in patients with DR at a peripheral tertiary eye care center of Nepal.

METHODS

This was a prospective, hospital based, cross-sectional study in which all consecutive cases of DR were evaluated. DR was classified according to Early Treatment Diabetic Retinopathy Study Research Group - report no. 10 Table A5-1 (Modified Airlie House Classification). Data entry and analysis was done in an SPSS unit version 20. Wherever applicable, variables were set as 100 eyes.

RESULTS

Total number of patients included in this study was 50. Commonest age group was 50-69 yrs. (43/77 yrs.; min/max) comprising 80% of the total population (n = 50) and the predominant population was male (76%). Non proliferative diabetic retinopathy (NPDR) was found in 69%, proliferative diabetic retinopathy (PDR) in 31% and advanced diabetic eye disease (ADED) in 3% (n = 100).

CONCLUSIONS

All the stages of DR were present at significant proportions in this study, noteworthy was the percentage of PDR. This study shows an urgency to gather a national data on DR, raise awareness among diabetics and train effective man power at a local level to diagnose DR at an early stage.