Prevalence of diabetic retinopathy in Iran: a systematic review and Meta-analysis

Visual impairment among diabetes patients in Ethiopia: A systematic review and meta-analysis

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.

Prevalence and risk factors of diabetic retinopathy in Basrah, Iraq

This study aimed to measure the prevalence and risk factors of diabetic retinopathy (DR) among patients with diabetes mellitus aged 20 to 82 years attending the Faiha Diabetes, Endocrine, and Metabolism Center (FDEMC) in Basrah. A cross-sectional study was conducted at FDEMC, including 1542 participants aged 20 to 82 from January 2019 to December 2019. Both eyes were examined for evidence of DR by a mobile nonmydriatic camera, and statistical analysis was performed to measure the prevalence rates (95% CI) for patients with different characteristics. The mean age of participants was 35.9, with 689 males (44.7%; 95% CI: 42.2-47.2%) and 853 females (55.3%; 95% CI: 52.8-57.8%). The prevalence rate of DR was 30.5% (95% CI: 28.1-32.8%), and 11.27% of cases were proliferative retinopathy. DR significantly increased with age (p-value=0.000), it was higher in females (p-value=0.005), and significantly increased with a longer duration of diabetes (p-value<0.001), hyperglycemia (p-value<0.001), hypertension (p-value=0.004), dyslipidemia (p-value<0.001), nephropathy (p-value<0.001) and smoking (p-value<0.001). There was no statistical association between DR and the type of diabetes or obesity. One-third of the participants in this study had DR. Screening and early detection of DR using a simple tool such as a digital camera should be a priority to improve a person's health status.

Can the level of HbA1C predict diabetic retinopathy among type II diabetic patients?

Background

Hemoglobin A1C (HbA₁C) test is the best care evaluation measurement due to a strong correlation between the test results and diabetic complications. So, this cross-sectional study aimed to assess whether the level of HbA₁C can predict Diabetic Retinopathy (DR) among Type 2 diabetes mellitus (T2DM) in the Iranian population.

Method

One hundred sixty-eight diabetic patients were selected via the convenience sampling method. Data were collected by research made questionnaire scale and laboratory test had been done. To estimate the cut off point for some variables statistical tests, formal measures of classification performance, model evaluation criteria and a decision Tree were used.

Results

The prevalence of DR was 29.8%. The Receiver Operating Characteristic (ROC) curve and decision tree showed the optimal cut-off point for the HbA1C variable that separates the patient with and without DR is HbA₁C = 8.15.

Conclusion

Current study showed an appropriate cutoff point for detecting the development of DR among diabetic patients. So, this cutoff point can be used as guide evidence in several clinical judgments on the Iranian population.

Global and Regional Prevalence of Diabetic Retinopathy; A Comprehensive Systematic Review and Meta-analysis

PURPOSE

We conducted a systematic search to estimate DR prevalence in different age and gender groups, and to evaluate the determinants of heterogeneity in its prevalence.

METHODS

A systematic and comprehensive search from inception to August 10, 2020, was done in international databases, including Scopus, PubMed, Web of Science, Embase, and other data sources without any restriction to find cross-sectional studies related to the prevalence of DR.

RESULTS

Of 6399 studies, 90 articles with a sample size of 563460 individuals and 204189 diabetic patients were analyzed. The estimated pooled prevalence of DR in the diabetic population in general; in female and in male was 28.41% (95% CI: 25.98 to 30.84); 25.93% (95% CI: 23.54 to 28.31) and 28.95% (95% CI: 26.57 to 31.32); respectively and the prevalence of DR showed no inter-gender difference. The heterogeneity of the pooled prevalence according to I² was 99% (p < .001). According to the meta-regression results, the variables of WHO region (Coefficient of AMRO vs SEARO: 15.56; p: 0.002), age (Coefficient of above 60 years vs below 40 year: 18.67; p: 0.001), type of DR (Coefficient: 19.01; p < .001), and publication year (Coefficient: -0.60; p: 0.001) had a significant correlation with heterogeneity.

CONCLUSION

One third of diabetic patients suffered from DR, mostly NPDR. DR increased markedly after the age of 60 years, which could be due to the longer duration of diabetes. Age, WHO region, type of DR, and publication year affected the heterogeneity in the prevalence of DR.

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.

Association of plasminogen activator inhibitor-1 4G5G Polymorphism with risk of diabetic nephropathy and retinopathy: a systematic review and meta-analysis

Background

The 4G5G polymorphism of Plasminogen activator inhibitor-1 (PAI-1) gene is reported to be associated with diabetes nephropathy and retinopathy (DNR) risk. However, the findings are conflicting. Herein, we conducted a case-control and meta-analysis study to explore the association of PAI-1 4G5G polymorphism with risk of DNR.

Methods

We retrieved PubMed, EMBASE, Web of Knowledge, and CNKI databases and screened eligible studies up to August 15, 2020. The strength of associations was assessed by odd ratio (OR) and the corresponding 95% confidence interval (95% CI).

Results

A total of 27 case-control studies including 16 studies with 1,825 cases case and 1,731 controls on DN and eleven studies with 1,397 cases and 1,545 controls on DR were selected. Pooled data showed that the PAI-1 4G5G polymorphism was significantly associated with DN (allele model: OR = 0.674, 95% CI 0.524-0.865, p = 0.002; homozygote model: OR = 0.536, 95% CI 0.351-0.817, p = 0.004; heterozygote model: OR = 0.621, 95% CI 0.427-0.903, p = 0.013; dominant model: OR = 0.575, 95% CI 0.399-0.831, p = 0.003; and recessive model: OR = 0.711, 95% CI 0.515-0.981, p = 0.038) and DR (homozygote model: OR = 0.770, 95% CI 0.621-0.955, p = 0.0.017) risk. Stratified analyses by ethnicity indicated that PAI-1 4G5G polymorphism was associated with DN and DR risk in Asians and Caucasians, respectively.

Conclusions

The present meta-analysis revealed that the PAI-1 4G5G polymorphism was associated with increased risk of DN and DR risk. However, well-designed large-scale clinical studies are required to further validate our results.

Health-related quality of life and its associated factors in patients with type 2 diabetes mellitus

Background:

Assessing the health-related quality of life in patients with type 2 diabetes mellitus is important for evaluation of treatment outcome. The purpose of this study was to evaluate the health-related quality of life in type 2 diabetes mellitus patients and its related factors in Yazd.

Methods:

Data were gathered by using the EuroQoL-five-dimension-5 level instrument as well as using medical records of 734 outpatients with type 2 diabetes mellitus who were referred to the largest governmental diabetes center in South of Iran, Yazd province. When appropriate, the Kruskal–Wallis test or the Wilcoxon test was used to test the difference in the health-related quality-of-life scores in each factor. Finally, the adjusted limited dependent variable mixture model was developed to investigate factors associated with health-related quality-of-life scores.

Results:

The mean and median of the EuroQoL-five-dimension-5 level index values of 717 patients who completed the questionnaires were 0.75 ± 0.006 and 0.72 ± 0.20, respectively, and those of the Visual Analogue Scale scores were 69.25 ± 0.63 and 75 ± 30, respectively. The mean scores for health-related quality of life were significantly higher for employed, educated, single, and male patients, as well as patients without comorbidities, diabetes-related complications, and hemoglobin A1c level >7%. Adjusted limited dependent variable mixture model showed that gender, age, marital status, and diabetes-related complications are significant independent predictors of EuroQoL-five-dimension-5 level index value.

Conclusion:

The mean scores for health-related quality of life in patients with type 2 diabetes mellitus were moderate in this study, and this finding is consistent with health-related quality-of-life scores reported in other studies conducted in the Middle East region. Therefore, health-related quality of life should be the most important consideration in the management of patients. In parallel, some factors, especially gender, should be considered to improve health-related quality of life.

Intravitreal Injections of Bevacizumab Plus Methotrexate versus Bevacizumab Alone for the Treatment of Diabetic Macular Edema: A Randomized, Sham-Controlled Trial

Purpose:

To evaluate the efficacy of intravitreal bevacizumab (IVB) combined with intravitreal methotrexate (IVM) in the treatment of diabetic macular edema (DME).

Methods:

In this prospective, interventional contralateral eye study, patients with bilateral DME were randomly allocated to receive three monthly injections of IVB (1.25 mg/0.05 mL) plus IVM (400 μg; 0.16 cc) or IVB alone. The outcome measure was changes in the best corrected visual acuity (BCVA), central macular thickness (CMT), and central macular volume (CMV).

Results:

Thirty-six treatment-naive eyes of 18 patients with a mean age of 62.38 ± 6.2 years were included in the study. BCVA logMAR changed from 0.95 ± 0.53 at baseline to 0.75 ± 0.53 in the combination group and from 0.72 ± 0.57 to 0.49 ± 0.50 in the IVB alone group at 1 month after the 3^rd injection. BCVA improvement in both groups was not statistically significant compared with the baseline value (P > 0.99). Compared with the baseline values, mean CMT and CMV were reduced in both groups; however, these changes did not reach a significant level. The differences of CMT changes between the groups were not statistically significant at month 1 (P = 0.82), month 2 (P = 0.21), and month 3 (P = 0.10). Furthermore, the differences of CMV changes between the groups were not statistically significant at month 1 (P = 0.76), month 2 (P = 0.82), and month 3 (P = 0.11).

Conclusions:

This pilot study demonstrated no significant therapeutic effects for IVB combined with IVM compared to IVB alone in treatment-naive DME patients over a 3-month course.

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.

Prevalence of diabetic retinopathy, proliferative diabetic retinopathy and non-proliferative diabetic retinopathy in Asian T2DM patients: a systematic review and Meta-analysis

AIM

To investigate the pooled prevalence of diabetic retinopathy (DR), proliferative DR (PDR) and nonproliferative DR (NPDR) in Asian type 2 diabetes mellitus (T2DM) patients.

METHODS

We performed a systematic search online search using PubMed, EMBASE, Web of Science, the Cochrane Library, and China WeiPu Library to identify eligible studies that reported the prevalence of DR, PDR and NPDR in Asian T2DM patients. Effect size (ES) with 95% confidence interval (CI) was used to evaluate the prevalence of DR, PDR and NPDR in Asian T2DM patients, respectively.

RESULTS

There were 41 references and 48 995 T2DM patients involved in this study. The prevalence of DR, PDR, and NPDR was 28%, 6%, and 27% in T2DM patients, respectively; while the prevalence of PDR and NPDR in DR patients was 17% and 83%, respectively. Subgroup analysis showed that prevalence of DR in T2DM patients from Singaporean, Indian, South Korean, Malaysian, Asian, and Chinese was 33%, 42%, 16%, 35%, 21% and 25%, respectively. In T2DM patients with NPDR from Indian, South Korean, Malaysian, Asian, Chinese, higher prevalence was found than that in PDR patients (45% vs 17%, 13% vs 3%, 30% vs 5%, 23% vs 2% and 22% vs 3%), as well as in DR patients (74% vs 26%, 81% vs 19%, 86% vs 14%, 92% vs 8% and 85% vs 15%). The prevalence of PDR in T2DM from India was higher than patients from other locations of Asia, and the same results were also observed in NPDR patients.

CONCLUSION

In either T2DM Asian patients or DR patients, NPDR is more common than PDR. Based on our results, we should pay more attention to NPDR screening and management in T2DM patients, and we also recommend suitable interventions to prevent its progression.