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Aytenew TM, Kefale D, Birhane BM, Kebede SD, Asferie WN, Hailemeskel HS, Kassaw A, Asnakew S, Kassie YT, Mekonnen GB, Kebede M, Eshetie Y, Ejigu N, Zeleke S, Agimas MC, Simegn A. Visual impairment among diabetes patients in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0303388. [PMID: 38820429 PMCID: PMC11142537 DOI: 10.1371/journal.pone.0303388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/24/2024] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION The increased prevalence of visual impairment among diabetes patients has become a major global public health problem. Although numerous primary studies have been conducted to determine the prevalence of visual impairment and its associated factors among diabetes patients in Ethiopia, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of visual impairment and identify associated factors among diabetes patients. METHODS An extensive search of literature was done on PubMed, Google Scholar, and Web of Sciences databases. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to calculate the pooled prevalence of visual impairment. RESULTS A total of 34 eligible primary studies with a sample size of 11,884 participants were included in the final meta-analysis. The pooled prevalence of visual impairment was 21.73% (95% CI: 18.15, 25.30; I2 = 96.47%; P<0.001). Diabetes mellitus with a duration of diagnosis ≥10 years [AOR = 3.18, 95% CI: 1.85, 5.49], presence of co-morbid hypertension [AOR = 3.26, 95% CI: 1.93, 5.50], poor glycemic control [AOR = 4.30, 95% CI: 3.04, 6.06], age ≥56 years [AOR = 4.13, 95% CI: 2.27, 7.52], family history of diabetes mellitus [AOR = 4.18 (95% CI: 2.61, 6.69], obesity [AOR = 4.77, 95% CI: 3.00, 7.59], poor physical activity [AOR = 2.46, 95% CI: 1.75, 3.46], presence of visual symptoms [AOR = 4.28, 95% CI: 2.73, 6.69] and no history of eye exam [AOR = 2.30, 95% CI: 1.47, 3.57] were significantly associated with visual impairment. CONCLUSIONS The pooled prevalence of visual impairment was high in Ethiopia. Diabetes mellitus with a duration of diagnosis ≥10 years, presence of co-morbid hypertension, poor glycemic control, age ≥56 years, and family history of diabetes mellitus, obesity, poor physical activity, presence of visual symptoms, and no history of eye exam were independent predictors. Therefore, diabetic patients with these identified risks should be screened, and managed early to reduce the occurrence of visual impairment related to diabetes. Moreover, public health policy with educational programs and regular promotion of sight screening for all diabetes patients are needed.
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Affiliation(s)
- Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhane
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis Kebede
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Shimels Hailemeskel
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannes Tesfahun Kassie
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrehiwot Berie Mekonnen
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melese Kebede
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yeshiambaw Eshetie
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Netsanet Ejigu
- Department of Midwifery, Dembya Primary Hospital, Koladiba, Gondar, Ethiopia
| | - Shegaw Zeleke
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Amare Simegn
- Department of Reproductive Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Li YQ, Zhang ST, Ke NY, Fang YC, Hu WL, Li GA, Huang F, Zhou YF. The impact of multiple metals exposure on the risk of developing proliferative diabetic retinopathy in Anhui, China: a case-control study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:112132-112143. [PMID: 37831242 DOI: 10.1007/s11356-023-30294-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
Through multiple different pathways, the environmental multiple metals make their ways to the human bodies, where they induce different levels of the oxidative stress response. This study further investigated the impact of multiple-metal exposure on the risk of developing proliferative diabetic retinopathy (PDR). We designed a case-control study with type 2 diabetic patients (T2D), in which the case group was the proliferative diabetic retinopathy group (PDR group), while the control group was the non-diabetic retinopathy group (NDR group). Graphite furnace atomic absorption spectrometry (GFAAS) and inductively coupled plasma optical emission spectrometry (ICP-OES) were used to detect the metal levels in our participants' urine samples. The least absolute shrinkage and selection operator (LASSO) regression approach was used to include these representative trace elements in a multiple exposure model. Following that, logistic regression models and Bayesian kernel machine regression (BKMR) models were used to describe the effect of different elements and also analyze their combined effect. In the single-element model, we discovered that lithium (Li), cadmium (Cd), and strontium (Sr) were all positively related to PDR. The multiple-exposure model revealed a positive relationship between Li and PDR risk, with a maximum quartile OR of 2.80 (95% CI: 1.10-7.16). The BKMR model also revealed that selenium (Se) might act as a protective agent, whereas magnesium (Mg), Li, and Cd may raise the risk of PDR. In conclusion, our study not only revealed an association between exposure to multiple metals and PDR risk but it also implied that urine samples might be a useful tool to assess PDR risk.
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Affiliation(s)
- Yan-Qing Li
- Department of Ophthalmology, First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Shushan District, Hefei, Anhui, China
| | - Si-Tian Zhang
- Department of Ophthalmology, First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Shushan District, Hefei, Anhui, China
| | - Nai-Yu Ke
- Department of First Clinical Medical College, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Yan-Cheng Fang
- Department of Ophthalmology, First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Shushan District, Hefei, Anhui, China
| | - Wen-Lei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Guo-Ao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Fen Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Yan-Feng Zhou
- Department of Ophthalmology, First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Shushan District, Hefei, Anhui, China.
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Azagew AW, Yohanes YB, Beko ZW, Ferede YM, Mekonnen CK. Determinants of diabetic retinopathy in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0286627. [PMID: 37289766 PMCID: PMC10249865 DOI: 10.1371/journal.pone.0286627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/19/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Diabetic retinopathy (DR) is the primary retinal vascular complication of diabetes mellitus and a leading cause of visual impairment and blindness. It affects the global diabetic population. In Ethiopia, about one-fifth of diabetic patients were affected by DR, but there were inconsistent finding across studies about the determinants factors of DR. Therefore, we aimed to identify the risk factors for DR among diabetic patients. METHODS We have accessed previous studies through an electronic web-based search strategy using PubMed, Google (Scholar), the Web of Science, and the Cochrane Library with a combination of search terms. The quality of each included article was assessed using the Newcastle Ottawa Assessment Scale. All statistical analyses were carried out using Stata version 14 software. The odds ratios of risk factors were pooled using a fixed-effect meta-analysis model. Heterogeneity was assessed using the Cochrane Q statistics and I-Square (I2). Furthermore, publication bias was detected based on the graphic asymmetry test of the funnel plot and/or Egger's test (p< 0.05). RESULTS The search strategy retrieved 1285 articles. After the removal of duplicate articles, 249 articles remained. Following further screening, about 18 articles were assessed for eligibility, of which three articles were excluded because of reporting without the outcome of interest, poor quality, and not full text. Finally, fifteen studies were reviewed for the final analysis. Co-morbid hypertension (HTN) (AOR 2.04, 95%CI: 1.07, 3.89), poor glycemic control (AOR = 4.36, 95%CI: 1.47, 12.90), and duration of diabetes illness (AOR = 3.83, 95%CI: 1.17, 12.55) were found to be confirmed associated factors of diabetic retinopathy. CONCLUSION In this study, co-morbid HTN, poor glycemic control, and longer duration of diabetes illness were found to be the determinant factors of DR. Aggressive treatment of co-morbid HTN and blood glucose, and regular eye screening should be implemented to reduce the occurrence of DR. TRIAL REGISTRATION The review protocol was registered in the international prospective register of systematic reviews (PROSPERO) with registration number PROSPERO: CRD42023416724.
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Affiliation(s)
- Abere Woretaw Azagew
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yeneabat Birhanu Yohanes
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zerko Wako Beko
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Mulu Ferede
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Kassa Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sahiledengle B, Assefa T, Negash W, Tahir A, Regasa T, Tekalegn Y, Mamo A, Teferu Z, Solomon D, Gezahegn H, Bekele K, Zenbaba D, Tasew A, Desta F, Regassa Z, Feleke Z, Kene C, Tolcha F, Gomora D, Dibaba D, Atlaw D. Prevalence and Factors Associated with Diabetic Retinopathy among Adult Diabetes Patients in Southeast Ethiopia: A Hospital-Based Cross-Sectional Study. Clin Ophthalmol 2022; 16:3527-3545. [PMID: 36274673 PMCID: PMC9581466 DOI: 10.2147/opth.s385806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is the most prevalent microvascular consequence of diabetes mellitus, and it can result in blindness that is irreversible. Due to delayed diagnosis and limited access to diabetic care, the situation is even worse in developing countries. Scientific evidence on the prevalence of DR and its associated factors among diabetes patients in low-income countries, such as Ethiopia, is limited. This study aimed to determine the prevalence of DR and associated factors among adult diabetes patients in southeast Ethiopia. METHODS A hospital-based cross-sectional study was conducted among diabetes patients who visited Madda Walabu University Goba Referral Hospital. Fundus and slit-lamp examination were performed for screening of DR. Multivariate binary logistic regression was computed to identify factors associated with DR. RESULTS A total of 256 patients (144 men, 56.2%) aged 50.15±15.71 years were included in the study. The prevalence of any DR was 19.9% (95% CI 15.4%-25.3%), mild nonproliferative diabetic retinopathy (NPDR) 10.9% (95% CI 7.6%-15.4%), moderate NPDR 5.9% (95% CI 3.5%-9.5%), severe NPDR 0.9% (95% CI 0.2%-3.9%), and proliferative DR 2.3% (95% CI 1.0%-5.1%). Duration of diabetes ≥10 years (AOR 10.22, 95% CI 1.70-61.44), central obesity (AOR 5.42, 95% CI 1.38-21.19), overweight/obese (AOR 2.65, 95% CI 1.02-6.92), lower high-density lipoprotein (HDL) cholesterol (AOR 5.82, 95% CI 1.86-18.24), moderate triglyceride:HDL cholesterol ratio (AOR 4.13, 95% CI 1.13-15.15), and urban dwelling (AOR 2.84, 95% CI 1.04-7.78) were significantly associated with DR. CONCLUSION One in every five DM patients had DR. Sociodemographic, anthropometric, and blood lipids were independently associated with DR. To reduce the burden of diabetes, strategies that focus on lifestyle modifications targeted at identified modifiable risk factors are essential.
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Affiliation(s)
- Biniyam Sahiledengle
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia,Correspondence: Biniyam Sahiledengle, Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia, Email
| | - Tesfaye Assefa
- Nursing Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Wogene Negash
- Nursing Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Anwar Tahir
- Nursing Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Tadele Regasa
- Biomedical Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Yohannes Tekalegn
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Ayele Mamo
- Pharmacy Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Zinash Teferu
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Damtew Solomon
- Biomedical Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Habtamu Gezahegn
- Biomedical Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Kebebe Bekele
- Surgery Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Demisu Zenbaba
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Alelign Tasew
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Fikreab Desta
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Zegeye Regassa
- Nursing Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Zegeye Feleke
- Nursing Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Chala Kene
- Midwifery of Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Fekata Tolcha
- Pediatrics and Child Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Degefa Gomora
- Midwifery of Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Diriba Dibaba
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Daniel Atlaw
- Biomedical Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
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Gelcho GN, Gari FS. Time to Diabetic Retinopathy and Its Risk Factors among Diabetes Mellitus Patients in Jimma University Medical Center, Jimma, Southwest Ethiopia. Ethiop J Health Sci 2022; 32:937-946. [PMID: 36262700 PMCID: PMC9554771 DOI: 10.4314/ejhs.v32i5.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022] Open
Abstract
Background Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the eye. Globally, diabetic retinopathy affects more than 103.12 million people. Diabetic retinopathy is among the leading causes of vision loss at the global level, including in Ethiopia. Therefore, the study aimed to assess the time to develop diabetic retinopathy and identify factors associated with diabetic retinopathy among diabetes patients. Methods A retrospective study was conducted from September 1, 2021 to January 30, 2022. Data was collected using semistructured questionnaire. The Cox proportional hazard model were used to determine the median time to develop diabetic retinopathy and identify predictors of diabetic retinopathy. Data was analyzed using R software. Results A total of 373 diabetes patients were included in this study. The prevalence of diabetic retinopathy was 41.3%. The median time was 41 months, ranging from 39 to 73 months. Elder age (HR=3.17, 95%CI: 1.53, 6.58), being male (HR=2.34, 95%CI: 1.35, 6.15), previous family history of diabetes (HR=4.16, 95%CI: 2.19, 8.37), longer duration of diabetes (HR=2.86, 95%CI: 1.41, 5.31) received only insulin therapy (HR=3.91, 95%CI: 1.36, 7.94), and high systolic blood pressure(HR=2.32; 95%CI: 1.12, 4.39) were statistically significant factors related to development of diabetes retinopathy. Conclusions More than half of diabetic patinets in this study were developed retinopathy diabetes within a few months of being diagnosed. As a result, we advocate that the best way to preserve our vision from diabetic retinopathy is to maintain our diabetes under control, and the high-risk population receive early screening for diabetes.
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Affiliation(s)
- Gurmessa Nugussu Gelcho
- Department of Statistics, College of Natural Science, Jimma University, Jimma, Oromia, Ethiopia
| | - Firomsa Shewa Gari
- Department of Statistics, College of Natural and Computational Science, Assosa University, Assosa, Benishangul Gumuz, Ethiopia
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Kaushik M, Nawaz S, Qureshi TS. Profile of sight-threatening diabetic retinopathy and its awareness among patients with diabetes mellitus attending a tertiary care center in Kashmir, India. Indian J Ophthalmol 2021; 69:3123-3130. [PMID: 34708753 PMCID: PMC8725088 DOI: 10.4103/ijo.ijo_831_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To study the profile of sight-threatening diabetic retinopathy (STDR), its association with various factors affecting it, and awareness of diabetic retinopathy (DR) among patients with diabetes mellitus (DM) attending a tertiary care center in Kashmir. Methods: In this prospective cross-sectional study, 625 consecutive patients with DM were assessed for STDR. Demographic/clinical data were obtained. Early treatment diabetic retinopathy study (ETDRS) criteria were used to grade fundus photographs. Severe nonproliferative DR, proliferative DR, and/or macular edema were classified as STDR. Optical coherence tomography was used to confirm the diagnosis of macular edema. Results: The mean age of patients was 56.36 ± 9.29 years. The male-to-female ratio was 0.92:1. The majority (99.36%) of patients had type 2 DM. STDR was seen in 208 (33.28%) patients. Non-sight-threatening diabetic retinopathy (NSTDR) was seen in 173 (27.68%) patients. Eye care was sought by 313 (50.08%) patients for the first time. STDR had a significant association with difficulty in accessing the health care facilities, duration of diabetes, uncontrolled diabetes, presence of other diabetes complications, use of insulin, and hypertension (P < 0.05 for all). Awareness that diabetes can affect eyes showed a significant association with age, gender, educational status, duration of diabetes, glycemic status, DR, and STDR (P < 0.001 for all). Conclusion: STDR is a common complication in diabetes and is duration- and glycemic control-dependent. Understanding the factors associated with STDR can help in making strategies for its prevention. Spreading awareness regarding STDR at the community level in the Kashmir valley is crucial in this regard.
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Affiliation(s)
- Madhurima Kaushik
- Department of Ophthalmology, Govt. Medical College, Srinagar, Jammu and Kashmir, India
| | - Shah Nawaz
- Department of Ophthalmology, Govt. Medical College, Srinagar, Jammu and Kashmir, India
| | - Tariq Syed Qureshi
- Department of Ophthalmology, Govt. Medical College, Srinagar, Jammu and Kashmir, India
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Seid K, Tesfaye T, Belay A, Mohammed H. Determinants of diabetic retinopathy in Tikur Anbessa Hospital, Ethiopia: a case-control study. Clin Diabetes Endocrinol 2021; 7:12. [PMID: 34325741 PMCID: PMC8323205 DOI: 10.1186/s40842-021-00128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diabetic retinopathy is the most frequent complication of Diabetes Mellitus and remains the leading cause of preventable blindness. However, there are limited studies on the determinants of diabetic retinopathy in the study area as well in Ethiopia. Hence, this study aimed to assess the determinants of diabetic retinopathy among diabetic patients at Tikur Anbessa Hospital. Methods An institution-based unmatched case–control study design was conducted at Tikur Anbessa Hospital from May 11 to June 26, 2020. Diabetic patients who developed retinopathy within 2 years were cases in the study. Patients who were free of retinopathy were controls in this study. Data were collected using a pretested interviewer-administered questionnaire, Topcon retinal examination, and a record review. The collected data were entered into Epi Data version 3.1 software, and analyzed using SPSS version 25. Binary logistic regression analysis was used to assess the determinants of diabetic retinopathy. Results A total of 282 patients (142 cases and 140 controls) were included in the study. The mean age (± Standard deviation) for the cases and the controls were 50.6 (SD: ± 18.7) and 44.9 (SD: ± 17.65) respectively. Patients who had a glucometer at home (AOR = 0.048; 95% CI: 0.005–0.492), exercise adherence (AOR = 0.075; 95% CI: 0.007–0.84), diabetes duration < 5 years (AOR = 0.005; 95% CI: 0.00–0.10) and 5–10 years (AOR = 0.041; 95% CI: 0.003–0.57), health information on diabetic complications (AOR = 0.002; 95% CI: 0.00–0.042) and appointments every month (AOR = 0.004; 95% CI: 0.00–0.073) and every 3 months (AOR = 0.022; 95% CI: 0.002–0.23) were less likely to develop diabetic retinopathy. Participants who had poor glycemic control (AOR = 19.9; 95% CI: 2.34–168.69), systolic hypertension (AOR = 23.4; 95% CI: 2.56–215.36) and nephropathy (AOR = 17.85; 95% CI: 2.01–158.1), had a higher risk of developing diabetic retinopathy. Conclusions Patients who had a glucometer at home, exercise adherence, diabetes duration < 10 years, health information on diabetic complications, and frequent follow-up had a preventive role. However, poor glycemic control, systolic hypertension, and nephropathy increase the risk of diabetic retinopathy. A concerted effort should be made to improve the health status of patients with Diabetes Mellitus, with particular emphasis on lifestyle modification practices to prevent diabetic retinopathy.
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Affiliation(s)
- Kalid Seid
- Department of Nursing, College of Health Science, Mizan-Tepi University, P.O. Box: 260, Mizan, SNNPR, Ethiopia.
| | - Temamen Tesfaye
- School of Nursing, Faculty of Health Science, Institute of Health, Jimma University, P.O. Box: 378, Jimma, Ethiopia
| | - Admasu Belay
- School of Nursing, Faculty of Health Science, Institute of Health, Jimma University, P.O. Box: 378, Jimma, Ethiopia
| | - Hayat Mohammed
- Department of Medical Laboratory Science, College of Health Science, Mizan-Tepi University, P.O. Box: 260, Mizan, SNNPR, Ethiopia
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Leley SP, Ciulla TA, Bhatwadekar AD. Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment. Clin Interv Aging 2021; 16:1367-1378. [PMID: 34290499 PMCID: PMC8289197 DOI: 10.2147/cia.s297494] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/04/2021] [Indexed: 12/24/2022] Open
Abstract
The elderly population in the United States is projected to almost double by the year 2050. In addition, the numbers of diabetics are rising, along with its most common complication, diabetic retinopathy (DR). To effectively treat DR within the elderly population, it is essential first to consider the retinal changes that occur due to aging, such as decreased blood flow, retinal thinning, and microglial changes, and understand that these changes can render the retina more vulnerable to oxidative and ischemic damage. Given these considerations, as well as the pathogenesis of DR, specific pathways could play a heightened role in DR progression in elderly patients, such as the polyol pathway and the vascular endothelial growth factor (VEGF) axis. Current ocular treatments include intravitreal corticosteroids, intravitreal anti-VEGF agents, laser photocoagulation and surgical interventions, in addition to better control of underlying diabetes with an expanding range of systemic treatments. While using therapeutics, it is also essential to consider how pharmacokinetics and pharmacodynamics change with aging; oral drug absorption can decrease, and ocular drug metabolism might affect the dosing and delivery methods. Also, elderly patients may more likely be nonadherent to their medication regimen or appointments than younger patients, and undertreatment with anti-VEGF drugs often leads to suboptimal outcomes. With a rising number of elderly DR patients, understanding how aging affects disease progression, pharmacological metabolism, and adherence are crucial to ensuring that this population receives adequate care.
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Affiliation(s)
- Sameer P Leley
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas A Ciulla
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University, Indianapolis, IN, USA
- Clearside Biomedical, Inc., Alpharetta, GA, USA
- Midwest Eye Institute, Indianapolis, IN, USA
| | - Ashay D Bhatwadekar
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University, Indianapolis, IN, USA
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