Clinical and Biochemical Associations with Diabetic Retinopathy in Male Patients in the Gaza Strip

Clinical and Molecular Characteristics of Diabetic Retinopathy and Its Severity Complications among Diabetic Patients: A Multicenter Cross-Sectional Study

Background: Diabetic retinopathy (DR) is a complication associated with uncontrolled DM. It is a leading preventable cause of visual impairment in the world and a cause of blindness in those under 75 years old in developing countries. We aimed to explore the prevalence and associated risk factors of DR among diabetic patients in the West Bank. Materials and Methods:A quantitative multicenter cross-sectional study was conducted in all West Bank cities. Nearly, 385 patients underwent a comprehensive eye examination in addition to blood and urine tests. A previously validated questionnaire for ocular examination classification was used together with a socio-demographic and past medical history information sheet. Results: The prevalence of all DR in the West Bank was 41.8%. The prevalence of non-proliferative diabetic retinopathy (NPDR) was 50.3% (38.5% for mild NPDR, 10.6% for moderate NPDR and 1.2% for severe NPDR). The prevalence of proliferative diabetic retinopathy (PDR) was 9.9% and 39.7% for diabetic macular edema (DME) (17.4% for mild, 15.5% for moderate and 6.8% for severe DME). The prevalence of vision-threatening PDR and DME was 49.7% for both. In a univariate analysis, DR was significantly associated with body mass index; BMI (p = 0.035), DM duration (p = 0.002), Low-density lipoprotein (LDL) (p = 0.034), glutamic-oxaloacetic transaminase (GOT) level (p = 0.016) andblood urea (BU) (p = 0.044). A multivariate analysis showed a strong significant association between DR andpatients who had DM for 10-19years (adjusted odds ratio; AOR (95%CI); 1.843 (1.05–3.22)), abnormal levels of LDL (AOR (95%CI); 0.50 (0.30–0.83)), abnormal levels of GOT (AOR (95%CI); 0.49 (0.27–0.89)), and overweight (AOR (95%CI); 0.39 (0.19–0.80)). Conclusions: We found that the prevalence of DR in Palestine was higher than the global prevalence. Referral coordination between ophthalmologists and internal physicians is necessary to better follow up with DR patients. An interventional educational program by clinicians and public health professionals is recommended.

Risk Factors Associated With Diabetic Retinopathy: A Cross-Sectional Study Within Palestinian Patients in Northern West Bank

Risk factors associated with diabetes mellitus (DM) have been widely researched worldwide, but the determinants of these factors among diabetic retinopathy (DR) in Palestine are currently unclear. We aimed to assess the prevalence of DR among DM in Northern West Bank and identify factors associated with DR natural history. Patients with Type 2 diabetes (T2D) (n = 300, age > 18 years) from a main diabetic center covering all northern provinces of Palestine were enrolled to this cross-sectional research. Demographic information including age, sex, and duration of T2D was obtained. Moreover, HbA1C, BMI, hypertension (HTN), controlled T2D, current smoking, and total cholesterol level were assessed. Potential correlations between these factors and DR diagnosed by ophthalmologist were evaluated using different tests on SPSS version 22. Prevalence of DR among our population was 30%; 47.8% of these patients showed mild non-proliferative DR (NPDR), 23.3% moderate NPDR, 16.7% severe NPDR, and 12.2% proliferative DR (PDR). Univariate logistic regression analysis showed age (p = 0.007), HTN (p = 0.022), uncontrolled T2D (p = 0.025), and duration of T2D (<0.001) were mostly associated with DR while multivariate logistic regression showed duration of T2D as the major and solely risk factor for prevalence of DR (p < 0.0001) and were positively correlated with severities of NPDR and being a strong predictor in the PDR (p = 0.001). We identified several important risk factors that affect DR, which could assist to develop effective strategies for metabolic disease prevention among populations in Palestine. Furthermore, our data suggest a necessity to control sugar serum levels and HTN.

Prevalence and association of clinical characteristics and biochemical factors with complications of diabetes mellitus in Palestinians treated in primary healthcare practice

AIMS

The current study was carried out to examine prevalence of complications related to diabetes mellitus (DM) and to investigate association between clinical variables and biochemical factors with complications of DM in patients treated in primary healthcare settings in the West Bank of Palestine.

MATERIALS AND METHODS

Sociodemographic, clinical, and biochemical variables were collected from 385 patients visiting 17 primary healthcare settings in the West Bank. Patients provided blood and urine samples, responded to a questionnaire interview, and were subjected to ophthalmic examination.

RESULTS

HbA_1c levels were predicted by duration of DM (p < 0.001), HDL (p = 0.011), alkaline phosphatase (p = 0.001), blood urea (p = 0.006), and LDL (p = 0.008). Triglycerides levels were predicted by blood urea (p = 0.002), HDL (p < 0.001), and total cholesterol (p < 0.001). GOT levels were predicted by LDL (p = 0.002) and GPT (p < 0.001). GPT levels were predicted by HDL (p = 0.003) and blood urea (p = 0.025). Urine albumin were predicted by total cholesterol (p = 0.001), LDL (p = 0.005), and blood urea (p = 0.036). CD ratio was predicted by the IOP and the IOP was predicted by the CD ratio (p = 0.001).

CONCLUSIONS

Prevalence of complications related to DM was high among patients with DM treated in primary healthcare practice. These complications and risk factors were predicted by certain clinical characteristics and biochemical factors. Policies and programs are needed to manage these modifiable risk factors.