Prevalence and associated factors of diabetic retinopathy in rural Korea: the Chungju metabolic disease cohort study

Trends in diabetic eye disorders and associated comorbidities in Taiwan: a 10-year nationwide population-based cohort study

BACKGROUND/AIMS

In-depth analysis is needed to investigate trends in diabetic retinopathy (DR), diabetic macular oedema (DME) and associated comorbidities in patients with type 2 diabetes mellitus (T2DM) so that we can better understand their prevalence and incidence.

METHODS

A retrospective population-based study was conducted using data from Taiwan's National Health Insurance Research Database from 2005 to 2015, and T2DM, DR and associated comorbidities were identified based on diagnostic codes. We used a standardised incidence rate with age and sex adjustment to estimate the prevalence and incidence of DR, proliferative DR (PDR), advanced PDR (aPDR) and DME, while the difference in each study period was calculated as the annual percentage change. We used the absolute standardised difference to analyse changes in related comorbidities in different periods.

RESULTS

The population of patients with DM increased over 50% between 2005 and 2015, while the prevalence and incidence of DR decreased, as did the incidence of PDR and aPDR. However, the prevalence and incidence of DME increased over the course of 10 years, with an upward trend in all forms of DR. The percentage of patients with hyperlipidaemia in DME and all DR increased, and the percentage of patients with end-stage renal disease (ESRD) was also elevated in DME.

CONCLUSION

The prevalence and incidence of DR, PDR and aPDR decreased with time in patientsT2DM, while the ratio of DME increased gradually. The incidence of hyperlipidaemia also increased in all forms of diabetic eye disorders, while ESRD increased solely in DME.

Prevalence of diabetic retinopathy in patients with newly diagnosed type 2 diabetes: A systematic review and meta-analysis

AIMS

Type 2 diabetes mellitus (T2DM) can remain undiagnosed for many years, during which micro- and macro-vascular complications may develop. This study aimed to assess the worldwide prevalence of diabetic retinopathy (DR) in patients with newly diagnosed T2DM.

MATERIALS AND METHODS

We systematically searched electronic databases for relevant studies published from inception to 01 January 2022. Selected studies reported the prevalence of DR among patients with newly diagnosed T2DM, specifying the case definition used. Random-effects meta-analysis was used to derive the pooled prevalence. Subgroup and meta-regression analyses were used to investigate variations in the prevalence estimates in terms of available variables.

RESULTS

Data from 77 studies including 99,847 patients with newly diagnosed T2DM were included from 26 countries. The pooled prevalence of DR among patients with newly diagnosed T2DM was 13.1% (95% CI, 11.1%-15.1%; I²  = 97.0%). DR was higher in clinic-based samples compared with community-based samples (15.0%, 95% CI = 12.4%-17.8% vs. 11.5%, 95% CI = 8.9%-14.5%; p = 0.05; I²  = 97.0%) and was higher in countries in the WHO African 19.2% (95% CI, 14.6%-24.3%; I²  = 76.0%), South-East Asia 15.4% (95% CI, 10.0%-21.6%; I²  = 79.1%), and European 15.0% (95% CI, 11.2%-19.2%; I²  = 82.0%) regions. A higher proportion of female patients was significantly associated with a lower prevalence of DR in patients with newly diagnosed T2DM. We observed that the prevalence of DR in patients with newly diagnosed T2DM has remained unchanged over time.

CONCLUSIONS

Globally, DR is a prevalent complication among patients with newly diagnosed T2DM indicating the importance of establishing effective strategies to promote regular screening for the early diagnosis of T2DM alongside routine ophthalmic assessment at the time of T2DM diagnosis to reduce the burden of vision-threatening retinopathy.

Comparison of catalase, glutathione peroxidase and malondialdehyde levels in tears among diabetic patients with and without diabetic retinopathy

Background

Various studies suggest that oxidative stress has a role in the etiology of diabetes mellitus (DM) and its complications. Detection of antioxidant enzymes and malondialdehyde (MDA) level in ocular fluid may provide the possible biomarkers for monitoring the progression of diabetic retinopathy (DR). The aim of this study was to compare catalase, glutathione peroxidase (GPx) and MDA levels in tears among diabetic patients with and without DR.

Methods

A cross-sectional study was conducted among type 2 DM patients. The patients were divided into three groups: no DR, non-proliferative DR (NPDR) and proliferative DR (PDR). Tears samples were collected using Schirmer strips for measurement of catalase, GPx and MDA.

Results

A total of 171 patients were recruited in this study (no DR, 58 patients; NPDR, 57 patients; PDR, 56 patients). There was significant difference in the mean level of GPx in tears between the three groups (no DR, 658.08 ± 115.70 U/L; NPDR, 653.78 ± 87.90 U/L; PDR, 605.31 ± 107.47 U/L, respectively) before and after adjustment for covariates (p = 0.013 and p = 0.001, respectively). Bonferroni post-hoc analysis showed PDR group had significantly lower mean GPx level than in no DR (p=0.001) and NPDR (p=0.037) after adjustment for covariates. There was no significant difference of mean catalase and MDA in the tears between the three groups before and after adjustment for covariates.

Conclusion

This study demonstrated that diabetic patient with DR is associated with low level of GPx in tears, suggesting that this antioxidant enzyme is a potential biomarker for predicting the presence of DR.

Metabolic impact of the VDR rs1544410 in diabetic retinopathy

Aims

To investigate the association between BsmI and DM2 in patients with and without DR and to correlate with clinical parameters in a population in northeastern Brazil.

Methods

Cross-sectional case-control study in which data were collected from 285 individuals, including 128 patients with DM2 and 157 with DR. Clinical, biochemical and anthropometric parameters were analyzed, in addition to the single nucleotide polymorphism (SNP) BsmI of the VDR gene (rs1544410), genotyped by PCR-RFLP.

Results

In the DR group we found a greater number of patients using insulin therapy (p = 0.000) and with longer duration of DM2 (p = 0.000), in addition to higher serum creatinine values (p = 0.001). Higher fasting glucose levels and higher frequency of insulinoterapy were independently observed in patients with DR and b allele carriers, when compared to BB.

Conclusion

The association of the bb/Bb genotypes (rs1544410) of the VDR gene with increased blood glucose levels and insulinoterapy may represent worse glicemic control in rs1544410 b allele carriers in DR Latin American individuals.

Visual impairment and its predictors among people living with type 2 diabetes mellitus at Dessie town hospitals, Northeast Ethiopia: institution-based cross-sectional study

BACKGROUND

Visual impairment is a functional limitation of the eye(s) that results in reduced visual acuity, visual field loss, visual distortion, perceptual difficulties, or any combination of the above. Type 2 diabetes mellitus is one of the common causes of visual impairment. Since there is no study conducted in Ethiopia so far in this regard, the current study aimed to determine the prevalence and predictors of visual impairment among people living with diabetes at Dessie town Hospitals, Northeast Ethiopia.

METHODS

Institution based cross-sectional study was carried out from 15 February to 15 March 2020 using simple random sampling to recruit study participants among type 2 diabetes. Visual impairment was measured using visual acuity test. We used Epi Data 3.1 and SPSS version 22 for data entry and statistical analysis, respectively. Bi-variable binary logistic regression was performed to check independent association of each factor with visual impairment. After selecting candidate variables at p < 0.25, we computed multivariable binary logistic regression to identify statistically associated factors of visual impairment. The degree of association was determined using adjusted odds ratio with 95%CI. In the final model, statistical significance was declared at p < 0.05.

RESULTS

Three hundred and twenty-two people living with T2DM participated in this study with 97% response rate. The prevalence of visual impairment was 37.58% (95% CI: 32.3, 42.9). Age (AOR: 1.06, 95% CI: 1.02, 1.09, p < or = 0.001), poor regular exercise (AOR = 2.91, 95%CI: 1.47-5.76, p < or = 0.001), duration of DM above 5 years (AOR = 2.42, 95% CI: 1.25-4.73, p < or = 0.01), insulin treatment (AOR = 14.05, 95% CI: 2.72, 72.35, p < or = 0.01), and poor glycemic control (AOR = 2.17, 95% CI: 1.13-4.14, p < 0.05) were statistically associated with visual impairment.

CONCLUSION

The prevalence of visual impairment in Dessie town hospitals accounted for more than a third of patients living with T2DM. Visual impairment is associated with increased age, poor regular exercise, longer duration of DM, and insulin treatment. Thus, early detection of VI through screening and regular follow-up is recommended to reduce the risk of VI and vision loss.

Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients Attending the Diabetic Clinic of the University of Gondar Hospital, Northwest Ethiopia

Objective

To investigate the level of diabetic retinopathy in type 2 diabetes (T2DM) patients attending the University of Gondar Hospital (UGH) Diabetic Clinic, Northwest Ethiopia.

Methods

An audit was carried out involving a total of 739 T2DM patients attending at the diabetic clinic of UGH. They represented approximately 90% and 50% of all T2DM patients under regular review at the urban and rural diabetic clinics of UGH, respectively. All were supervised by the same clinical team for a long period. Eye examinations were performed for visual acuity, cataract, and retinal changes (retinal photography and slit-lamp biomicroscopy). Body mass index (BMI) and HbA1c levels were measured. The presence or absence of hypertension was recorded.

Results

Men constituted 41.5% of the group, the mean age at diagnosis of T2DM was 50.4 years, and 50.2% were hypertensive. The BMI was 25.0 ± 4.1 kg/m², and HbA1c was 7.75 ± 1.63% (61.2 ± 17.8 mmol/mol) (mean ± SD, for BMI and HbA1c)). Severe visual impairment/blindness was reported in 10.6%, 15.2% had cataract, 16.0% had retinopathy, and 11.1% had maculopathy. The prevalence of retinopathy increased with time from diagnosis of T2DM (chi-square for trend, p < 0.001) and with increasing HbA1c level (chi-square for trend, p=0.03).

Conclusion

These results compare well with the most recent results in well-equipped, wealthier regions of the world and show the importance of stable healthcare infrastructure for chronic-disease management.

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.

Retinopathy is a Strong Determinant of Atherosclerosis in Type 2 Diabetes: Correlation with Carotid Intima Media Thickness

OBJECTIVE

We investigated the correlation between the severity of diabetic retinopathy (DR) and carotid intima media thickness (IMT) as a marker of atherosclerosis in patients with type 2 diabetes.

METHODS

The study group consisted of 140 normotensive Egyptian patients (68 males and 72 females) with type 2 diabetes and DR. Carotid IMT was evaluated using high-resolution B-mode ultrasonography. DR was assessed and graded using colored fundus photography and fundus fluorescein angiography, as either nonproliferative DR (NPDR) or proliferative DR (PDR).

RESULTS

Carotid IMT was greater in patients with PDR compared to those with NPDR (1.094 ± 0.142 mm vs. 0.842 ± 0.134 mm; P<.001). Carotid IMT showed positive correlation with diabetes duration (P<.01), systolic blood pressure (P<.001), diastolic blood pressure (P<.01), fasting blood glucose (P<.01), postprandial blood glucose (PPBG) (P<.001), glycated hemoglobin (P<.01), total cholesterol (P<.01), triglycerides (TGs) (P<.001), and DR (P<.0001). No significant difference was found between males and females in any of the studied parameters. Multiple regression analysis revealed that the determinants of carotid IMT in the studied group were age (P<.01), PPBG (P<.01), TGs (P<.001), and DR (P<.0001).

CONCLUSION

Our study proves that both NPDR and PDR are strong determinants of carotid IMT and atherosclerosis in patients with type 2 diabetes.

Difference between old and young adults in contribution of β-cell function and sarcopenia in developing diabetes mellitus

AIMS/INTRODUCTION

To investigate the difference in contributing factors in developing diabetes between old and young adults.

MATERIALS AND METHODS

Subjects with recent-onset diabetes were selected from a nationwide survey data and classified according to age: elderly (age ≥75 years), middle-age (age 45-64 years) and young (age 25-39 years). The homeostasis model assessment of insulin resistance and β-cell function were calculated. Sarcopenia was assessed using dual-energy X-ray absorptiometry.

RESULTS

The prevalence of recent-onset diabetes was 13.5%, 8.0%, and 1.4% in patients aged ≥75 years (unweighted n = 1,082), 45-64 years (unweighted n = 6,532), and 25-39 years (unweighted n = 5,178), respectively. Homeostasis model assessment of β-cell function along with homeostasis model assessment of insulin resistance showed increasing trends as onset age increased in recent-onset diabetes (P for trend < 0.001 in both). Elderly-onset diabetic patients had significantly higher homeostasis model assessment of β-cell function and homeostasis model assessment of insulin resistance compared with the middle-age-onset group (P < 0.001 and 0.014, respectively). Multivariate analysis showed that sarcopenia was significantly associated with recent-onset diabetes only in patients aged ≥75 years (odds ratio [OR] 2.478, 95% confidence interval [CI] 1.379-4.452) but not in patients aged 45-64 years. In the middle-age group, abdominal obesity (OR 2.933, 95% CI 2.086-4.122), hypertriglyceridemia (OR 1.529, 95% CI 1.078-2.169]) and low high-density lipoprotein cholesterolemia (OR 1.930, 95% CI 1.383-2.695) were associated with recent-onset diabetes.

CONCLUSIONS

Elderly-onset diabetic patients had higher insulin resistance and relatively preserved β-cell function compared with middle-age-onset patients. Sarcopenia might play a more important role in developing diabetes in the elderly population.

Iranian risk model as a predictive tool for retinopathy in patients with type 2 diabetes

OBJECTIVE

Diabetic retinopathy (DR) is the leading cause of blindness in patients with type 1 or type 2 diabetes. The gold standard for the detection of DR requires expensive equipment. This study was undertaken to develop a simple and practical scoring system to predict the probability of DR.

METHODS

A total of 1782 patients who had first-degree relatives with type II diabetes were selected. Eye examinations were performed by an expert ophthalmologist. Biochemical and anthropometric predictors of DR were measured. Logistic regression was used to develop a statistical model that can be used to predict DR. Goodness of fit was examined using the Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve.

RESULTS

The risk model demonstrated good calibration and discrimination (ROC area=0.76) in the validation sample. Factors associated with DR in our model were duration of diabetes (odds ratio [OR]=2.14, confidence interval [CI] 95%=1.87 to 2.45); glycated hemoglobin (A1C) (OR=1.21, CI 95%=1.13 to 1.30); fasting plasma glucose (OR=1.83, CI 95%=1.28 to 2.62); systolic blood pressure (OR=1.01, CI 95%= 1.00 to 1.02); and proteinuria (OR=1.37, CI 95%=1.01 to 1.85). The only factor that had a protective effect against DR were body mass index and education level (OR=0.95, CI 95%=0.92 to 0.98).

CONCLUSIONS

The good performance of our risk model suggests that it may be a useful risk-prediction tool for DR. It consisted of the positive predictors like A1C, diabetes duration, sex (male), fasting plasma glucose, systolic blood pressure and proteinuria, as well as negative risk factors like body mass index and education level.

The Relationship between Estimated Glomerular Filtration Rate and Diabetic Retinopathy

Diabetic retinopathy (DR) is the leading cause of visual impairment and blindness in working-aged people. Several studies have suggested that glomerular filtration rate (GFR) was correlated with DR. This is a hospital-based study and the aim of it was to examine the relationship between the GFR and DR in patients with type 2 diabetes mellitus (T2DM). We used CKD-EPI equation to estimate GFR and SPSS 19.0 and EmpowerStats software to assess their relationship. Among the 1613 participants (aged 54.75 ± 12.19 years), 550 (34.1%) patients suffered from DR. The multivariate analysis revealed that the risk factors for DR include age (P < 0.001, OR = 0.940), duration of diabetes (P < 0.001, OR = 1.163), hemoglobin A1c (P = 0.007, OR = 1.224), systolic blood pressure (P < 0.001, OR = 1.032), diastolic blood pressure (P = 0.007, OR = 0.953), high density lipoprotein cholesterol (P = 0.024, OR = 3.884), and eGFR (P = 0.010, OR = 0.973). Through stratified analysis and saturation effect analysis, our data suggests that eGFR of 99.4 mL/min or lower might imply the early stage of DR in diabetic patients. Thus, the evaluation of eGFR has clinical significance for the early diagnosis of DR.

Development and progression of diabetic retinopathy and associated risk factors in Korean patients with type 2 diabetes: the experience of a tertiary center

The aim of this study was to evaluate the incidence of and risk factors for the development of diabetic retinopathy (DR) and progression to proliferative DR (PDR) in Korean patients. Patients diagnosed with type 2 diabetes and followed for more than 5 years at a university-based clinic since 2000 were consecutively enrolled in this retrospective cohort study. Based on the DR classification at the initial and final visits, the incidence and progression of DR was determined and patient characteristics were compared according to DR progression. Hazard ratios of each putative risk factor for DR progression were calculated with a multivariate Cox proportional hazard model. Rate of DR development and progression to PDR were 32.1/1,000 and 26.2/1,000 person-years, respectively. A longer duration of diabetes and higher mean HbA1c level were significant risk factors for the development of DR. Regarding progression to PDR, higher mean HbA1c level, higher standard deviation of HbA1c, and higher urine albumin-to-creatinine ratio were significant risk factors. The rates of development of DR and progression to PDR in Koreans with type 2 diabetes are lower than those reported over the last decade. An inadequate blood glycemic control is the common risk factor for development and progression of DR.

Prevalence of diabetes and diabetic retinopathy in a Brazilian population

PURPOSE

To evaluate the prevalence of type 2 diabetes mellitus and diabetic retinopathy (DR) in a Brazilian population.

METHODS

Population-based, cross-sectional study conducted in 9 cities located in the Midwest region of the state of São Paulo, Brazil, between 2006 and 2007, including 4690 individuals aged ≥30 years. Diabetes was self-reported and DR was assessed by indirect ophthalmoscopy.

RESULTS

The prevalence of type 2 diabetes was 8.68% (95% confidence interval, CI, 7.87-9.48%), and DR was present in 7.62% (95% CI 5.02-10.20%) of participants with self-reported type 2 diabetes. Approximately 35.4% of individuals diagnosed with DR did not know they had diabetes prior to DR diagnosis. Prevalences of low vision and blindness were higher among those with diabetes and DR. Cataract was still a major cause of blindness in this population.

CONCLUSION

This is the first large population-based study on DR in Brazil. High rates of visual impairment were found in persons with type 2 diabetes, but cataract is still one of the main causes of blindness. Large surveys are necessary for public health policy advocacy in developing countries.

Age at diagnosis and C-peptide level are associated with diabetic retinopathy in Chinese

Objective

To find the associations between diabetic retinopathy and age at diagnosis, C-peptide level and thyroid-stimulating hormone (TSH) level in Chinese type 2 diabetes mellitus.

Methods

3100 hospitalized type 2 diabetic patients in Peking University People's Hospital were included in this retrospective study. Their medical history and the laboratory data were collected. All the patients received examination of diabetic retinopathy (DR) by professional ophthalmologist.

Results

Comparisons among patients with NDR, NPDR and PDR showed that with the progression of diabetic retinopathy, patients turned to have older age but younger age at diagnosis of diabetes, and have higher SBP, longer duration of diabetes, higher mean HbA1c but lower fasting and 2 hours postprandial C-peptide level. Moreover, with the progression of diabetic retinopathy, patients turned to have higher prevalence of primary hypertension, higher prevalence of peripheral vascular sclerosis, higher proportion with insulin treatment. TSH level was comparable among the three groups of patients. Association analysis showed that after adjusting for age, sex, duration of diabetes, body mass index, HbA1c, blood pressure and albuminurea creatinine ratio and insulin treatment, age at diagnosis (OR 0.888, 95%CI 0.870–0.907, p = 0.00) and postprandial C-peptide (OR 0.920, 95%CI 0.859–0.937, p = 0.00) are the independent associated factors of DR in Chinese type 2 diabetes.

Conclusions

According to the results, postprandial C-peptide level and age at diabetes may be two independent associated factors with DR in Chinese type 2 diabetes. The lower level of postprandial C-peptide, the younger age at diagnosis, may indicate the higher prevalence of DR.

Prevalence and risk factors for diabetic retinopathy in rural India. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study III (SN-DREAMS III), report no 2

OBJECTIVE

The study was aimed at estimating the prevalence of type 2 diabetes mellitus and diabetic retinopathy in a rural population of South India.

DESIGN

A population-based cross-sectional study.

PARTICIPANTS

13 079 participants were enumerated.

METHODS

A multistage cluster sampling method was used. All eligible participants underwent comprehensive eye examination. The fundi of all patients were photographed using 45°, four-field stereoscopic digital photography, and an additional 30° seven-field stereo digital pairs were taken for participants with diabetic retinopathy. The diagnosis of diabetic retinopathy was based on Klein's classification.

MAIN OUTCOME MEASURES

Prevalence of diabetes mellitus and diabetic retinopathy and associated risk factors.

RESULTS

The prevalence of diabetes in the rural Indian population was 10.4% (95% CI 10.39% to 10.42%); the prevalence of diabetic retinopathy, among patients with diabetes mellitus, was 10.3% (95% CI 8.53% to 11.97%). Statistically significant variables, on multivariate analysis, associated with increased risk of diabetic retinopathy were: gender (men at greater risk; OR 1.52; 95% CI 1.01 to 2.29), use of insulin (OR 3.59; 95% CI 1.41 to 9.14), longer duration of diabetes (15 years; OR 6.01; 95% CI 2.63 to 13.75), systolic hypertension (OR 2.14; 95% CI 1.20 to 3.82), and participants with poor glycemic control (OR 3.37; 95% CI 2.13 to 5.34).

CONCLUSIONS

Nearly 1 of 10 individuals in rural South India, above the age of 40 years, showed evidence of type 2 diabetes mellitus. Likewise, among participants with diabetes, the prevalence of diabetic retinopathy was around 10%; the strongest predictor being the duration of diabetes.

Prevalence and factors associated with diabetic retinopathy in a Korean adult population: the 2008-2009 Korea National Health and Nutrition Examination Survey

AIM

We examined the prevalence and factors associated with diabetic retinopathy (DR) in a Korean adult population.

METHODS

Fundus examination data from 10,345 people in the fourth Korea National Health and Nutrition Examination Survey from 2008 to 2009 were examined. For each participant, one 45° nonmydriatic digital retinal image, centered on the fovea, was taken per eye. DR was defined as the presence of one or more retinal microaneurysms or retinal blot hemorrhages with or without more severe lesions.

RESULTS

The weighted prevalence of DR was 0.9% (95% CI, 0.7-1.1) in a Korean adult population and 11.0% (95% CI, 8.9-13.6) in Korean adults with diabetes. In a logistic regression analysis, only HbA1c and diabetes duration were independently associated with DR; the other variables examined, including age, gender, exercise, current smoking, heavy alcohol drinking, presence of hypertension, total cholesterol, triglycerides, high-density lipoprotein cholesterol, anti-lipid medication, oral anti-diabetes treatment, and insulin treatment, were not associated with DR.

CONCLUSIONS

According to these national survey data, 1 in 10 people with diabetes has diabetic retinopathy. Glycemic control is the most important factor for preventing retinopathy in patients with diabetes.

Prevalence and risk factors for diabetic retinopathy in a high-risk Chinese population

Background

Lifestyle plays an important role in the development of diabetic retinopathy. The lifestyle in Guangzhou is different from other cities in China as the Cantonese prefer eating rice porridge, but not spicy foods. The objectives of this study were to investigate the prevalence and determinants of diabetic retinopathy in a high-risk population of Guangzhou.

Methods

Subjects (619 totals) aged over 45 years old, without known diabetes were recruited from five randomly selected Guangzhou communities in 2009–2010. All participants were invited to complete the Finnish Diabetes Risk Score (FINDRISC) questionnaire. Subjects with FINDRISC score ≥ 9 were included in the study, and underwent an investigation of demographic data, a standardized physical examination, ocular fundus examination, and laboratory analyses. The minimum criterion for diagnosis of diabetic retinopathy was the presence of at least one microaneurysm.

Results

Of 619 subjects, 208 eligible subjects (122 women) with FINDRISC score ≥ 9 were included in the study. The mean age was 69.2 ± 8.5 years. Diabetic retinopathy was detected in 31 subjects, and the prevalence of diabetic retinopathy in subjects with high risk for diabetes was 14.9%. In binary logistic regression analysis, risk factors associated with diabetic retinopathy were history of impaired glucose regulation [odds ratio (OR), 7.194; 95% confidence interval (CI): 1.083, 47.810], higher hemoglobin A1c (HbA1c; OR, 2.912; 95% CI: 1.009, 8.402), higher two-hour postprandial plasma glucose level (OR, 1.014; 95% CI: 1.003, 1.025), and presence of microalbuminuria (OR, 5.387; 95% CI: 1.255, 23.129).

Conclusions

Diabetic retinopathy was prevalent in a high-risk Chinese population from Guangzhou. Histories of impaired glucose regulation and microalbuminuria were strong risk factors for diabetic retinopathy.

Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States

There is an epidemic of diabetes in Asia. Type 2 diabetes develops in East Asian patients at a lower mean body mass index (BMI) compared with those of European descent. At any given BMI, East Asians have a greater amount of body fat and a tendency to visceral adiposity. In Asian patients, diabetes develops at a younger age and is characterized by early β cell dysfunction in the setting of insulin resistance, with many requiring early insulin treatment. The increasing proportion of young-onset and childhood type 2 diabetes is posing a particular threat, with these patients being at increased risk of developing diabetic complications. East Asian patients with type 2 diabetes have a higher risk of developing renal complications than Europeans and, with regard to cardiovascular complications, a predisposition for developing strokes. In addition to cardiovascular-renal disease, cancer is emerging as the other main cause of mortality. While more research is needed to explain these interethnic differences, urgent and concerted actions are needed to raise awareness, facilitate early diagnosis, and encourage preventive strategies to combat these growing disease burdens.

Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countries

BACKGROUND

As the global prevalence of diabetes increases, so will the numbers of people with diabetic retinopathy. Our review aimed to provide a comprehensive picture of available studies of diabetic retinopathy and how prevalence varies around the developed and developing world.

METHODS

A detailed literature search using PubMed was undertaken. The following search term was used: 'diabetic retinopathy AND prevalence'. The titles and abstracts of all publications identified by the search were reviewed and 492 studies were retrieved. Inclusion and exclusion criteria were applied.

RESULTS

A total of 72 articles from 33 countries were included. There were only 26 population-based studies using fundus photography (12 in developing countries), of which only 16 (eight in developing countries) were published since 2000. Prevalence estimates varied from as low as 10% to as high as 61% in persons with known diabetes and from 1.5 to 31% in newly diagnosed diabetes. Across all the studies, the median (interquartile range) prevalence of any diabetic retinopathy in known diabetes was 27.9% (22-37%) and 10.5% (6-16%) in newly diagnosed diabetes. Prevalence of diabetic retinopathy was higher in developing countries.

CONCLUSION

Significant gaps exist in that reliable population-based data from developing nations and indigenous populations in particular are lacking. Major differences in study characteristics and methodologies make comparisons very difficult. More research is required and study methodologies must be better standardized. This will provide important information for prevention and treatment strategies.

Predictors for diabetic retinopathy in normoalbuminuric people with type 2 diabetes mellitus

BACKGROUND

Previous studies have reported that microalbuminuria is an independent risk factor for the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (DM). For this reason, the clinical significance of DR in normoalbuminuric type 2 DM patients may be overlooked. The aim of this study was to investigate the prevalence of DR and predictors for DR in normoalbuminuric patients with type 2 DM.

METHODS

A total 310 patients with type 2 DM and normoalbuminuria, who were referred to the Department of Ophthalmology for screening of DR were included in this study. DR was clinically graded according to the International Clinical Diabetic Retinopathy guidelines. The urinary albumin excretion rate (UAER) was assessed via 24-hour urine collection and measured by immunoturbidimetric assay. Normoalbuminuria was defined as a UAER < 20 μg/min in 2 out of 3 consecutive tests taken within 2-3 months.

RESULTS

DR of any grade was present in 64/310 (20.7 %) patients. Mild non-proliferative diabetic retinopathy (NPDR) was most prevalent in patients with DR of any grade (36/64, 56 %). The duration of diabetes (OR 1.01, 95 % CI, 1.01 - 1.02, p < 0.001), hemoglobin levels (OR 0.73, 95 % CI, 0.59 - 0.91, p = 0.004) and a higher tertile of UAER (OR 4.04, 95 % CI, 1.71 - 9.57, p = 0.001) had independently significant association with DR. NPDR as well as PDR was more prevalent in patients with higher tertile of UAER compared with those with lower tertile of UAER (NPDR, p = 0.002 and PDR, p = 0.027, respectively).

CONCLUSIONS

Our findings suggest that patients with normoalbuminuric type 2 DM also require close monitoring for the early detection of DR, especially if they have a higher UAER, longer duration of diabetes, or lower hemoglobin levels.