Diabetic retinopathy in Oman: a hospital based study

Prevalence of Diabetic Retinopathy Among Individuals with Diabetes in Gulf Cooperation Council countries: A Systematic Review and Meta-analysis

Objectives

To determine the proportion of diabetic retinopathy (DR) among individuals with diabetes mellitus in the Gulf Cooperation Council (GCC) countries.

Methods

This study was executed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Online databases including Scopus, Web of Sciences, PubMed, Index Medicus for the eastern Mediterranean region, Medline, and ProQuest, were utilized to retrieve studies on the prevalence of DR in GCC countries that were conducted from 2003 to 2019.

Results

Twenty articles were included in the meta-analysis, involving 61 855 patients. The prevalence of DR was 20.5% (95% CI: 20.212-20.850). The highest prevalence rate was observed in Saudi Arabia (69.8%; 95% CI: 64.989-74.216) and the lowest in the UAE (6.0%; 95% CI: 2.780-11.084). There was a significant heterogeneity between the reviewed studies (p < 0.001).

Conclusions

The prevalence of DR was high in the GCC countries. Our findings provide crucial information for the public healthcare systems in these countries to actively educate the public and screen at-risk populations for undiagnosed cases of diabetes, detect early stages of retinopathy, and provide required care to minimize the number of untreated cases.

Prevalence of diabetic retinopathy in patients with diabetes in Alexandria and North-West Delta, Egypt

PURPOSE

The purpose of this research was to estimate the prevalence of DR in Alexandria and the North-West Delta region.

METHODS

All diabetic patients attending the general ophthalmology clinics (Group 1), diabetic internal medicine clinics (Group 2), or reached out in the local communities (Group 3) were eligible to participate. Fundus photographs were graded according to the Scottish DR grading system by three independent UK-certified graders. Adjudication by a consultant was done when needed.

RESULTS

Out of 11,033 screened patients, 10,811 had a gradable fundus photograph in at least one eye and were included. The numbers of cases in groups 1, 2 and 3 were 3940, 2826, and 4045, respectively. Males represented 38.35% of the cases. Mean age was 55 ± 12.63. For the whole sample, groups 1, 2 and 3, the DR prevalence was 32.49, 46.4%, 29.13%, and 21.29%, respectively. The prevalence of proliferative DR (grade R4) was 6.16%, 11.83%, 5.02%, and 1.45%, respectively, and of referable maculopathy (Grade M2) was 19.95%, 31.42%, 15.92%, and 11.59%, respectively. In univariate analysis, older age, higher random blood glucose, and longer DM duration were associated with a higher risk of both DR and referable diabetic maculopathy. This association was maintained in multivariate analysis for the high random blood glucose level and the longer duration of DM (but not for the older age).

CONCLUSION

A significantly higher prevalence of DR, grades R4 and M2 was found in the hospital-recruited patients than in diabetics from the local communities.

Prevalence of diabetic retinopathy in the Eastern Mediterranean Region: a systematic review and meta-analysis

Objectives

Individual studies in the Eastern Mediterranean Region (EMR) have shown the high prevalence of diabetic retinopathy. We conducted a meta-analysis to yield an estimate of the prevalence of diabetic (type 1 and 2) retinopathy in the EMR. Additionally, we explored its potential modulators.

Methods

Two-step screening of relevant articles published from 1 January 2000 to 13 December 2019 was carried out. An estimation of summary proportions, subgroup analysis, meta-regression, and publication bias assessment were performed.

Results

One hundred nine articles were included in the meta-analysis, involving 280,566 patients. The prevalence of diabetic retinopathy was 31% (95% confidence interval [CI] = 28, 33). The highest and lowest diabetic retinopathy prevalence rates were observed in low human development index (HDI) countries (63.6; 95% CI = 52.4, 74.0) and very high HDI countries 22.6 (95% CI = 20.5, 24.7), respectively.

Conclusions

The prevalence of diabetic retinopathy is high in the EMR. Our results provide important information for diverse healthcare surveillance systems in the EMR to implement the modifiable risk factors, diabetes screening to decrease undiagnosed diabetes, early detection of retinopathy, and proper diabetes care to decrease untreated diabetes.

Diabetic retinopathy screening and treatment through the Brazilian National Health Insurance

The current study aimed to investigate diabetic retinopathy (DR) screening and treatment coverages among diabetic patients evaluated through the Brazilian National Health Insurance from 2014 to 2019. The Brazilian Public Health System Information Database was used as the primary data source. DR screening coverage was calculated as the rate of procedures of clinical dilated fundus exam and color fundus photograph over the number of diabetic patients. DR treatment coverage was calculated as the rate of procedures of intravitreal injection, photocoagulation, and panretinal photocoagulation over the number of diabetic patients presumably in need of DR treatment. The overall screening coverage increased from 12.1% in 2014 to 21.2% in 2019 (p < 0.001) with substantial regional discrepancies so that North region was the only one with no changes along the period. The overall treatment coverage increased from 27.7% in 2014 to 44.1% in 2019, with Southeast and Midwest absorbing the demand for service from the North, Northeast and South. Despite an improvement along the past years, both screening and treatment coverages for DR in diabetes patients are ineffective in Brazil. Public health policies should address resources disparities throughout the country aiming to offer same healthcare conditions to patients regardless their geographic location.

Retinopathy among Adult Diabetics and Its Predictors in Northwest Ethiopia

BACKGROUND

Diabetic retinopathy is the leading cause of blindness among working-aged adults worldwide, including developing countries such as Ethiopia, and the burden of diabetes-related blindness is undeniably posing a massive challenge to the health care system. Diabetes and its micro- and macrovascular complications are becoming more prevalent among Ethiopian diabetics. For that reason, the purpose of this study was to assess the incidence of diabetic retinopathy and its predictors among diabetics in Ethiopia.

METHODS

A hospital-based retrospective cohort study was conducted using 494 randomly selected diabetics aged above 18 years at Felege Hiwot Comprehensive Specialized Hospital from 2011 through 2014 and was followed until December 2019. The preliminary and longitudinal data was abstracted into demographics, clinical, and physiological attributes using a standardized structured questionnaire. The collected data was entered into the system using EpiData version 4.2 and analyzed using STATA version 14.0. The survival experience of the patients was assessed using the Kaplan-Meier survivor function. The predictors of diabetic retinopathy were identified by the Cox proportional hazard model. Bivariable and multivariable Cox proportional hazard models were computed, and variables having a P value of < 0.05 in the multivariable Cox proportional hazard model were declared as significant predictors of diabetic retinopathy.

RESULTS

During the follow-up, the overall incidence rate of diabetic retinopathy was 48 per 1000 person-years (95% CI: 40.0-57.0). Age in years (AHR 1.02; 95% CI: 1.00-1.04), fasting blood sugar level (AHR 1.02; 1.00-1.04), hypertension (AHR 2.61; 95% CI: 1.47-4.63), DM patients who had LDL > 100 mg/dl (AHR 2.73; 95% CI: 1.32-5.64), total cholesterol > 200 mg/dl (AHR 2.22; 95% CI: 1.08-4.55), and positive proteinuria (AHR 1.74; 95% CI: 1.10 -2.73) were found to be the significant predictors of diabetic retinopathy.

CONCLUSION

The overall incidence rate of diabetic retinopathy was found to be high in both type 1 and type 2 DM. Age, fasting blood sugar levels, hypertension, proteinuria, dyslipidemia, and high systolic blood pressure were all predictors of the development of diabetic retinopathy. Controlling glycemia, dyslipidemia, proteinuria, and blood pressure is critical for halting the progression of diabetic retinopathy.

Knowledge, Attitude, and Practice around Diabetic Eye Disease among Diabetic Patients in Jazan Region, Saudi Arabia

PURPOSE:

This study aims to assess knowledge, attitude, and practice (KAP) around diabetic eye disease in patients with diabetes mellitus (DM) attending primary health-care centers (PHCCs) in Jazan region, Saudi Arabia.

METHODS:

All diabetic patients attending eight PHCCs in Jazan region between December 2018 and December 2019 were invited to participate in this cross-sectional study. Face-to-face interviews were held to gather responses to a validated 20-item questionnaire.

RESULTS:

In total, 293 patients aged 9–90 years (mean 50 years, standard deviation 14 years) agreed to participate, including 189 (64.5%) females and 104 (35.5%) males. Most (n = 251; 85.7%) had type 2 DM, the remainder (42; 14.3%) having type 1 DM. The mean duration of DM was 8.2 ± 6.4 years. Eye complications were self-reported by 114 (38.9%) participants. More than one-third (36.2%) of the participants had never undergone an eye examination. Less than one-third of participants (29% and 28% respectively) had an excellent level of knowledge or practice about diabetic eye disease, and only 12% demonstrated very positive attitude. KAP levels were independently predicted by patients' age, gender, and eye complication status.

CONCLUSION:

KAP relating to eye disease and eye care among Saudi patients with DM were less than desired. Rigorous efforts are required to raise awareness of eye complications among diabetic patients.

Analytical Data Review to Determine the Factors Impacting Risk of Diabetes in North Al-Batinah Region, Oman

Diabetes is one of the most widespread diseases resulting in an increase in mortality rate, and negatively affecting Oman’s economy. In 2019, an estimated 1.5 million deaths were directly caused by diabetes world health organization (WHO). The total number of diabetes cases among Omanis aged between 20 and 79 in 2015 is about 128,769, which increased in 2020 to 149,195. However, the total forecast number of diabetes cases will double in 2050 to 352,156. The healthcare spend on diabetes is 16.6%, which has triggered the need for the study. This research aims to review and analyze the prevailing situation around diabetes in Oman and its risk factors using multilinear regression tests, ANOVA, and descriptive analysis. Two hundred and fourteen samples were collected through a well-defined questionnaire using the purposive sampling technique. The study’s empirical results reveal that females, who were 79% of the respondents, have at least one of their family members as a diabetes patient; 41% of the respondents were affected by Type-2 (T2-DM) diabetes, and 38% were unaware of their type of diabetes. While, 91% of them were undergoing medication. The study indicates the risk factors that impact the diabetes number and type in North Oman, which include Aage with a rate of (0.595), followed by family history (0.560), smoking habits (0.530), and being overweight (0.435). Age plays an important role in the type of diabetes of the patients, and the types of diabetes impacts medication type. The type of diabetes has influenced the frequency of diabetes patients’ self-testing at home. Overall, 92% were rushed to the hospital or took medication immediately in case of a considerable variation in the readings; and 68% of the respondents complained that visiting the hospital is a costly affair and the health service is deteriorating.

The value of glycosylated hemoglobin in the diagnosis of diabetic retinopathy: a systematic review and Meta-analysis

OBJECTIVE

Glycosylated hemoglobin (HbA1c) has obvious clinical value in the diagnosis of diabetes, but the conclusions on the diagnostic value of diabetic retinopathy (DR) are not consistent. This study aims to comprehensively evaluate the accuracy of glycosylated hemoglobin in the diagnosis of diabetic retinopathy through the meta-analysis of diagnostic tests.

METHODS

Cochrane Library, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), China Wanfang Database, Chinese Biomedical Literature Database (CBM) were searched until November, 2020. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the quality of the included studies. The pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR) and areas under the receiver operating characteristic (ROC) curve were calculated by Stata 15.0 software.

RESULTS

After screening, 18 high-quality papers were included. The results of meta-analysis showed that the combined DOR = 18.19 (95% CI: 10.99-30.11), the sensitivity= 0.81 (95% CI): 0.75 ~ 0.87), specificity = 0.81 (95%CI: 0.72 ~ 0.87), +LR = 4.2 (95%CI: 2.95 ~ 6.00), -LR = 0.23 (95%CI: 0.17 ~ 0.31), and the area under the Summary ROC curve was 0.88 (95%CI:  0.85 ~ 0.90).

CONCLUSION

The overall accuracy of HbA1cC forin diagnosing diabetic retinopathy is good. As it is more stable than blood sugar and is not affected by meals, it may be a suitable indicator for diabetic retinopathy.

Prevalence of Diabetic Retinopathy in Oman: A Two Decade National Study

OBJECTIVES

Diabetes mellitus (DM) is one of the major chronic diseases with a world prevalence of 8.5%. Oman has shown a consistent rise in the prevalence of DM, reaching 14.5% in 2017. A major complication of DM is diabetic retinopathy (DR). There is limited information available about the prevalence of DR and its subtypes in Oman. This is the largest national study conducted to determine the prevalence of DR and its subtypes in Oman.

METHODS

We extracted the records of 2000 Omani patients with DM and retrospectively screened for DR, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) reported between 2000 and 2017. The sample included patients from 79 medical centers from all governorates of Oman. A total of 616 patients were included in the study. We investigated the prevalence of DR among both genders and different age groups. We studied the association between the progression of DM into DR.

RESULTS

The prevalence of DR, NPDR, and PDR within patients diagnosed with DM was 19.2% (95% confidence interval (CI): 16.2-22.5), 8.6% (95% CI: 6.6-11.1), and 1.3% (95% CI: 0.7-2.5), respectively. Moreover, females have shown a higher prevalence of any DR, compromising 60.2% of all patients diagnosed with DR, 62.3% of all NPDR patients, and 75.0% of all PDR patients. However, there was no significant association between sex and DR (p = 0.840). There was a significant association between having DM for 10 years and DR (p = 0.010).

CONCLUSIONS

The prevalence of DR increased from 14.3% in 2003 to 19.3% in 2017. Effective health policies and screening programs should be employed to control the increased prevalence of DM and DR.

Diabetes Self-Management and the Associated Factors Among Adult Omanis with Type 1 Diabetes

Objectives

This study aimed to assess and explore factors affecting diabetes self-management (DSM) among Omani adults with type one diabetes mellitus (T1DM).

Methods

This cross-sectional study was conducted from May to November 2018. Convenience sampling was used to recruit participants from three referral hospitals in Oman. Data were collected using the Diabetes Self-Management Questionnaire, Empowerment Scale (short form), Medical Outcome Study Social Support Scale, Diabetes Knowledge Test and glycosylated haemoglobin test results. Linear multiple regression analysis was used to explore possible predictors of DSM.

Results

A total of 210 people participated in the study (response rate: 87.5%). The majority of participants were female (70.5%) with a mean age of 26.82 ± 8.25 years. The mean score for DSM was 6.8 ± 1.4, which represents 68% of the total maximum score. More than one-third (36.2%) of the participants had poor glycaemic control. The predictors of high levels of DSM were being employed (P = 0.049), earning a low monthly income of less than 300 Omani rials (P = 0.014), having other chronic diseases (P = 0.029), a high diabetes self-efficacy (DSE; P = 0.003) and high social support (SS; P = 0.006).

Conclusion

According to the findings of this study, Omanis with T1DM have suboptimal DSM levels. Factors such as diabetes knowledge, DSE and SS are modifiable factors that can be targeted by interventions from different healthcare professionals to enhance DSM.

Diabetic retinopathy among Omanis: Prevalence and clinical profile

PURPOSE

The aim of this study is to describe the prevalence, severity and clinical profile of diabetic retinopathy (DR) among Omani diabetic patients attending a tertiary care hospital.

MATERIALS AND METHODS

This is a retrospective study involving the record review of diabetic patients attending the diabetes retina clinic of the National Diabetes and Endocrine Centre in the period between June 2015 and May 2016. Retinal evaluation of 442 native patients was conducted using direct ophthalmological examination and digital photography. DR was graded using the Early Treatment DR Study criteria. The statistical analysis was conducted using SPSS, version 20.

RESULTS

The estimated total prevalence of DR was 31% (95% confidence interval: 26.6-35.3). Mild nonproliferative diabetic retinopathy (NPDR) constitutes 21.3%, while moderate-to-severe NPDR and proliferative diabetic retinopathy constitute 4.5% and 5.2%, respectively. The prevalence of vision-threatening diabetic retinopathy (VTDR) and diabetic maculopathy was 15.4% and 13.3%, respectively. Retinopathy was significantly associated with age, diabetes duration, Type 2 diabetes mellitus, coexisting comorbidities or complications, systolic blood pressure, glycated hemoglobin (HbA1c), fasting blood sugar, triglycerides, and albumin/creatinine ratio. In the regression analysis, age (P = 0.02), duration (P < 0.001), and HbA1c (P < 0.001) were independently associated with DR.

CONCLUSIONS

The prevalence of DR and VTDR among Omani diabetics is high. Age, duration of diabetes, and HbA1c are the risk factors for the development of DR among Omanis. This emphasizes the importance of planning resources for different modalities of treatment of DR to face the future challenge.

Determinants of diabetic retinopathy in Southwest Ethiopia: a facility-based case-control study

Background

Diabetic Retinopathy is one of the serious complications patients’ diabetic patients suffer from. Little is known about which risk factors are associated with this complication. The aim of this study was therefore to identify determinants of Diabetic Retinopathy in Jimma University Medical Center.

Methods

A facility-based case-control study was conducted. Cases were Diabetic patients with diabetic retinopathy and who were on follow up at the Jimma University Medical Center while controls were Diabetic patients but free of diabetic retinopathy and who were on follow up at the Jimma University Medical Center. Cases and controls were identified and 311 of them were recruited using systematic random sampling. Data were entered into the Epi-Data version 4.1 and analyzed using SPSS Version 20. Binary Logistic regression analysis was conducted to identify determinants of diabetic retinopathy.

Result

A total of 106 cases and 205 controls diabetic participated in the study. Being ≥60 years of age (AOR = 5.04,95%CI: 1.83,13.87),being illiterate (AOR = 7.17, 95% CI: 2.61,19.7), poor adherence to medication (AOR =3: 95% CI: 1.29,6.95),having high systolic blood pressure (AOR = 3.38:95% CI: 1.26,9.05), having family history of Diabetes Mellitus (AOR = 3.95: 95% CI: 1.64,9.54), having other micro vascular complications (AOR = 3.76,95% CI: 1.33,10.66), poor glycemic control (AOR = 9.08, 95%CI: 3.7,22.29), poor cholesterol control (AOR = 0.21, 95%CI: 0.08,0.51) and being anaemic (AOR = 2.8, 95%CI: 1.05,7.47) were the independent determinants of diabetic retinopathy.

Conclusion

This study found that poor adherence to medication, being at the age of 60 years and above, being illiterate patients, having high systolic blood pressure, having a family history of Diabetes Mellitus, having other micro vascular complication, poor glycemic control, poor cholesterol control and being anemic patient were the independent determinants of diabetic retinopathy. Therefore, more attention should be given to older age and illiterate patients. Giving more emphasis for patients poorly adhered to anti-diabetic medications and giving advice for diabetic patients with high systolic blood pressure to follow their blood pressure regularly are also vital. Diabetic patients should also control their Blood sugar and blood cholesterol levels to prevent diabetic retinopathy or reduce its further complications.

Diabetic retinopathy (DR) among 40 years and older Saudi population with diabetes in Riyadh governorate, Saudi Arabia - A population based survey

Purpose

To present the prevalence and determinants of diabetic retinopathy (DR) among more than 40 years old Saudi population.

Methods

A population based survey was conducted in Riyadh district between 2014 and 2017. All Saudi aged >40 years suffering from diabetes and confirmed in the diabetes register of the Primary Health Center (PHC) were the study population. Representative sample was examined. The Best corrected Visual acuity (BCVA), anterior and posterior segment assessment was performed. Digital fundus camera captured the retinal images. DR was graded into No DR, Non-proliferative DR (Mild, Moderate, Severe) and proliferative DR (PDR). Diabetic macular edema (DME) was separately noted. Sight Threatening Diabetic Retinopathy (STDR) included PDR and/or DME.

Results

We examined 890 persons. The age sex adjusted prevalence of DR was 44.7% (95% CI 44.1 – 45.3). The DR among male was significantly higher than in females. [RR = 1.4 (95% CI 1.02 – 1.8)]. The DR in 60 plus population was higher compared to 40 to 60 years old diabetics [RR = 1.64 (95% CI 1.6 – 1.7), P < 0.001]. The crude prevalence of STDR was 12.4% (95% CI 9.1 – 15.7). Among diabetic with DR, bilateral and unilateral Severe Visual Impairment (SVI) rate were 1% and 1.8%. The coverage of retinal laser treatment for STDR was 6.1%.

Conclusions

The DR among diabetics is high among adult Saudi population. Both DR and STDR were more in males. Visual disabilities among DR cases were few. For early detection and timely management the services need urgent attention.

[What do we know about diabetic retinopathy at the Sourô Sanou university medical center in Bobo-Dioulasso (CHUSS)?]

INTRODUCTION

Ocular damage is one of the numerous complications of diabetes. Proliferative diabetic retinopathy can result in blindness. The purpose of our work was to study the aspects of diabetic retinopathy on fundus examination in diabetic patients in Bobo-Dioulasso in a hospital environment.

METHODS

This is a descriptive, cross-sectional, prospective study from March 1st to August 31st 2014 of diabetic patients in the Sourô Sanou university hospital. We used the Francophone Diabetes Society's classification.

RESULTS

We included 246 patients (487 eyes). The frequency of diabetic retinopathy (DR) was 47.1%, and the frequency of diabetic maculopathy 8.9%. Proliferative DR and severe Non-Proliferative DR represented 3.3% of eyes, and blindness occurred in 3%. Among diabetics with DR, the mean age was 55.75 years (standard deviation 11.04 years); the median duration of diabetes was 36 months, and 99.1% of the diabetic patients were categorized as type 2. There was a statistically significant association between diabetic retinopathy and duration of diabetes progression, history of neuropathy, presence of proteinuria on 24hour urines, hypercreatininemia, and also between triglyceride levels and diabetic maculopathy.

CONCLUSION

Diabetic retinopathy affects almost half of diabetic patients at the Sourô Sanou university hospital. An earlier, multidisciplinary management approach might prevent this.

The prevalence of retinopathy among type 2 diabetic patients in Iran: A systematic review and meta-analysis

Diabetic retinopathy is one of the most major causes of blindness and disability in diabetic patients and imposes very high cost on Health Care System. Studies conducted in the country showed different and inconsistent prevalence of the disease. The study aims to determine the overall prevalence of retinopathy in patients with type 2 diabetes in Iran through a systematic review and meta-analysis. The present study was conducted via meta-analysis method during March, 2000 to October, 2018. The articles related to the subject under study were obtained from Magiran, SID, Medline (PubMed), Science Direct, Scopus and Google Scholar databases. I2 index was used to examine the heterogeneity of articles studied; and the data was analyzed by Comprehensive Meta-Analysis Software. Through the study of 34 articles and 17,079 individuals with age range of 5-83, the overall prevalence of retinopathy for type 2 diabetic patients in Iran and on the basis of meta-analysis, was obtained that was 37.8% (32.84-43%, 95% confidence interval); the highest prevalence of retinopathy for type 2 diabetic patients was in Tehran province with 78% (68.8-85.1%, 95% confidence interval) in 2006 and the lowest prevalence of retinopathy for type 2 diabetic patients was in Isfahan province with 9% (7.1-11.4, 95% confidence interval) in 2006; furthermore, the prevalence of retinopathy for type 2 diabetic patients in Iran increases with increased sample size that it was statistically significant (P < 0.05). Regarding the high prevalence of retinopathy for type 2 diabetic patients in the country, it is essential that health policy makers take effective measures to reduce the disease incidence in diabetic patients.

Prevalence of Blindness and Visual Impairment among Jordanian Diabetics

PURPOSE

To investigate the prevalence of blindness and visual impairment among a population of Jordanian diabetics.

METHODS

A total of 986 diabetic patients were fully assessed, including complete history, examination, and laboratory tests. All patients underwent detailed eye examination, which included visual acuity, slit-lamp examination, tonometry, funduscopy, and fundus fluorescein angiography (FFA).

RESULTS

Of all patients examined, 53.2% were male and 46.8% were female. The mean age and duration of diabetes were 55.3 and 11.9 years. Of all patients, 93.3% had type 2 while 6.7% had type 1 diabetes mellitus (DM). Over half (50.3%) were on oral hypoglycemic agents, 34% on insulin, and 14.5% on both types of treatment, whereas only 1.2% were on diet alone. The mean value for HbA1c was 7.7%. The prevalence of blindness among participants was found to be 7.4%, while 10.1% were visually impaired. Diabetic retinopathy (DR) was present in 64.1%, 37.8% had cataract, and 8.7% had undergone cataract surgery. Using multivariate logistic regression analysis, visual impairment was significantly associated with age, treatment of diabetes, and DR, while only age and retinopathy were significantly related to blindness.

CONCLUSIONS

DM is a common disease in Jordan and DR is highly prevalent among Jordanian diabetics. National screening and educational programs are highly needed to reduce the risk of blindness and visual impairment among diabetic patients.

Neuropathy of type 1 diabetes in the Arab world: A systematic review and meta-analysis

AIMS

Although type 1 diabetes (T1D) is a common disease in the Arab nations, there is no data available on the prevalence of peripheral neuropathy (PN) among T1D subjects in Arab countries. The aim of this study is to analyze the prevalence of PN in T1D subjects via published literature and to draw attention to the dearth of the published work in this serious complication of T1D.

METHODS

A meta-analysis was performed on studies representing different Arab countries with a total number of 2243 T1D subjects.

RESULTS

The pooled prevalence of PN among T1D subjects in the Arab region was estimated as 18% with 95% confidence intervals (CI): 0.09-0.34. The PN prevalence was significantly higher in the >16-yr age group, with 59.1% (95% CI: 0.45-0.72) compared to 9.5% (95% CI: 0.05-0.19) in the <16-yr age group. Furthermore, the PN prevalence was significantly higher in the group with more than 10-yr T1D, 35% (95% CI: 0.15-0.62) than in the group with less than 10-yr T1D, 9.4% (95% CI: 0.04-0.21).

CONCLUSION

In Arab countries, PN is common in adults and children with T1D, but prevalence varies widely. Older age Arab people (>16years) with T1D are affected more with PN than younger age Arab people (<16years). PN is more frequently present in Arab subjects with a longer duration of T1D diabetes than in those with shorter duration.

Association between diabetic foot ulcer and diabetic retinopathy

PURPOSE

We aimed to investigate the prevalence of diabetic retinopathy (DR) in patients with diabetic foot ulcer (DFU) and elucidate the association between DR and DFU severities and their shared risk factors.

METHODS

A retrospective review was conducted on DFU patients who underwent ophthalmic and vascular examinations within 6 months; 100 type 2 diabetic patients with DFU were included. The medical records of 2496 type 2 diabetic patients without DFU served as control data. DR prevalence and severity were assessed in DFU patients. DFU patients were compared with the control group regarding each clinical variable. Additionally, DFU patients were divided into two groups according to DR severity and compared.

RESULTS

Out of 100 DFU patients, 90 patients (90%) had DR and 55 (55%) had proliferative DR (PDR). There was no significant association between DR and DFU severities (R = 0.034, p = 0.734). A multivariable analysis comparing type 2 diabetic patients with and without DFUs showed that the presence of DR [OR, 226.12; 95% confidence interval (CI), 58.07-880.49; p < 0.001] and proliferative DR [OR, 306.27; 95% CI, 64.35-1457.80; p < 0.001), higher HbA1c (%, OR, 1.97, 95% CI, 1.46-2.67; p < 0.001), higher serum creatinine (mg/dL, OR, 1.62, 95% CI, 1.06-2.50; p = 0.027), older age (years, OR, 1.12; 95% CI, 1.06-1.17; p < 0.001), higher pulse pressure (mmHg, OR, 1.03; 95% CI, 1.00-1.06; p = 0.025), lower cholesterol (mg/dL, OR, 0.94; 95% CI, 0.92-0.97; p < 0.001), lower BMI (kg/m2, OR, 0.87, 95% CI, 0.75-1.00; p = 0.044) and lower hematocrit (%, OR, 0.80, 95% CI, 0.74-0.87; p < 0.001) were associated with DFUs. In a subgroup analysis of DFU patients, the PDR group had a longer duration of diabetes mellitus, higher serum BUN, and higher serum creatinine than the non-PDR group. In the multivariable analysis, only higher serum creatinine was associated with PDR in DFU patients (OR, 1.37; 95% CI, 1.05-1.78; p = 0.021).

CONCLUSIONS

Diabetic retinopathy is prevalent in patients with DFU and about half of DFU patients had PDR. No significant association was found in terms of the severity of these two diabetic complications. To prevent blindness, patients with DFU, and especially those with high serum creatinine, should undergo retinal examinations for timely PDR diagnosis and management.

Association of Diabetes Related Complications with Heart Rate Variability among a Diabetic Population in the UAE

Microvascular, macrovascular and neurological complications are the key causes of morbidity and mortality among type II diabetes mellitus (T2DM) patients. The aim of this study was to investigate the alterations of cardiac autonomic function of diabetic patients in relation to three types of diabetes-related complications. ECG recordings were collected and analyzed from 169 T2DM patients in supine position who were diagnosed with nephropathy (n = 55), peripheral neuropathy (n = 64) and retinopathy (n = 106) at two hospitals in the UAE. Comparison between combinations of patients with complications and a control diabetic group (CONT) with no complication (n = 34) was performed using time, frequency and multi-lag entropy measures of heart rate variability (HRV). The results show that these measures decreased significantly (p<0.05) depending on the presence and type of diabetic complications. Entropy, (median, 1st- 3rd interquartile range) for the group combining all complications (1.74,1.37-2.09) was significantly lower than the corresponding values for the CONT group (1.77, 1.39-2.24) with lag-1 for sequential beat-to-beat changes. Odds ratios (OR) from the entropy analysis further demonstrated a significantly higher association with the combination of retinopathy and peripheral neuropathy versus CONT (OR: 1.42 at lag 8) and an even OR for the combination of retinopathy and nephropathy (OR: 2.46 at lag 8) compared to the other groups with complications. Also, the OR of low frequency power to high frequency power ratio (LF/HF) showed a higher association with these diabetic-related complications compared to CONT, especially for the patient group combining all complications (OR: 4.92). This study confirms that the type of microvascular or peripheral neuropathy complication present in T2DM patients have different effects on heart rate entropy, implying disorders of multi-organ connectivity are directly associated with autonomic nervous system dysfunction. Clinical practice may benefit from including multi-lag entropy for cardiac rhythm analysis in conjunction with traditional screening methods in patients with diabetic complications to ensure better preventive and treatment outcomes in the Emirati Arab population.

Evaluating digital diabetic retinopathy screening in people aged 90 years and over

PURPOSE

To evaluate the effectiveness of digital diabetic retinopathy screening in patients aged 90 years and over.

METHODS

This is a retrospective analysis of 200 randomly selected patients eligible for diabetic retinopathy screening aged 90 years and over within the Birmingham, Solihull, and Black Country Screening Programme.

RESULTS

One hundred and seventy-nine (90%) patients attended screening at least once.

OUTCOMES

133 (74%) annual screening after their first screen, of whom 59% had no detectable diabetic retinopathy; 38 (21%) were referred for ophthalmology clinical assessment-36 for nondiabetic retinopathy reasons and two for diabetic maculopathy. Cataract accounted for 50% of all referrals for ophthalmology clinical assessment. Of the 133 patients placed on annual screening, 93 (70%) were screened at least once more. In terms of level of diabetic retinopathy, assessability or other ocular pathologies, 8 improved, 51 remained stable, and 31 deteriorated. Of the latter, 19 patients were referred for ophthalmology clinical assessment; none of these for diabetic retinopathy.

CONCLUSIONS

Screening provides opportunistic identification of important nondiabetic retinopathy eye conditions. However, in view of the low identification rate of sight-threatening diabetic retinopathy in patients aged 90 years and over, and the current mission statement of the NHS Diabetic Eye Screening Programme, systematic annual diabetic retinopathy screening may not be justified in this age group of patients, but rather be performed in optometric practice.

Diabetic retinopathy and its risk factors in a society with a type 2 diabetes epidemic: a Saudi National Diabetes Registry-based study

PURPOSE

To assess diabetic retinopathy prevalence and its risk factors in a society with type 2 diabetes epidemic using the Saudi National Diabetes Registry (SNDR).

METHOD

This is a cross-sectional study using patient's clinical data found in SNDR data base. A cohort of 50,464 Saudi patients with type 2 diabetes aged ≥25 years were selected to assess for the prevalence and risk factors for diabetic retinopathy.

RESULTS

The overall prevalence of diabetic retinopathy is 19.7%, where 9.1% have non-proliferative diabetic retinopathy (NPDR), 10.6% have proliferative diabetic retinopathy (PDR) and 5.7% have macular oedema (ME). Duration of diabetes and age are the most significant risk factors for diabetic retinopathy with odds ratio (OR) and 95% confidence interval (95% CI) 8.88 (8.30-9.50) and 5.76 (5.10-6.55), respectively. Nephropathy, neuropathy, insulin use, poor glycemic control, hypertension and male gender significantly increased the risk for diabetic retinopathy. Smoking, hyperlipidemia and obesity significantly reduced the risk for diabetic retinopathy among type 2 Saudi diabetic cohort.

CONCLUSION

vThe low prevalence of diabetic retinopathy in our registry may be a result of the shortage or absence of well-structured screening programmes. Therefore, many patients with NPDR might have been missed. A prevention programme is needed to reduce the effect of diabetic retinopathy risk factors in this society.

Adherence to Medications among Type 2 Diabetes Mellitus Patients in Three Districts of Al Dakhliyah Governorate, Oman: A cross-sectional pilot study

OBJECTIVES

This pilot study aimed to assess the medication adherence of type 2 diabetes mellitus (T2DM) patients in three wilayats (districts) of the Al Dakhliyah governorate, Oman, and to identify the probable reasons for medication non-adherence.

METHODS

A cross-sectional questionnaire-based pilot survey was conducted among T2DM Omani patients between February and June 2012 to assess their medication adherence and the relationship between their socio-demographic characteristics and adherence levels.

RESULTS

A total of 158 patients participated in the survey. The majority of the participants were unemployed or were housewives (66.5%). Forgetfulness was the most frequent reason for medication non-adherence (36.4%). Participants demonstrated an excellent level of adherence to their medicines (median total score = 3). No significant difference in median total adherence scores was observed based on the evaluated parameters.

CONCLUSION

The medication adherence of T2DM patients in the area under study was good. A larger study in a wider population is warranted to obtain a more representative picture of this important factor which contributes to public health.

Diagnostic accuracy of direct ophthalmoscopy for detection of diabetic retinopathy using fundus photographs as a reference standard

AIMS

To determine the diagnostic accuracy of direct ophthalmoscopy for the presence and severity of diabetic retinopathy (DR) using fundus photographs as a reference standard.

METHODS

Patients with type 2 diabetes attending the outpatient department (OPD) of a tertiary care diabetes center, from October 2009 to March 2010 were recruited in the study after obtaining signed informed consent. Patients with type 1 diabetes and gestational diabetes or having eye problems were excluded. After checking visual acuity, direct ophthalmoscopy of each eye was done by diabetologist, followed by photography of two fields of retina by fundus camera. DR was graded by a retinal specialist, according to International Diabetic Retinopathy Disease Severity Scale. According to severity, patients with DR were grouped into non-sight threatening diabetic retinopathy (NSTDR) and sight threatening diabetic retinopathy (STDR). Sensitivity and specificity of direct ophthalmoscopy for detection of any retinopathy, NSTDR and STDR was calculated.

RESULTS

A total of 728 eyes were examined by direct ophthalmoscopy as well as fundus photography. Sensitivity (95% CI) of direct ophthalmoscopy for any retinopathy, NSTDR and STDR was found to be 55.67% (50.58-60.78), 37.63% (32.67-42.59) and 68.25% (63.48-73.02) respectively. Whereas, specificity of direct ophthalmoscopy was found to be 76.78% (72.45-81.11), 71.27% (CI: 66.63-75.91) and 90.0% (86.93-93.07) for any retinopathy, NSTDR and STDR respectively.

CONCLUSION

The sensitivity and specificity of direct ophthalmoscopy performed by the diabetologist for the presence and severity of DR was lower compared to the recommended level of sensitivity and specificity of a screening test of DR.

Epidemiology and treatment outcomes of diabetic retinopathy in a diabetic population from Cameroon

BACKGROUND

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. It can lead to significant visual loss. The aim of this study was to determine the frequency and clinical profile of diabetic retinopathy, and assess the outcomes of laser photocoagulation therapy in a diabetic population in Cameroon.

METHODS

We carried out a prospective cohort study during 24 months in the Department of Ophthalmology of the Douala General Hospital, Cameroon. We included all diabetic patients who were referred from diabetes clinics for ophthalmologic evaluation. Data included type and duration of diabetes, visual acuity, intra-ocular pressure, results of fundoscopy and fluorescein angiography, and outcomes two months after treatment with laser photocoagulation.

RESULTS

We included 407 patients; 88% had type 2 diabetes. Their mean duration of diabetes was 6.4 years (SD=6.6). Forty point three percent (164/407) of patients were found to have DR on fundoscopy. Of the 164 patients with DR, 63.4% (104/164) had non-proliferative and 36.6% (60/164) had proliferative DR. Diabetic maculopathy was found in 14.5% (59/407) of all participants, and 36% (59/164) of patients with DR. There was a strong correlation between the duration of diabetes and retinopathy status (p < 0.001, r = 0.9541). Overall, 17.4% (71/407) of patients were eligible for laser photocoagulation. Of these, 66.2% (47/71) were treated, and 78.7% (37/47) of treated patients came back for control two months later. Among these treated patients an improvement of the retinopathy was noted in 73% (27/37), no change in 16.2% (6/37) and a worsening in 10.8% (4/37). Severe proliferative DR was significantly associated with treatment failure (p < 0.001).

CONCLUSIONS

The frequency of DR may be high among diabetic patients in Cameroon. There was a good uptake of laser photocoagulation therapy among patients affected by DR in our setting, with good treatment outcomes. Interventions to prevent diabetes and increase the precocity of diagnosis and treatment of DR should be scaled up.

Diabetic retinopathy and its risk factors at the university hospital in Jamaica

PURPOSE

To determine the frequency of diabetic retinopathy and its risk factors in diabetic patients attending the eye clinic at the University Hospital of the West Indies (UHWI).

MATERIALS AND METHODS

This was a prospective cohort study of diabetic outpatients attending the Eye Clinic at the UHWI. Data were collected on age, gender, type of diabetes mellitus (DM), type of diabetic retinopathy, other ocular diseases, visual acuity, blood glucose and blood pressure.

RESULTS

There were 104 patients (208 eyes) recruited for this study. There were 58.6% (61/104) females (mean age 53.6 ± 11.9 years) and 41.4% (43/104) males (mean age 61.7 ± 12.1 years). Type II DM was present in 68.3% (56% were females) of the patients and Type I DM was present in 31.7% (69.7% were females). Most patients (66%) were compliant with their diabetic medications. The mean blood glucose was 11.4 ± 5.3 mmol/L. Elevated blood pressure (<130/80) was present in 82.7% of patients. The mean visual acuity was 20/160 (logMAR 0.95 ± 1.1). The frequency of diabetic retinopathy was 78%; 29.5% had background retinopathy, and 50.5% of eyes had proliferative diabetic retinopathy (PDR) of which 34% had tractional retinal detachments. The odds ratio of developing PDR was 1.88 (95% confidence intervals (CI): 1.02-3.3) for Type I DM compared to 0.74 (95% CI: 0.55-0.99) for Type II DM. PDR was more prevalent in females (χ(2), P = 0.009) in both Type I and II DM.

CONCLUSIONS

Jamaica has a high frequency of PDR which is more common in Type I diabetics and females. This was associated with poor glucose and blood pressure control.

Diabetes in the Middle East and North Africa

AIMS

Even though the Middle East and North Africa (MENA) region had the highest comparative prevalence of diabetes in 2012, little is known about the nuances of diabetes risk and capacity to address the burdens. To provide a comprehensive overview, we reviewed the literature on diabetes in the MENA region.

METHODS

We conducted a systematic search in PubMed between January 1990 and January 2012 for studies on diabetes in the MENA region without language restriction.

RESULTS

There was a paucity of country-specific epidemiology data in the region. Diabetes prevalence varied widely across studies, from 2.5% in 1982 to 31.6% in 2011. Older age and higher body mass index were the most strongly associated risk factors for diabetes. Among people with diabetes, over half did not meet recommended care targets. In addition, macrovascular and microvascular complications were observed in 9-12% and 15-54% of diabetes population, respectively.

CONCLUSIONS

This review suggests a need for more representative surveillance data in this noteworthy focal point of the global diabetes epidemic. Such actions will not only help to understand the actual burden of diabetes but also motivate actions on design and implementation of diabetes prevention and control programs.

Short term outcome of Ahmed glaucoma valve implantation in management of refractory glaucoma in a tertiary hospital in Oman

Background:

We present outcomes of Ahmed Glaucoma Valve (AGV) implantation in treating refractory glaucoma in a tertiary hospital in Oman. Refractory glaucoma was defined as previously failed conventional glaucoma surgery and an uncontrolled intraocular pressure (IOP) of more than 21 mm Hg despite treatment with three topical and/or oral therapy.

Materials and Methods:

This historical cohort study was conducted in 2010. Details of medical and surgical treatment were recorded. Ophthalmologists examined eyes and performed glaucoma surgeries using AGV. The best corrected distant vision, IOP, and glaucoma medications were prospectively reviewed on 1^st day, 1^st, 6^th, 12^th week postoperatively, and at the last follow up.

Result:

Glaucoma specialists examined and treated 40 eyes with refractory glaucoma of 39 patients (20 males + 19 females). Neo-vascular glaucoma was present in 23 eyes. Vision before surgery was <3/60 in 21 eyes. At 12 weeks, one eye had vision better than 6/12, seven eyes had vision 6/18 to 6/60, and eight eyes had vision 6/60 to 3/60. Mean IOP was reduced from 42.9 (SD 16) to 14.2 (SD 8) and 19.1 (SD 7.8) mmHg at one and 12 weeks after surgery, respectively. At 12 weeks, five (12.5%) eyes had IOP controlled without medication. In 33 (77.5%) eyes, pressure was controlled by using one or two eye drops. The mean number of preoperative anti-glaucoma medications (2.38; SD 1.1) was reduced compared to the mean number of postoperative medications (1.92; SD 0.9) at 12 weeks.

Conclusion:

We succeeded in reducing visual disabilities and the number of anti-glaucoma medications used to treat refractory glaucoma by AGV surgery.

Prevalence of Diabetic Retinopathy in Western Indian Type 2 Diabetic Population: A Hospital - based Cross - Sectional Study

CONTEXT

Diabetic Retinopathy (DR) can be defined as a damage which is caused to microvasculature in the retina by prolonged hyperglycaemia. Various studies have been conducted in south India, to find out prevalence of DR. It remains a less explored domain among type 2 diabetic patients in western India.

OBJECTIVES

(1) To assess prevalence of diabetic retinopathy in type 2 DM in western Indian population. and (2) To find out effect of duration of diabetes on severity of DR in this population.

STUDY DESIGN

A hospital - based, cross - sectional study.

MATERIAL AND METHODS

A total of 168 patients with type 2 DM underwent detailed opthalmoscopic examinations for DR. The ETDRS classification was followed to categorize retinopathy in different stages.

RESULTS

We observed that overall, prevalence of DR in type 2 patients of western India was 33.9%. Prevalences of non-proliferative DR and proliferative DR were 25.5% and 8.33% respectively. Statistically significant differences (p value<0.05) were observed between prevalences of DR in each group of patients which was classified, and duration of diabetes. Prevalence of CSME (clinically significant macular oedema) was 6.5%. Associated hypertension showed a statistically significant (p value<0.05%), higher prevalence of DR.

CONCLUSION

This study concluded that prevalence of DR in type 2 DM patients of western India was 33.9% and that it increased with duration of diabetes. Associated hypertension is a risk factor for development of DR. It was further noted that proliferative DR was prevalent only after having diabetes for 11 years.

Screening and public health strategies for diabetic retinopathy in the Eastern Mediterranean region

Diabetic retinopathy (DR) is a complication of diabetes mellitus that can cause blindness. As the prevalence of diabetes increases globally and patients live longer, the cases of DR are increasing. To address the visual disabilities due to DR, screening of all diabetics is suggested for early detection. The rationale and principles of DR screening are discussed. Based on the available evidence, the magnitude of DR in countries in the Eastern Mediterranean region (EMR) is presented. Public health strategies to control visual disabilities due to DR are discussed. These include generating evidence for planning, implementing standard operating procedures, periodic DR screening, focusing on primary prevention of DR, strengthening DR management, health information management and retrieval systems for DR, rehabilitating DR visually disabled, using low-cost technologies, adopting a comprehensive approach by integrating DR care into the existing health systems, health promotion/counseling, and involving the community. Although adopting the public health approach for DR has been accepted as a priority by member countries of EMR, challenges in implementation remain. These include limitations in the public health approach for DR compared to that for cataract, few skilled workers, poor health systems and lack of motivation in affecting health-related lifestyle changes in diabetics.Visual disabilities due to DR are likely to increase in the coming years. An organized public health approach must be adopted and all stakeholders must work together to control severe visual disabilities due to DR.

Type II Diabetes Mellitus in Arabic-Speaking Countries

The global epidemic of diabetes has not spared the Arabic-speaking countries, which have some of the highest prevalence of type II diabetes. This is particularly true of the Arab Gulf, a conglomerate of high income, oil-producing countries where prevalence rates are the highest. The prevalence rates among adults of the Arabic speaking countries as a whole range between 4%-21%, with the lowest being in Somalia and the highest in Kuwait. As economic growth has accelerated, so has the movement of the populations to urban centers where people are more likely to adopt lifestyles that embrace increased high-calorie food consumption and sedentary lifestyles. These factors likely contribute to the increased prevalence of obesity and diabetes in the Arabic speaking countries.

Explorative study on diabetes neuropathy among type II diabetic patients in Universiti Sains Malaysia Hospital

OBJECTIVE

The aim of this study was to determine risk factors and prevalence of diabetic neuropathy (DN) among type II diabetic patients in Malaysian hospital setting.

SUBJECTS AND METHODS

a observational prospective longitudinal follow up study design was selected, total no of respondents were 1077 type 2 diabetes mellitus outpatients recruited via attended the diabetes clinics at Hospital Universiti Sains Malaysia (HUSM) in Kelantan. The diagnosis of neuropathy was confirmed by nerve conduction studies. Logistic regression analysis was used to assess the independent variables that affect the development of neuropathy.

RESULTS

The prevalence of nephropathy is 54.3%. Longitudinal logistic regression identified four predictive variables on the development and progression of diabetic neuropathy that are: duration of diabetes, retinopathy, HbA1c at second visit, and creatinine clearance third visit.

CONCLUSION

Findings of this study show high prevalence of diabetic neuropathy. HbA1c and creatinine clearance are two modifiable risk factors for the development of diabetic neuropathy.

Retinopathy and risk factors in diabetic patients from Al-Madinah Al-Munawarah in the Kingdom of Saudi Arabia

Background

Diabetes mellitus is accompanied by chronic and dangerous microvascular changes affecting most body systems, especially the eye, leading to diabetic retinopathy. Diabetic retinopathy without appropriate management is emerging as one of the leading causes of blindness. Therefore, it is necessary to improve the early diagnosis of diabetic retinopathy, reduce the risk of blindness, and identify relevant risk factors.

Methods

This descriptive study was designed to estimate the prevalence of retinopathy and its staging in diabetic patients attending the diabetes clinic at King Fahd Hospital in Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia, from 2008 to 2010. Patients completed a questionnaire, underwent a full medical assessment carried out by the treating clinicians, and were examined for evidence of diabetic retinopathy using standard ophthalmic outpatient instruments.

Results

In total, 690 randomly selected diabetic patients of mean age 46.10 ± 11.85 (range 16–88) years were included, comprising 395 men (57.2%) of mean age 46.50 ± 11.31 years and 295 women (42.8%) of mean age 45.55 ± 12.53 years. The mean duration of diabetes mellitus was 11.91 ± 7.92 years in the women and 14.42 ± 8.20 years in the men, and the mean total duration of known diabetes mellitus was 13.35 ± 8.17 years. Glycated hemoglobin was higher in men (8.53% ± 1.81%) than in women (7.73% ± 1.84%), and this difference was statistically significant (P ≤ 0.0001). Of the 690 diabetic patients, 249 (36.1%) had retinopathy. Mild nonproliferative diabetic retinopathy was present in 13.6% of patients, being of moderate grade in 8% and of severe grade in 8.1%. A further 6.4% had proliferative diabetic retinopathy.

Conclusion

Regular screening to detect diabetic retinopathy is strongly recommended because early detection has the best chance of preventing retinal complications.

A Retrieval System for Patients with Avoidable Blindness Due to Diabetic Retinopathy who do not Present for Ophthalmic Assessment in Oman

Background:

Many patients with diabetes do not present for eye examinations, foregoing the recommended management for diabetic eye care. Proactive steps are being taken in Oman to retrieve defaulters (patients who do not present or “no-show”) with Sight Threatening Diabetic Retinopathy (STDR). We present the outcomes of the defaulter retrieval system in five regions of Oman in 2009.

Materials and Methods:

Ophthalmologists examine eyes periodically, family physicians focus on primary prevention of Diabetic Retinopathy (DR) and medical retina specialists manage DR in Oman. A person with proliferative stage of DR (PDR) and/or Diabetic Macular Edema (DME) in either eye is considered as STDR and is registered at regional hospitals. The eye care staff identify the defaulters and the hospital staff help them retrieve the defaulters. The reminder of reappointment is sent using the text messages on telephone. The glycemic control of STDR cases was also noted in Nizwa Hospital.

Results:

We registered 654 STDR cases, of which 494 (75%) were defaulters. Lack of awareness, transport, absence of a decision maker, and fear of laser treatment were the main causes for defaulting. We successfully retrieved 328 (66.4%) defaulters. The retrieval rates among male and female patients were 51.2% and 82%, respectively. The retrieval varied by region. In Nizwa hospital, 114 of 131 STDR cases (85%) had poor glycemic control.

Conclusion:

Defaulter retrieval system could help healthcare providers to identify and motivate patients with STDR towards better compliance. Primary prevention measures among STDR cases were poor and need further focus.

Macular Function in Prediabetic and Diabetic Omani Adults: A Microperimetric Evaluation

Purpose.

To assess if functional visual loss preceded structural changes or vice versa in diabetic patients by evaluating the macular function in prediabetic patients and in diabetic patients with varying grades of retinopathy and comparing the findings with those of age-matched healthy controls by means of microperimetry

Methods.

Retinal sensitivity, fixation pattern, and test response were evaluated in 25 prediabetic patients (50 eyes), 25 diabetic patients (50 eyes), and 25 age-related normal nondiabetic patients (50 eyes) using Nidek microperimetry. The diabetic patients were classified into 3 groups on the basis of clinical and fundus fluorescein angiographic evidence: group 1 = no clinical or angiographic evidence of retinopathy, group 2 = background retinopathy only, group 3 = with macular edema. Classification of retinopathy was based on Early Treatment Diabetic Retinopathy Study standards. Statistical analysis was conducted by Fisher exact test.

Results.

In diabetic patients, 20 eyes (40%) had no clinical or angiographic evidence of retinopathy, 13 eyes (26 %) had background changes, and 17 eyes (34%) had macular edema. Statistically significant difference in the fixation pattern, test response, and retinal sensitivity was noted in the diabetic and the prediabetic patients when compared to the controls.

Conclusions.

Significant loss of macular function in the eyes of prediabetic subjects was noted. These preliminary findings probably support the hypothesis that neurodegeneration precedes mi-croangiopathy.

Knowledge of Primary Prevention of Diabetic Retinopathy among General Ophthalmologists, Mid Level Eye Care Personnel and General Physicians in Oman

OBJECTIVE

We present the outcomes of knowledge of diabetes and associated ocular complications among personnel comprising the eye care team in Oman.

MATERIALS AND METHODS

A closed ended questionnaire was administered during November 2008 and November 2009 to eye care team members in six regions of Oman, where trainings were held. All participants of these trainings were included in our study. The questionnaire comprised 15 questions that tested the knowledge of the diagnosis and treatment of diabetes and its ocular complications. They circled the most suitable reply for a list of choices. The replies were compared with the gold standard (answers from a medical retina specialist, a diabetologist's and general ophthalmologists answers). The participants were divided into two groups; acceptable (more than 50% score compared to gold standard) and less than desired (less than 50% score compared to gold standard.) We estimated the areas of acceptable level of knowledge in different subgroups.

RESULTS

All 87 (100%) of eye care team members participated. Of the 42 general ophthalmologists, 30 (71.4%) had an acceptable level of knowledge about primary prevention, ideal blood sugar and blood pressure levels and complication of diabetes. The acceptable level of knowledge among mid level eye care providers and general physicians was found in 15 (54.5%) and 4 (33.3%) respondents respectively.

CONCLUSION

Less than the desired number of participants of the eye care team had an acceptable level of knowledge about primary prevention, ideal blood sugar and blood pressure levels and complications of diabetes. The training of eye care personnel need to enhance knowledge in the weak areas is identified in this study.

Prevalence and determinants of diabetic retinopathy among persons ≥ 40 years of age with diabetes in Qatar: a community-based survey

PURPOSE

We present the prevalence and determinants of diabetic retinopathy (DR) in persons 40 years and older with diabetes in Qatar.

METHODS

This community-based survey was held in 2009 at 49 randomly selected clusters. Demographic details and history of diabetes mellitus (DM) and its management were collected by nurses. Ophthalmologists examined the retina by slit-lamp biomicroscopy using +90 D lens and/or indirect ophthalmoscopy. Digital photographs of retina were obtained. The best-corrected visual acuity of each eye was noted. Diabetic retinopathy was graded as mild, moderate, or severe nonproliferative DR, proliferative DR, or diabetic macular edema.

RESULTS

We examined 540 (97.3%) participants with DM. Diabetes mellitus status of 487 persons could be confirmed from medical records. The age- and sex-adjusted prevalence of DR among the diabetic population 40 years and older was 23.5% (95% confidence interval [CI] 19.7-27.3), with 8192 cases of DR among patients with DM. Longer duration of diabetes (odds ratio 1.14 [95% CI 1.10-1.19]) and poor glycemic control (odds ratio 1.12 [95% CI 1.02-1.23]) were risk factors for DR. Awareness of regular eye checkup was found in 62% of participants. Only 20% of persons with sight-threatening DR had undergone laser treatment in at least 1 eye. Visual acuity in the better eye was 6/6 to 6/18 in 90% of persons with DR.

CONCLUSIONS

Universal and periodic eye screening of patients with diabetes is recommended in Qatar. Health promotion for primary prevention and resource review are needed for early detection and management of sight-threatening DR.

Risk factors for microvascular complications of diabetes among South Indian subjects with type 2 diabetes--the Chennai Urban Rural Epidemiology Study (CURES) Eye Study-5

BACKGROUND

This study assessed the relationship between and risk factors for microvascular complications of diabetes in an urban South Indian type 2 diabetes population.

METHODS

Subjects with diabetes (n = 1,736) were selected from the population-based Chennai Urban Rural Epidemiology Study (CURES) Eye Study conducted on a representative population of Chennai city in south India. Four-field stereo retinal color photography was done, and diabetic retinopathy (DR) was classified according to the Early Treatment DR Study grading system. Neuropathy was diagnosed if the vibratory perception threshold of the big toe using biothesiometry was ≥ 20V. Overt nephropathy was diagnosed if the subjects had persistent macroalbuminuria (urinary albumin excretion ≥ 300 μg/mg of creatinine) and microalbuminuria if it was between 30 and 299 μg/mg of creatinine. Among the 1,715 subjects with gradable fundus photographs, 1,608 individuals who had information on all test parameters were included.

RESULTS

Overall, DR was present in 282 (17.5%), neuropathy in 414 (25.7%), overt nephropathy in 82 (5.1%), and microalbuminuria in 426 (26.5%) subjects. Eighteen subjects had all three microvascular complications of diabetes. The risk of nephropathy (odds ratio [OR] = 5.3, P<0.0001) and neuropathy (OR = 2.9, P<0.0001) was significantly higher among the subjects with sight-threatening DR compared to those without DR. Common risk factors identified for all the three microvascular complications of diabetes were age, glycated hemoglobin, duration of diabetes, and serum triglycerides. DR was associated with nephropathy after adjusting for age, gender, hemoglobin A1c, systolic blood pressure, serum triglycerides, and duration of diabetes (OR = 2.140, 95% confidence interval = 1.261-3.632, P = 0.005).

CONCLUSIONS

This is the first population-based study from India to report on all microvascular complications of diabetes and reveals that the association between DR and nephropathy is stronger than that with neuropathy.

[Vitreoretinal surgery in Oman]

PURPOSE

Vitreoretinal diseases in Middle Eastern countries currently rank in importance behind cataract, trachoma and glaucoma. This study reports on the most frequent causes of vitreoretinal diseases and the results of vitreoretinal surgery in Oman in order to gain insights into requirements in training and equipment.

METHODS

Demographic data and biomicroscopic examinations were performed over a 5-year period. Pars plana vitrectomies were carried out with the Accurus 800CS (Alcon) and EyeLite® 532 nm Laser (Alcon), endotamponade with silicone oil 5600 cs (adatomed) or C₃F₈ Ispan (Alcon), oval silicone sponge scleral buckles 5.5 x 7.5 mm type 507 (Geuder®) in adults and oval silicone sponge scleral buckles 3.0 × 5.0 mm type 506 (Geuder®) in children (up to 12 years) were sutured with Mersilene parallel to the limbus. Patients were followed after 4 weeks and 1 year. Evaluation of data was done by descriptive statistics (Fisher exact and χ²-tests).

RESULTS

From 2002 to 2006, 2,910 vitreoretinal surgeries were performed on 784 adult and 101 pediatric eyes. Main indications were proliferative diabetic vitreoretinopathy (PDVR) (229/784 eyes=29%), followed by trauma (166/784=21%), and PVR retinal detachment (112/784=14.3%) in adults and in children the main indication was trauma (73/101 eyes=73%). The postoperative vision in adults with trauma, PVR retinal detachment, epiretinal gliosis and IOL extraction was significantly different and better (p=0.003, p=0.044, p=0.029, p=0.001, respectively) and the postoperative vision in PDVR with uncontrolled diabetes mellitus II significantly different and worse (p=0.001). Of the eyes with PDVR in uncontrolled diabetes mellitus 165 out of 229 (72%) lost distance vision (p=0.00014). All patients with serious macular edema and an HbA(1c) of ≥9.5% lost 5 m distance in vision. The mean HbA(1c) in all patients who experienced postoperative blindness was 13.5%. Postoperative vision was significantly better in children operated for trauma complications (p=0.046) whereby patients with contusion of the globe had a significantly better final result (p=0.0302) than patients with penetrating injuries. Revision surgery was indicated most frequently after surgery for proliferative vitreoretinopathy due to prior retinal detachment surgery.

CONCLUSIONS

The most frequent causes of preventable retinal blindness in Oman are pediatric trauma and advanced diabetic vitreoretinopathy. Eyes operated for trauma had a better outcome than PDVR in patients with uncontrolled diabetes mellitus. The large number of eyes with PDVR in the final stages and sequelae of trauma legitimates preventive medical measures and an expansion of vitreoretinal services with supportive external training of specialists and allied health professions.

Gender inequality in vision loss and eye diseases: evidence from the Sultanate of Oman

PURPOSE

The data from surveys of vision loss and monitoring of services were used to assess changes in gender inequality in Oman.

STUDY DESIGN

Retrospective review of data collection instruments.

MATERIALS AND METHOD

The data sets of 12 years between 1996 and 2007 were abstracted to assess the gender equality for vision loss, eye disease prevalence, and service use. They included two surveys (1996 and 2005), Health Information from eye units (1998 and 2007), and eye screening in schools.

RESULTS

In 1996, the prevalence of bilateral blindness in > or = 40 years of age was higher in females [Odd's Ratio (OR) = 0.36 (95% Confidence Interval (CI) 0.24 - 0.53)]. Gender differences in the prevalence of cataract [OR = 0.82 (95% CI 0.63 - 1.03)] were not significant while trachomatous trichaisis (TT) was less in males [OR = 0.33 (95% CI 0.22-0.48)]. In 2005, gender differences in the prevalence of bilateral blindness [OR = 0.97 (95% CI 0.71 - 1.34)] and TT [OR = 0.66 (95% CI 0.42- 1.04)] were not statistically significant.But males were associated with higher prevalence of cataract [OR = 1.26 (95% CI 1.00 - 1.59)]. Surgery rates for cataract, glaucoma and TT were not different by gender. More male compared to female patients with diabetic retinopathy were treated. Myopia was significantly higher in girls. Compliance of spectacle wear was higher in girls.

CONCLUSIONS

Gender inequality for eye care seems to have reduced in the last 10 years in Oman. However, apart from TT and glaucoma patients the difference in service utilization by gender was not statistically significant.

Diabetic retinopathy, visual impairment and ocular status among patients with diabetes mellitus in Yemen: a hospital-based study

Background:

We present a series of patients with diabetes mellitus (DM) who attended an eye hospital in Sana, Yemen during 2004.

Aim:

To determine the magnitude and risk factors of diabetic retinopathy (DR).

Design:

Cross-sectional study.

Materials and Methods:

Ophthalmologists assessed vision, ocular pressure, ocular media and posterior segment to note ocular manifestations among patients with DM. DR was graded by using bio-microscope and Volk lens. The prevalence and 95% confidence interval of ocular complications of DM were calculated. Risk factors of DR like age, sex, duration of diabetes and hypertension were evaluated.

Statistical Analysis:

Univariate and multivariate analysis.

Results:

Our series comprised 350 patients suffering from DM. The duration of diabetes was ≥15 years in 101 (29%) patients. Physician was treating 108 DM patients with insulin. The prevalence of DR was 55% (95% CI 49.6–60.1). The proportions of background diabetic retinopathy (BDR), preproliferative diabetic retinopathy (PPDR), proliferative diabetic retinopathy (PDR) and diabetic macular edema were 20%, 13%, 17% and 22% respectively. The prevalence of blindness among DM patients was 16%. The prevalence of cataract and glaucoma was 34.3% and 8.6%. Duration of DM was the predictor of DR. One-fifth of the patients had sight-threatening DR and needed laser treatment.

Conclusions:

DR was of public health magnitude among our patients. An organized approach is recommended to address DR in the study area.

Diabetic retinopathy and ocular co-morbidities among persons with diabetes at Sumail Hospital of Oman

PURPOSE

We evaluated the magnitude of diabetic retinopathy (DR) and other ocular co-morbidities among patients with diabetes in 2006. We also assessed resources for eye care at Oman's Sumail Hospital.

METHODS

We reviewed the DR register in May 2008. Physicians diagnosed diabetes. Ophthalmologists used a biomicroscope to identify ocular co-morbidities. The best-corrected vision of each eye was noted. DR grading, as recommended by the World Health Organization, was adopted. The prevalence of DR was calculated. Grades of DR were correlated to vision. Projections of patients with diabetes mellitus and DR were compared to the study outcomes.

RESULTS

We randomly picked 418 (49%) of the 843 registered persons with diabetes for our study. The prevalence of DR was 7.9% (95% confidence interval 6.6, 9.2). Sight-threatening DR was found in 43 of 689 (5.3%) eyes. Prevalence of DR was 6.3% among persons with diabetes who were screened for the first time; it was 9.3% among those rescreened. Diabetic macular edema was present in 42 (5%) eyes. Patients with DR had a higher risk of blindness (vision less than 6/60) compared to those without DR (odds ratio 5.0; 95% confidence interval 3.74, 6.69). Laser surgery had to be used for 85 (20.3%) DR patients. Early cataract and trachomatous corneal opacities were main co-morbidities.

CONCLUSIONS

The coverage of screening for diabetes and DR in our study area was less than the national coverage. Better management facilities for DR could improve patients' eye care at Sumail Hospital. Good vision in persons with diabetes could be a reason for them not accepting regular eye check-ups and laser treatment.

Magnitude and determinants of ocular morbidities among persons with diabetes in a project in Ahmedabad, India

BACKGROUND

Visual disabilities due to diabetes are on the rise, especially in urban areas of developing countries. Proper health planning will need evidence-based information.

STUDY DESIGN AND METHODS

We estimated the prevalence and identified the determinants of eye complications among persons with diabetes screened in Ahmedabad, India, during 2007-2008. This was a review of the data from a health institution-based project. Physicians collected information on diabetes, and ophthalmologists examined the patients for visual acuity, diabetic retinopathy (DR), glaucoma, and cataracts. World Health Organization-recommended grading of DR was used. Frequencies, prevalence, and 95% confidence interval (CI) values were calculated.

RESULTS

Of 40,919 persons who we examined for diabetes, 9,246 (66.6%) persons knew that they had diabetes, whereas 4,641 (33.4%) persons were detected with diabetes for the first time. The prevalence of DR, early cataract, and glaucoma among those who knew that they had diabetes was 14.6% (95% CI 13.9-15.3), 44.4% (95% CI 43.4-45.4), and 5.4% (95% CI 4.9-5.9), respectively. The prevalence of DR among persons with diabetes (new and old) was 10.1% (95% CI 9.6-10.6). Although poor vision was positively associated with DR (chi2 = 706), 40% of those with DR had vision better than 20/60. Male sex (odds ratio [OR] = 1.31), longer duration of diabetes (chi2 = 1,808), hypertension (OR = 1.13), good sugar control (OR = 0.09), and nephropathy (OR = 2.16) were the factors associated with DR. Regression analysis suggested that longer duration of diabetes and poor control of diabetes were the predictors of DR.

CONCLUSIONS

The prevalence of DR was low. Long duration of diabetes, poor control of blood sugar, presence of nephropathy, and hypertension were associated with DR. Good vision could mislead about the severity of DR.

Effect of macular photocoagulation on visual acuity of Omani patients with clinically significant macular edema

BACKGROUND

The aim of this study was to determine the effect of macular laser treatment on the visual acuity (VA) of Omani diabetic patients with clinically significant macular edema (CSME). Visual outcome was also correlated with duration and control of diabetes and presence or absence of hypertension and hyperlipidemia.

MATERIALS AND METHODS

This is a retrospective noncomparative cohort study involving 101 eyes of 72 Omani diabetic patients. Change in VA was determined using Snellen's VA chart. The mean duration of follow-up was approximately 21 months (range, 16-24 months).

RESULTS

29.7% of the patients maintained their vision, 35.6% showed improvement, whereas 34.7% showed a decrease in their vision. Positive visual outcome showed a statistically significant direct relationship with tight control of diabetes and absence of hypertension and an inverse relationship with the duration of diabetes. Presence of hyperlipedemia did not show a statistically significant relationship with positive visual outcome. However, it showed a trend to better visual outcome in the absence of hyperlipedemia. Peak incidence of macular edema was seen at the age of 52.3 years.

CONCLUSION

Macular photocoagulation was found to be an effective method of treatment for CSME among Omani diabetic patients, which has resulted in a positive visual outcome in 65.3% of the patients (stable and improved vision). Effective control of diabetes, duration of diabetes, and hypertension are the factors which influence the postlaser visual outcome.

Regular visits to a diabetes clinic were associated with lower magnitude of visual disability and diabetic retinopathy-a hospital-based historical cohort study in yemen

BACKGROUND

We associated regularity in visits to a diabetes clinic with the presence of diabetic retinopathy (DR) and visual disabilities.

METHODS

This historical cohort study was conducted in 2004. The physician reported details of diabetes mellitus (DM), hypertension, and other illness. The ophthalmologist examined eyes and noted visual acuity, DR, and other ocular morbidities. We calculated the relative risk (RR) of different complications of diabetes.

RESULTS

Our cohort consisted of 228 patients (114 in each group, one that attended diabetes clinics regularly [group A] and one that had irregular attendance [group B]). DR was found in 47 (41.2%) and 68 (61.4%) patients, respectively. The risk of DR was significantly higher in group B (RR = 1.51, 95% confidence interval [CI] 1.23 to 2.18). The severity of DR was also positively associated with irregularity in clinic visits (x(2) = 33.56, degrees of freedom = 5, P = 0.000003). The risk of bilateral blindness (RR = 4.0, 95% CI 1.38 to 11.6) and low vision disability (RR = 2.53, 95% CI 1.84 to 3.47) were higher in group B. The duration of diabetes and the regularity in clinic visits were the predictors of DR.

CONCLUSIONS

The presence of DR and visual disabilities among patients with diabetes is associated with irregular attendance at diabetes clinics. The regularity of medical visits seems to be a proxy indicator of better primary prevention of eye complications of DM.

Addressing the threat of chronic diseases in Oman

INTRODUCTION

The overall health status of the Omani population has evolved over the past 4 decades from one dominated by infectious disease to one in which chronic disease poses the main challenge. Along with a marked reduction in the incidence of infectious diseases, improvements in health care and socioeconomic status have resulted in sharp declines in infant and early childhood mortality and dramatic increases in life expectancy.

METHODS

Focusing on the time period from 1990 through 2005, we reviewed relevant epidemiological studies and reports and examined socioeconomic indicators to assess the impact of the changing disease profile on Oman's economy and its health care infrastructure.

RESULTS

Over the next 25 years, the elderly population of Oman will increase 6-fold, and the urbanization rate is expected to reach 86%. Currently, more than 75% of the disease burden in Oman is attributable to noncommunicable diseases, with cardiovascular disease as the leading cause of death. The distribution of chronic diseases and related risk factors among the general population is similar to that of industrialized nations: 12% of the population has diabetes, 30% is overweight, 20% is obese, 41% has high cholesterol, and 21% has the metabolic syndrome.

CONCLUSION

Unless reforms are introduced to the current health care system, chronic diseases will constitute a major drain on Oman's human and financial resources, threatening the advances in health and longevity achieved over the past 4 decades.