Prevalence and determinants of diabetic retinopathy in Al hasa region of saudi arabia: primary health care centre based cross-sectional survey, 2007-2009

Knowledge, Attitude, and Practice on Diabetic Retinopathy among Final-Year Medical Students in Riyadh

Introduction

This study aimed to evaluate the awareness, knowledge, and attitude on diabetic retinopathy of final-year medical students and the association of knowledge, attitude, and practice with the gender of medical students.

Methods

A descriptive cross-sectional study was conducted at the College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia. The initial part of the questionnaire included demographic details, while the remaining parts of the questionnaire included six questions on knowledge, four on attitude, and three on practice. IBM SPSS Statistics 24 was used to retrieve and analyze data from an Excel file. A P value <0.05 was considered as statistically significant.

Results

Of 84 medical students, 51 (60.71%) and 33 (39.19%) were male and female medical students, respectively. The total knowledge score for male and female medical students was 4.28 (SD = 0.92). The majority of students correctly answered practice questions, indicating good significant practice toward diabetic retinopathy among diabetic patients with A score of 1.93 (SD = 0.83).

Conclusion

The majority of final-year medical students were good in knowledge and practice toward prevention and treatment of diabetic retinopathy, which helps them become better future care providers for patients with diabetes and diabetic retinopathy.

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 microvascular complications among patients with type 2 diabetes mellitus who visited diabetes clinics in Saudi Arabia

OBJECTIVES

To determine the microvascular complications prevalence in patients with type 2 diabetes mellitus (DM) in the eastern province of the Kingdom of Saudi Arabia.

METHODS

The participants in this retrospective, cross-sectional study included patients with type 2 DM who visited the diabetes clinics of primary health care centers of 2 National Guard Hospitals, Eastern Province, Saudi Arabia.

RESULTS

This study included 935 patients with type 2 diabetes (54.1% women versus 45.9% men). Oral hypoglycemic medication was the most common treatment (90.3%). Overall, 55.1% of patients visited the ophthalmology clinic for retinopathy screening. The last glycated hemoglobin A1c result (mean: 8.04%) was higher than the second-to-last result (mean: 8.03%), or the third-to-last result (mean: 7.99%). The prevalence of microvascular complications of DM was 55.1%. Independent significant factors linked with a higher risk of microvascular issues of DM were higher age, visits to an ophthalmology clinic, and the use of injection therapy. The most typical complications that our patients experienced was nephropathy (80.2%), followed by retinopathy (32.7%), and neuropathy (8.4%).

CONCLUSION

Microvascular complications were extremely common in type 2 DM patients in our region. Being older, regularly visiting an ophthalmologist, and using injection therapy were predictive factors correlated with a higher chance of experiencing these complications.

An Assessment on the Awareness of Diabetic Retinopathy Among Participants Attending the Diabetes Awareness Camp in Saudi Arabia

Aim The objective of this study is to assess the level of awareness of the effect of diabetes and diabetic retinopathy (DR) on the eye among a sample of the Jeddah community. Methods A cross-sectional study was conducted among those attending a diabetes awareness camp in Jeddah, Saudi Arabia, in November 2021. Participants were asked to answer questions in a structured questionnaire that was already used in a previous study. Responses were analyzed using Statistical Package for the Social Sciences (SPSS) version 25 (IBM SPSS Statistics, Armonk, NY, USA). Results A total of 352 participants were included in this study, 184 (52.3%) of them were females. Of the participants, only 74 (21%) had diabetes mellitus (DM). The vast majority (94%) of the participants believed that diabetes could affect the eyes, and 94.3% believed that maintaining the level of blood sugar could maintain the eye and the level of vision. Moreover, 77.3% were aware that diabetes could lead to visual impairment and blindness. Around one-third of the total participants and less than half of the diabetic group were found familiar with DR. Although 96% of diabetic participants reported the need for diabetics to get their eyes checked annually, only 70% did so. Lack of awareness of the effect of diabetes on the retina was the main barrier preventing diabetic groups from getting their eye checked. Conclusion Despite the good level of awareness among the community and diabetics about diabetes and its effect on the eyes, there is less awareness that DR is one of the most dangerous complications that lead to visual impairments. These findings assure the importance to raise awareness of DR among the community and diabetics and increase awareness of the importance of annual eye examinations.

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.

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.

Saudi Arabia Guidelines for diabetic macular edema: A consensus of the Saudi Retina Group

Diabetes mellitus (DM) and its complications are major public health burdens in Saudi Arabia. The prevalence of diabetic retinopathy (DR) is 19.7% and the prevalence of diabetic macular edema (DME) is 5.7% in Saudi Arabia. Diabetic macular edema is a vision-threatening complication of DR and a major cause of vision loss worldwide. Ocular treatments include retinal laser photocoagulation, anti-vascular endothelial growth factor (anti-VEGF) agents, intravitreal corticosteroids, and vitreoretinal surgery when necessary. The present consensus was developed as a part of the Saudi Retina Group's efforts to generate Saudi guidelines and consensus for the management of DME, including recommendations for its diagnosis, treatment, and best practice. The experts' panel stipulates that the treatment algorithm should be categorized according to the presence of central macula involvement. In patients with no central macular involvement, laser photocoagulation is recommended as the first-line option. Patients with central macular involvement and no recent history of cardiovascular (CVS) or cerebrovascular disorders can be offered anti-VEGF agents as the first-line option. In the case of non-responders (defined as an improvement of <20% in optical coherence tomography or a gain of fewer than 5 letters in vision), switching to another anti-VEGF agent or steroids should be considered after 3 injections. Within the class of steroids, dexamethasone implants are recommended as the first choice. In patients with a recent history of CVS events, the use of anti-VEGF agents is not recommended, regardless of their lens status. The experts' panel recommends that a future study be conducted to provide a cut-off point for early switching to steroid implants in pseudo-phakic eyes.

Correlates of diabetic retinopathy in type 2 diabetes mellitus patients in Makkah Al-Mukarramah, Saudi Arabia

BACKGROUND:

Diabetic retinopathy (DR) is a serious complication of diabetes that can cause visual impairment. The objective of this study was to estimate the prevalence and identify the determinants of DR in type 2 diabetes mellitus patients attending the diabetic center at Al-Noor Specialist Hospital in Makkah, Saudi Arabia.

MATERIALS AND METHODS:

A cross-sectional study was conducted in a sample of type 2 diabetic patients registered at the diabetic center at Al-Noor Specialist Hospital. Data was collected using a validated self-administered questionnaire. Grading of DR was done by slit-lamp examination and colored fundus photographs. Descriptive analysis included frequency and percentage for categorical variables, and mean, median, standard deviation (SD), and interquartile range, for continuous variables. Chi-square test used to test for association between two categorical variables; Student's t-test or Mann-Whitney U test as appropriate employed to compare continuous variable between two groups. Logistic regression analysis was utilized to identify correlates of DR after controlling for confounders.

RESULTS:

The study comprised 251 type 2 diabetic patients aged between 28 and 80 years, with an arithmetic mean of 56.8 and standard deviation of ±9.9 years. The prevalence of DR was 54.6%; mild nonproliferative (NP) type was present in 52.6% of the patients with DR, whereas severe NP type was present in 15.3% of them; the proliferative type was present in only 4.4% of those with DR. Multivariate logistic regression analysis revealed that patients who had had diabetes for a 11 to 16 years (adjusted odds ratio [AOR] = 3.52, P = 0.035), patients who did not take daily medications on time (AOR = 9.75, P = 0.008), patients who did not go for fundus examination annually (AOR = 3.62, P = 0.011), and patients with uncontrolled diabetes (AOR = 12.18, P < 0.001) were at higher significant risk for DR. Patients not treated with insulin were 70% less likely to develop DR (AOR = 0.30, P = 0.015). An increase of one unit in body mass index was significantly associated with increase in the probability of developing DR by 11% (AOR = 1.11, P = 0.024).

CONCLUSION:

DR is very prevalent in type 2 diabetic patients attending the diabetic center at Al-Noor Specialist Hospital, Makkah Al-Mukarramah; particularly the mild NP type.

Prevalence, Risk Factors, and Patient Awareness of Diabetic Retinopathy in Saudi Arabia: A Review of the Literature

Diabetes mellitus is a common disease in Saudi Arabia and globally, with some studies reporting about 30% prevalence among the Saudi population. Diabetic retinopathy (DR) is the leading cause of blindness among working-age patients, and it has a prevalence of 34.6% among diabetics worldwide. The objectives of this review were to examine the prevalence of DR in Saudi Arabia, describe the major associated risk factors, and raise awareness about the disease among diabetics.

The prevalence of DR in Saudi Arabia has risen substantially in recent decades. Significant risk factors associated with DR include older age, longer duration of diabetes, poor glycemic control, and hypertension. Awareness and education about diabetes are associated with better outcomes and fewer complications.

Knowledge, Attitude, and Practices (KAP) of Diabetics Towards Diabetes and Diabetic Retinopathy in Riyadh, Saudi Arabia: Cross-Sectional Study

BACKGROUND

Diabetes mellitus (DM) and its complication present a major morbidity burden among Saudi population. Awareness and proper knowledge of this highly prevalent disease is crucial to enhance early detection and proper intervention. Therefore, the main aim of this study was to identify the knowledge, attitude, and practices (KAP) of diabetic patients towards diabetes and diabetic retinopathy in Riyadh, Saudi Arabia.

METHODS

This cross-sectional study was conducted in 50 randomly selected primary care centers and two university hospitals in Riyadh, Saudi Arabia, between May and December 2018. Diabetic patients ≥18 years old were enrolled in the study. A validated KAP-45 questionnaire was used to assess the KAP levels of diabetics towards diabetes and diabetic retinopathy.

RESULTS

A total of 313 participants were enrolled in the study. The majority were males 168 (59.8%). The median age was 49 ±24, and the median duration of diabetes was 8 ±11 years. The average knowledge score for diabetes was 10 (good). While the average knowledge score for diabetic retinopathy was 4.5 (suboptimal). The average attitude scores for both diabetes and diabetic retinopathy were 0 and 2 (suboptimal), respectively. The average practice score for diabetes was 5 (good) while it was 3 (low) for diabetic retinopathy. The most common barrier to comply with regular follow-up was inadequate knowledge about the importance of periodic eye exam 47.1% (107). Patients with low socio-economic status had a significantly poor knowledge regarding diabetes (P<0.0001) and diabetic retinopathy (P<0.015), respectively. However, patients with low educational level had a significantly poor knowledge (p<0.0001) and poor practice regarding diabetes (P<0.013), respectively.

CONCLUSION

It is important to improve education and awareness of DM and diabetic retinopathy among diabetics, as it's essential for controlling the disease and reducing its complications, by improving patient compliance to treatment and follow-up.

Knowledge, attitudes, and practices regarding diabetic retinopathy among primary health care physicians in Al-Hasa, Saudi Arabia

Background

Diabetic retinopathy (DR) has been shown to be the third most observed cause of visual loss in Saudi Arabia. In the Al-Hasa region in particular, the prevalence of DR has been shown to be 30%. Primary health centre (PHC) physicians play a central role in the early detection and prevention of DR. The aim of this study was to evaluate the knowledge, attitudes, and practices regarding DR of PHC physicians in Al-Hasa, Saudi Arabia.

Methods

A cross-sectional descriptive study was conducted at PHCs in Al-Hasa, Saudi Arabia. A self-administered questionnaire was provided to every participant along with a consent form. Out of 71 centres in the region, 63 were included in this study. The questionnaire consisted of three sections and a total of 18 questions. Statistical analysis was carried out using the Statistical Package for the Social Sciences version 21 software program (IBM Corp., Armonk, NY, USA).

Results

One hundred forty-one of 209 physicians completed the questionnaire for a response rate of 67%. The mean of overall knowledge score for all participants was 2.6 ± 1.16 points out of four points. Only 34 (24.1%) of the participants correctly referred their diabetic patients according to the guidelines of the American Academy of Ophthalmology. Additionally, only 52 (36.9%) physicians educated their patients regarding the early detection of diabetic complications.

Conclusion

The present study concluded that there exist gaps in applying the correct guidelines. Physicians’ attitudes toward patient education were overall satisfactory. Further medical symposiums and workshops are warranted to teach physicians about diabetic complications and screening schedules, including DR.

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.

Knowledge and practices of fundoscopy among general practitioners in Qassim Province, Saudi Arabia, for the management of diabetic retinopathy and diabetic macular edema: A cross-sectional study

Objectives:

Blindness is one of the most widespread final pathways of diabetic retinopathy and its associated diabetic macular edema. The general practitioners are the first to encounter these diabetic patients. Fundoscopy is now considered as an ideal way for the diagnosis of patients with diabetic retinopathy. Therefore, this study was undertaken to know the ability and skills of general practitioners for the diagnosis and management of patients with diabetic retinopathy and diabetic macular edema.

Methods:

This study was conducted in all major cities in Qassim province of Saudi Arabia during January to May 2017. A validated questionnaire was used to assess the general practitioners’ knowledge and practice for the management of diabetic retinopathy and diabetic macular edema. Questions related to referrals, diagnosis, and treatment options to diabetic retinopathy and diabetic macular edema were asked to the general practitioners.

Results:

Of 96 general practitioners, 76 returned the questionnaire with a response rate of 79.2%. Only 26.3% general practitioners referred patients with type 1 diabetes to ophthalmologists as per guidelines set by the American Academy of Ophthalmology, whereas 74% of general practitioners showed good knowledge for referring patients with type 2 diabetes to ophthalmology clinics. Lack of knowledge was also noticed for the treatment of diabetic retinopathy, as only 36.8% of general practitioners replied positive for dilated fundus examination option, whereas 78.9% of general practitioners chose laser photocoagulation as a treatment option. Similar response from them was observed for patients with diabetic macular edema. Furthermore, data also showed years in practice of general practitioners was well correlated with their knowledge for the management of diabetic retinopathy and diabetic macular edema.

Conclusion:

The general practitioners included in this study showed lack of knowledge in handling patients with diabetic retinopathy and diabetic macular edema. Therefore, refresher courses are needed that highlight the acquisition of their skills in fundoscopy.

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.

Barriers for Adherence to Diabetic Retinopathy Screening among Saudi Adults

Background

Diabetic retinopathy (DR) is one of the major complications of diabetes mellitus (DM) and the leading cause of blindness among adults. However, adherence to diabetic retinopathy screening (DRS) significantly reduces blindness. A substantial proportion of diabetics have suboptimal compliance to DRS, which inversely affects their outcomes. Therefore, the aim of this study is to determine the level of adherence to DRS and to explore the factors possibly associated with poor adherence to regular screening among diabetics in Riyadh, Saudi Arabia.

Method

A cross-sectional study was conducted that encompassed 404 adult diabetic patients attending outpatient clinics in four hospitals in Riyadh. A validated, self-administered questionnaire was used for data collection that included five main sections: sociodemographic data, diabetic profile, assessment of knowledge about DR, attitude toward DRS, and barriers to DRS. Data were analyzed by SPSS, version 23 (IBM Corp., Armonk, NY); qualitative variables were described as percentages, and quantitative variables were described as means ± standard deviation (SD). We used the chi-square test to measure the associations between qualitative variables and binary logistic regression analysis to predict the independent barriers to DRS.

Result

The average age of the participants was 54 years, and 69.1% were females. The average duration of diabetes was 12.3 years. Type 2 DM was the most prevalent form of DM (63.6%). DR was reported by 20% of participants. Poor knowledge about DRS was prevalent in 51%. More than one-fifth were never screened for DR. About one-third of participants agreed that cost was an important contributing barrier. Adequate knowledge, increased duration of diabetes, and presence of neurological complications increased independent adherence to screening.

Conclusion

One-fifth of participants reported having DR. Half the participants had poor knowledge about DR, which formed a major barrier against regular screening. However, most participants had positive attitudes about DR screening. Therefore, intervention strategies to increase patients’ awareness of DR might be the cornerstone of ensuring proper adherence to DRS.

Microvascular complications among patients with diabetes: An emerging health problem in Saudi Arabia

Diabetes mellitus, besides disrupting the carbohydrate metabolism process, also induces vascular disease and impacts nearly all the types and sizes of blood vessels. In fact, vascular complications cause majority of the morbidity, hospitalizations and mortality of patients with diabetes mellitus. Retinopathy, nephropathy and neuropathy (microvascular complications) impact hundreds of millions of diabetics and normally target those having long-term or uncontrolled forms of the disease; however, these disorders can also exist at the time of diagnosis or in those yet to be diagnosed. The Kingdom of Saudi Arabia is the biggest country in the Middle East that occupies around four-fifths of the Arabian Peninsula supporting a population of more than 33.3 million people. The prevalence of diabetes mellitus is increasing at an alarming rate in Saudi Arabia. Over 25% of the adult population is suffering and that figure is projected to more than double by 2030. In fact, diabetes mellitus has approximately registered a 10-fold upsurge in the past three decades in Saudi Arabia. However, the prevalence and risk factors of microvascular complications in diabetes mellitus patients have not yet been clearly documented in Saudi Arabia. Hence, in this review, we aim to provide an overview of the microvascular complications among patients with diabetes in Saudi Arabia, utilizing data from the currently available published literature. This is an attempt to facilitate the government and healthcare systems aware of the enormous worth of prevention, early detection and appropriate management of such microvascular complications.

Awareness of diabetic retinopathy among patients with type 2 diabetes mellitus in primary health care in security forces hospital Riyadh, Saudi Arabia

Background

Diabetes mellitus (DM) is a metabolic disease that is characterized by distortion in the metabolism of carbohydrates, lipids, and proteins and involves hyperglycemia. DM has different types. Several complications are associated with diabetes including diabetic retinopathy (DR). DR can further results in bad outcomes that can be avoided by early diagnosis and management.

Aim

The aim of this paper is to assess the awareness and knowledge level about DR among type 2 DM patients in primary health care in security forces hospital.

Methods

This is a cross-sectional study that was conducted on Saudi patients with type 2 DM who visited primary health care in security forces hospital.

Results

This study included 174 participants, with equal male to female ratio was 1:1, there were 64.9% participants who reported controlled blood glucose level, and 47.1% reported that eye was affected by diabetes. There were 82.8% participants who had awareness about DR; the level of awareness differs significantly with sex (P value = 0.04) and the level of DM control (P value = 0.02).

Conclusion

There was high level of knowledge regarding DR; however, there were few percent of participants who had no awareness and still at risk.

Awareness of diabetic retinopathy among people with diabetes in Jeddah, Saudi Arabia

BACKGROUND

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the foremost cause of blindness. This study aimed to assess the level of awareness of DR and its related risk factors among patients with DM in Jeddah, Saudi Arabia.

METHODS

A cross-sectional study was conducted among patients with DM attending primary health care centers at the Ministry of Health in Jeddah. A structured, pretested, self-administered questionnaire was used to collect information on the sociodemographic and DM- and DR-related characteristics of the patients.

RESULTS

A total of 377 patients were enrolled. About 82.6% of the patients were aware that DM can affect their eyes, and they listed physicians, ophthalmologists, television, and family members as common sources of information on the topic. About 36% of the patients reported that their doctors had not advised them about it. More than half responded that they did not feel their vision to be affected by DM. More than 58% had never been diagnosed with DR. About 35% did not go to their eye checkups, even though around 59% thought that DR could lead to blindness. Of the 64% of patients whose DM was well controlled, 11% and 25% listed surgery and laser treatment, respectively, as available treatment options for DR. The following factors were found to be significant in relation to the subjects' awareness that DM can affect their eyes: the patients' perception of their doctors' advice about DR; the experience of having their vision affected by DM; the knowledge that DR may lead to blindness; the practice of going to eye checkups.

CONCLUSIONS

Despite having good awareness about DM and its effects on eyes, the patients exhibited a relative lack of awareness about DR. Considering the association of DR with DM, its increasing magnitude is a potential burden on the community and health systems.

Diabetics Retinopathy Knowledge and Awareness Assessment among the Type 2 Diabetics

INTRODUCTION

Diabetic retinopathy (DR) is a leading cause of blindness worldwide. In Saudi Arabia and other Arab countries, several studies estimated the prevalence of DR ranging from 30 - 40%.

AIM

To assess the DR knowledge and its association with diabetes control among Type 2 diabetic patients.

METHODS

A cross-sectional study of patients with Type II diabetes (T2D) who had a routine visit to the endocrine clinic to assess the DR knowledge and its relation to the glycemic control. We used a questionnaire that was used in previously published studies, and the reliability was assessed using the alpha Cronbach coefficient. Patients who answered correctly > 60% were considered to have good knowledge about DR.

RESULTS

Total of 253 patients participated, 43.4% has diabetes > 10 years and 30.7% have it for 5 - 10 years, 36.4% did college degree or higher, 40.8% considered having low income. 37.7% of participants were not screened for the DR in the past year. 28.4% of participants think that seeing optometrist is enough for DR diagnosis. Diabetics with good knowledge who have T2D > 10 years were 46.3% compared to 38.6% (p = 0.04). Diabetics with good knowledge have mean A1c of 8.55 vs. 8.59 (p = 0.32), mean BMI 30.4 vs. 30.2 (p = 0.46), mean diastolic pressure was 77.12% vs. 79.48% (p = 0.03).

CONCLUSION

Almost two-thirds of screened T2D were considered to have good knowledge about DR. The good knowledge group tends to have a longer duration of T2D, more likely to have a college degree, and tend to have non -significantly better A1c control.

Prevalence of Diabetic Retinopathy in a Population of Diabetics From the Middle East With Microvascular Ocular Motor Palsies

BACKGROUND

Vascular risk factors are increasing rapidly in the Middle East. Growing inactivity and obesity have contributed to an epidemic of Type 2 diabetes mellitus (DM) in the Arab population. Microvascular palsies of the third, fourth, and sixth cranial nerves, which occur in an isolated manner, are relatively common in patients with DM, hypertension, or other vascular risk factors.

METHODS

In this retrospective analysis, patients with diabetes with microvascular palsies were assessed for the prevalence of diabetic retinopathy (DR). We compared these data with the prevalence of DR in the general population of diabetics in Saudi Arabia and to a similar published study done in an American population.

RESULTS

In total, 126 patients with diabetes were included in the study. The sixth nerve was most frequently involved in 67 patients (53%). Seventy-seven patients (61%) had DR, compared with 49 (39%) without DR. The prevalence of DR in the general population of Saudi patients with diabetes ranged from 30% to 36.1%.

CONCLUSIONS

Our study demonstrated a higher prevalence of DR in patients with microvascular palsies compared with the general population of patients with diabetes in the Arab population. This is in contrast to a previous study in an American population. Our results might be secondary to differences between the 2 populations, in particular, the continued increase in the prevalence of vascular risk factors (mainly diabetes) and poor control of these risk factors in the Middle East.

Microvascular and macrovascular complications of type 2 diabetic mellitus in Central, Kingdom of Saudi Arabia

Objectives

To determine the prevalence of macrovascular and microvascular complications of type 2 diabetes mellitus and its associated determinants.

Methods

We evaluated the online medical records of patients with type 2 diabetes mellitus who have been seen in chronic disease unit between April and June 2014. Seven hundred and forty-eight participants satisfied the inclusion criteria. Of these, 317 (42.4%) were males with a mean age of 57.9 years, 681 (64.3%) were obese with body mass index (BMI) of greater than 30, while only 9.6% had normal BMI (<25).

Results

Only 158 (21.1%) had controlled hemoglobin A1c level. Retinopathy prevalence was 14.8% and neuropathy was 5.6%. Macrovascular complications accounted for 12.1%. Patients’ age and duration of diabetes were main predictors of developing complications. Patients with more than 20 years history of diabetes have 30% more odds of developing the complications when compared to patients with less than 10 years of diabetes history. Each increment in age by one year increases the odds of developing microvascular complications by 4% and macro vascular complication by 2%.

Conclusion

Our results showed diabetic patients with poor glycemic control, and longer duration of diabetic history had higher prevalence of both macrovascular and microvascular.

Association of ARHGAP22 gene polymorphisms with the risk of type 2 diabetic retinopathy

BACKGROUND

Little is known about the contribution of ARHGAP22 polymorphism to diabetic retinopathy (DR) risk. We performed a case-control study to investigate the associations between ARHGAP22 and the risk of DR in a Chinese Han population.

METHODS

A total of 341 patients with type 2 diabetes mellitus (T2DM) were selected. All patients underwent a complete eye examination. Based on this, the patients with T2DM were divided into two subgroups: 188 patients with DR and 153 patients without DR. Five single nucleotide polymorphism (SNPs) were selected and genotyped using the MassARRAY method (Sequenom, San Diego, CA, USA). The odds ratio (OR) and 95% confidence intervals (CIs) were calculated by unconditional logistic regression adjusted for age and sex.

RESULTS

Two susceptibility SNPs in ARHGAP22 were found to be associated with an increased risk of DR both before and after the adjustment: rs10491034 under the dominant model (adjusted OR = 0.51, 95% CI = 0.27-0.95, p = 0.032) and additive model (adjusted OR = 0.47, 95% CI = 0.26-0.84, p = 0.0098) and rs3844492 under the codominant model (adjusted OR = 3.14, 95% CI = 1.10-9.01, p = 0.023) and recessive model (adjusted OR = 3.52, 95% CI = 1.26-9.85, p = 0.011).

CONCLUSIONS

Our findings reveal a significant association between SNPs in the ARHGAP22 gene and DR risk in a Han Chinese population.

Effect of diet on type 2 diabetes mellitus: A review

Globally, type 2 diabetes mellitus (T2DM) is considered as one of the most common diseases. The etiology of T2DM is complex and is associated with irreversible risk factors such as age, genetic, race, and ethnicity and reversible factors such as diet, physical activity and smoking. The objectives of this review are to examine various studies to explore relationship of T2DM with different dietary habits/patterns and practices and its complications. Dietary habits and sedentary lifestyle are the major factors for rapidly rising incidence of DM among developing countries. In type 2 diabetics, recently, elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications. Improvement in the elevated HbA1c level can be achieved through diet management; thus, the patients could be prevented from developing the diabetes complications. Awareness about diabetes complications and consequent improvement in dietary knowledge, attitude, and practices lead to better control of the disease. The stakeholders (health-care providers, health facilities, agencies involved in diabetes care, etc.) should encourage patients to understand the importance of diet which may help in disease management, appropriate self-care and better quality of life.

Diabetic retinopathy: Knowledge, awareness and practices of physicians in primary-care centers in Riyadh, Saudi Arabia

PURPOSE

Diabetic retinopathy (DR) is a serious cause of irreversible blindness and is the most common complication of diabetes. Annual fundus examination for diabetics aids in the prevention of blindness and allows intervening at a timely manner. As primary care physicians (PCP) are the main providers for diabetic care in Saudi Arabia, we aim to evaluate the current knowledge and awareness, and to assess practices among PCP regarding DR.

METHODS

We conducted a cross-sectional study covering 46 randomly selected primary-care centers in Riyadh during October 2015. A Self-administered questionnaire was distributed to PCP containing 3 sections. The first section covered participants' demographics and professional background. The second section contained multiple-choice questions on knowledge related to diabetes and DR. The third section was to assess physicians' practices.

RESULTS

A total of 216 PCPs completed the questionnaire. The mean overall knowledge score was 57 ± 14 out of 100. There was a significant difference in knowledge score between physicians who had obtained a subspecialty degree in family medicine compared to others (59 ± 14, 53.3 ± 14 respectively; P = 0.003). Only 19% of PCPs were aware of anti-vascular endothelial growth factor (VEGF) injections as a modality of treatment. A defect was found in the screening and follow-up of type 1 diabetics, and only 24% of physicians correctly referred patients with type 1 diabetes to an ophthalmologist.

CONCLUSION

Our study uncovered areas of defects in knowledge among PCP regarding DR. This needs to be addressed in future seminars and workshops with an emphasis on the proper ophthalmological screening and management of diabetic patients.

Association between Sickle Cell Trait and the Prevalence and Severity of Diabetic Retinopathy

Purpose

To determine whether Sickle cell trait (SCT) is associated with an increased severity of diabetic retinopathy.

Methods

This was a single center retrospective study case control study of 100 eyes of 100 patients with diabetes mellitus (DM) with SCT (SCT group) and 100 eyes of 100 age-matched patients with DM without SCT (control group). The main outcome measure was the difference in the prevalence of sight threatening DR [here defined as diabetic macular edema (DME) and/or proliferative diabetic retinopathy (PDR)], between the SCT and control groups. Secondary outcome measures included differences in visual acuity, ocular comorbidities, intraocular pressure, glycemic control as assessed by random blood glucose measurement, diabetes duration, nephropathy, hyperlipidemia and hypertension.

Results

The SCT group had statistically significantly shorter duration of DM (median [25% quartile] 15 [8.3] years versus 20 [14.7] years, respectively)(P<0.001) and presented with statistically better metabolic control (mean difference 1.6 mmol/l, (95% confidence interval [CI], 0.1–3.3;P = 0.03). The prevalence of PDR and/or DME was significantly lower in the SCT group (58%) compared to the control group, (95%)(P<0.001). The absence of SCT (adjusted odds ratio [AOR] = 24; 95% CI, 8–72; P<0.001) and longer duration of DM (AOR = 1.1 [95% CI, 1.02–1.13]; P = 0.003) were independent predictors of PDR and/or DME.

Conclusions

SCT seems to protect against the development and progression of DR. This may have implications for monitoring and screening. Prospective studies are required to confirm this association. If true, this association may indicate an increased blood glucose buffering capacity of abnormal hemoglobin.

Diabetic retinopathy and the associated risk factors in diabetes type 2 patients in Abha, Saudi Arabia

Objectives:

To assess the proportion and grades of retinopathy and its risk factors in diabetes type 2 patients.

Materials and Methods:

This was a cross-sectional study of 401 type 2 diabetic patients. A questionnaire and checklist were used to collect the data. Retinopathy was diagnosed and graded by fundus photographs and slit lamp examination. The duration of diabetes, age of patients, age at onset of diabetes, body mass index, hemoglobin A1c level, blood pressure, and complications were noted.

Results:

The mean age of male and female patients was 54.93 and 54.25 years; 57.6% were males. The mean age of onset and mean duration of diabetes were 43.91 and 13.4 years, respectively. The proportion of retinopathy was 36.4%. Grades of retinopathy were: Mild 57.5%, moderate 19.9%, severe nonproliferative 11%, and proliferative retinopathy 11.6%; 7.2% of patients had maculopathy. Retinopathy was significantly associated with older age, younger age at onset, longer duration of disease, poorly controlled blood sugar, hypertension, insulin use; the presence of neuropathy and nephropathy appeared as a significant risk. Younger age at onset, longer duration, and insulin use appeared as the strongest predictors for diabetic retinopathy.

Conclusions:

More than a third (36.4%) of the diabetic patients attending a diabetic center had retinopathy. The control of the risk factors may reduce both prevalence and consequences of retinopathy.

Magnitude and determinants of diabetic retinopathy among persons with diabetes registered at employee health department of a tertiary Eye Hospital of central Saudi Arabia

Background:

To estimate the magnitude and determinants of diabetic retinopathy (DR) among persons with diabetes registered at the employee health department of King Khaled Eye Specialist Hospital (KKESH).

Methods:

A retrospective review of medical records was conducted in 2013–14 at KKESH. The case record review extracted demographic, profile of diabetes, diabetic complications, and different blood indices to determine the status of potential risk factors. Ocular profile, especially DR was also noted.

Results:

Our cohort had 94 staff with diabetes. Eye examination was carried out in 51 (54.8%) of them. The rate of DR was 52% (95% confidence interval (CI) 28–66). Sight-threatening diabetic retinopathy (STDR) (proliferative DR and/or diabetic macular edema) was present in 40% of those examined. Good glycemic control was noted in 42% of participants. Duration of diabetes was associated with DR (P = 0.04). Good glycemic control was negatively associated to DR (odds ratio = 0.2 [95% CI 0.04–0.6]). The coverage of eye screening was 55% only. Laser treatment was given to 80% of STDR cases. The lens opacity and glaucoma rate was 15% and 8.3%, respectively.

Conclusions:

Low coverage for eye screening and laser treatment to diabetics among the staff of an eye hospital is a matter of concern. The underlying causes of low coverage of screening, digital fundus photography as a screening tool and management should be addressed.

Incidence Density and Risk Factors of Diabetic Retinopathy Within Type 2 Diabetes: A Five-Year Cohort Study in China (Report 1)

A prospective study was carried out from August 2010 to August 2014 in the community of Fengyutan (China). Six hundred and twenty two T2D subjects were collected. The incidence density of diabetic retinopathy (DR) was 1.81% person-year (95% confidence interval, CI: 1.21–2.43% person-year). After a Cox regression model analysis and adjusted confounding factors, independent predictors related to the incidence of DR including male gender (adjusted hazard ratios, aHR: 1.47, 95% CI: 1.21–1.62), with hypertension (aHR: 1.49, 95%: 1.12–1.73), duration of diabetes > 10 years (aHR: 2.28, 95%: 2.05–2.42), uncontrolled diabetes (aHR: 1.76, 95%: 1.41–2.01), total cholesterol ≥ 200 mg/dL (aHR: 1.54, 95%: 1.34–1.72) and HbA1c ≥ 7% (mmol/mol) (aHR: 2.12, 95%: 1.87–2.32). Duration of T2D revealed the significantly dose-response relationship to the onset of DR. The incidence density of DR in the Chinese community was relatively low in comparison with other studies. More attention should be paid to the T2D patients, especially of male gender, with hypertension, longer duration of diabetes, uncontrolled diabetes, total cholesterol ≥ 200mg/dL and HbA1c ≥ 7% (mmol/mol).

Prevalence of chronic complication among type 2 diabetics attending primary health care centers of Al Ahsa district of Saudi Arabia: a cross sectional survey

Background:

The morbidity and mortality related to diabetes is a great global concern. The knowledge of chronic complications of diabetes and associated co morbidity factors is very important for formulating the necessary policies and action plan.

Aims:

To determine the prevalence of chronic complications and comorbidity among the type 2 diabetics attending the primary health care centers of Al Ahsa district of Saudi Arabia.

Material and Methods:

This cross sectional retrospective survey was carried out on 506 type 2 diabetic patients attending the different primary health care centers of ministry of health, Al Ahsa. Data regarding the co morbidity factors and chronic complications were recorded from the health records of the selected diabetic patients. Data analysis was done by SPSS version 16. A p<0.05 was considered significant for all statistical calculations.

Results:

Overall 72.72% (95% CI 69.78-74.45) of the study subjects were suffering from one or more complications of diabetic mellitus. Among them 33.39% (165) were suffering from single, 25.29% (128) with two and 15% (75) from more than two complications. The overall prevalence of complication among the female subjects was significantly higher than the male (78.16%, 95% CI 76.76-84.40 Vs 65.76%, 95% CI 61.63-69.89, p=.038). The chronic complication was higher among the urban population than the rural population (77.3% 95% CI 72.88-80.26 Vs 69.78% 95% CI 66.1%-76.92%, p=.035).

Conclusion:

The result showed a high percentage of chronic complications among the diabetic patients of this region. The high percentage of obesity, hypertension and dyslipidaemia among them are important co morbidity factors which if not controlled can cause further increase in the number of chronic complications.

The clinical utility of eye exam simulator in enhancing the competency of family physician residents in screening for diabetic retinopathy

OBJECTIVES

To evaluate the utility of eye exam simulators in the training and assessment of family medicine residents for screening diabetic retinopathy (DR) utilizing direct ophthalmoscopy (DO).

METHODS

This prospective, single arm, cross-sectional study was conducted at King AbdulAziz University Hospital, Jeddah, Kingdom of Saudi Arabia in April 2013, wherein the final year family medicine residents of the Saudi Board family medicine training program, underwent a practical session on DO using an eye exam simulator. The cognitive and motor skills of the participating family residents in performing DO, and their competency at diagnosing DR was assessed before, and after a practical session with the eye simulator.

RESULTS

A total of 14 out of total 20 final year residents consented to join the study. Of these, 57.1% were females. A total of 42.9% (6/14) showed initial motor skill competency, and 35.7% showed cognitive skill competency to diagnose DR. Before the session on the eye simulator, merely 7.1% of the residents expressed confidence in performing DO. After the practical session, 78.6% (11/14) showed motor, and 64.3% (9/13) showed cognitive skill competency, in diagnosing DR. A total of 50% were adequately confident in performing DO. A total of 71.4% (10/14) of the residents preferred learning DO via simulation practical sessions than clinical rotation in ophthalmology clinics.

CONCLUSION

Eye exam simulators are good tools in learning and assessment of DO skills leading to significant improvement in the efficiency and confidence of family physicians in screening for DR.

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.

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.

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.

Prevalence of diabetic retinopathy in various ethnic groups: a worldwide perspective

The alarming rise in diabetes prevalence is a global public health and economic problem. Diabetic retinopathy is the most common complication of diabetes and the leading cause of blindness among working-age populations in the Western world. Screening and prompt treatment of diabetic retinopathy are not top priorities in many regions of the world, because the impacts of other causes of preventable blindness remain an issue. Ethnicity is a complex, independent risk factor for diabetic retinopathy. Observations from white populations cannot be extrapolated fully to other ethnic groups. The prevalence of diabetic retinopathy, sight-threatening diabetic retinopathy, and clinically significant macular edema are higher in people of South Asian, African, Latin American, and indigenous tribal descent compared to the white population. Although all ethnic groups are susceptible to the established risk factors of diabetic retinopathy-such as length of exposure and severity of hyperglycemia, hypertension, and hyperlipidemia-ethnic-specific risk factors also may influence these rates. Such risk factors may include differential susceptibility to conventional risk factors, insulin resistance, differences in anthropometric measurements, truncal obesity, urbanization, variations in access to healthcare systems, genetic susceptibility, and epigenetics. The rates of nonproliferative diabetic retinopathy appear to be declining in the United States, supporting the observation that better medical management of diabetes and prompt treatment of sight-threatening diabetic retinopathy substantially improve the long-term diabetic retinopathy incidence; studies from other parts of the world are limited and do not mirror this finding, however. We examine the ethnicity and region-based prevalence of diabetic retinopathy around the world and highlight the need to reinforce ethnicity-based screening and treatment thresholds in diabetic retinopathy.

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.