Predictors of severity of retinopathy among subjects with early onset type 2 diabetes mellitus (original) (raw)
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Prilozi - Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki, 2023
Introduction: Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and the leading cause of visual impairment and blindness. The aim of the study was to estimate and compare the prevalence of DR and to determine an association between DR and systemic risk factors in hospitalized type 1 (DMT1) and type 2 (DMT2) diabetic patients. Material and methods: We analyzed 260 patients with diabetes, 43 with DMT1 and 217 with DMT2. The following data were collected: age, gender, type and duration of diabetes, glycemic control, blood pressure, estimated glomerular filtration rate, ophthalmologic examinations and routine biochemical parameters. Results: Out of the total number of 260 patients, 77 (29.6%) had non-proliferative DR (NPDR), 21 (8.1%) had proliferative DR (PDR), 29 (11.1%) had diabetic macular edema (DME), and 69 (23.5%) had diabetic cataracts. Forty-three (16.5%) patients were previously diagnosed with DMT1 and 217 (83.5%) with DMT2. The duration of diabetes was not significantly longer in DMT1 (12.8±11.2 years) in comparison to DMT2 (11.07±8.1 years). The prevalence of NPDR and PDR did not differ statistically in either groups. DME was more prevalent in DMT2 than in DMT1 (P<0.05). Diabetic cataract was found in 26.7% vs. 6.7% of patients with DMT2 and DMT1, respectively (p<0.01). The duration of diabetes significantly correlated with NPDR and PDR in DMT1 (r=o.31, p<0.05; r=0.55, p<0.001, respectively). In DMT2, significant correlations were found between the duration of diabetes and cataract, NPDR, PDR and DME (r=0.31, p<0.001; r=0.43 p<0.01, r=0.16 p<0.05 and r=0.20 p<0.01, respectively). Fasting plasma glucose (FPG) significantly correlated with PDR (r=0.258, p<0.05), while HbA1c with DME (r= 0.15 p<0.05). Conclusion: The duration of diabetes and hyperglycemia were associated with DR in both types of diabetes.
Journal of Diabetes and its Complications, 2009
To determine the differences observed between two transversal studies separated 14 years. Methods: The sample was obtained by randomized hazard selection of 1157 Type 2 and 93 Type 1 diabetic patients in the 2006 study, and 741 Type 2 and 76 Type 1 diabetic patients in the 1993 study. We evaluate the prevalence of diabetic retinopathy (DR), microalbuminuria, overt nephropathy, and its risk factors. Results: In Type 2 diabetic patients, we observed a decrease of the prevalence of DR from 39.41% in the 1993 study to 27.48% in the 2006 study, but we did not observe it in Type 1 diabetic patients-35.52% in 1993 to 36.55% in 2006. The diabetic macular edema prevalence is similar in both studies-7.15% in 1993 and 7.86% in 2006 in Type 2 patients, and 11.84-12.90% in Type 1; microalbuminuria decreased in Type 2 but not in Type 1 patients (from 22.13% to 17.02% in Type 2, and 28.33-27.95% in Type 1); overt nephropathy decreased in both types of diabetic patients
Associated risk factors in the early stage of diabetic retinopathy
Eye and Vision
Background: To investigate the retinal capillary density (RCD) of the macula using optical coherence tomography angiography (OCT-A) in type 2 diabetic patients and to further determine the association with risk factors. Methods: A total of 212 eyes from 212 subjects were recruited; subjects included diabetics with no retinopathy (NDR, n = 90 eyes), diabetics with mild retinopathy DR (MDR, n = 36 eyes), and healthy participants (Control, n = 86 eyes). All participants underwent OCT-A scanning. RCD was quantified by superficial and deep retinal capillary layers (SRCL and DRCL) from OCT-A images. Results: RCD in SRCL and DRCL was lower in NDR (P < 0.001) as well as in MDR (P < 0.001) when compared with control eyes. Diabetic patients were subdivided according to individual risk factors, complications related to diabetes, and hyperglycemia. Diabetic patients showed lower RCD in both the SRCL and DRCL when compared with healthy controls. Diabetics with age > 55y, HbA1c > 7% had significantly reduced DRCL (P < 0.05) when compared with the other group of diabetics (age < 55y, HbA1c < 7%). Diabetics with a blood urea nitrogen (BUN) > 8.2 mmol/L had significantly reduced SRCL and DRCL when compared to the other group of diabetics. Conclusions: Risk factors including older age, higher level of HbA1c, LDL-C and BUN, were associated with lower RCDs found in type 2 diabetic patients with and without mild DR by OCT-A. The impairment of retinal capillary by OCT-A may play a key role in the early monitoring of management in diabetes.
2013
Objective: To assess the association of Diabetic Retinopathy (DR) with type and duration of Diabetes Mellitus, mode of treatment and glycaemic control. Methods: An observational study was carried out. Patients with the diagnosis of either Type1, insulin dependent diabetes mellitus (IDDM) or Type 2, non-insulin dependent diabetes mellitus (NIDDM) were enrolled into the study through non-probability, convenient sampling method from Jinnah Medical College Hospital Karachi from July 2012 to March 2013. Thorough history and physical examination was done on each patient. Glycaemic control was assessed by glycosylated Hb level (HbAIc). All information so collected was entered into a proforma. Data was analyzed using SPSS version 20. Results: A total of 108 patients were examined. Out of these, 33 (30.6%) had Type 1 and 75 (69.4%) had Type 2 diabetes. In Type 1 group, 18 (54.5%) were female while in Type 2 group, 37 p atients (49.3%) were female. In Type 1 group, 60.6% (n=20) had DR comp ar...
Investigative Opthalmology & Visual Science
PURPOSE. To characterize 2-year changes occurring in neurodegeneration, edema, and capillary dropout in nonproliferative diabetic retinopathy. METHODS. Two-year prospective longitudinal observational cohort of eyes/patients with type 2 diabetes using spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA). Eyes were examined three times with intervals of 1 year. Thickness of the full retina and layer-by-layer measurements were used to identify edema or neurodegeneration. OCTA vessel density maps of the retina were used to identify capillary dropout. Early Treatment Diabetic Retinopathy Study (ETDRS) classification was performed using the seven-field ETDRS protocol. RESULTS. A total of 62 eyes from 62 patients with diabetes were followed for 2 years. After verification for image quality, a total of 44 eyes from 44 patients (30% women) aged 52 to 80 years were retained for data analysis. There were 18 eyes with ETDRS grades 10 to 20, 17 eyes with ETDRS grade 35, and 9 eyes with ETDRS grades 43 to 47. During the 2-year follow-up period, there was a progressive increase in capillary dropout, whereas edema and neurodegeneration remained stable. In multivariate analysis, considering a model adjusted for age, sex, hemoglobin A 1C , visual acuity, and diabetes duration, vessel density remained significantly different between Diabetic Retinopathy Severity Scale groups (Wilks' λ = 0.707; P = 0.015) showing association with disease progression. CONCLUSIONS. Capillary dropout increased in a period of 2 years in eyes with minimal, mild, and moderate diabetic retinopathy, whereas the presence of edema and neurodegeneration remained stable.
Journal of Evolution of Medical and Dental Sciences, 2015
Diabetic retinopathy is a microangiopathy primarily affecting pre-capillary venules, although larger vessels may also be involved. Retinopathy exhibits features of both microvascular occulusion and leakage. Diabetic maculopathy is the most common cause of visual impairment in diabetic patients. AIMS To asses the prevalence of Diabetic Retinopathy (DR) in diabetic patients. To find the correlation of diabetic retinopathy with various risk factors. SETTING AND DESIGN Hospital based prospective study. MATERIALS AND METHODS Detailed history with visual acuity, slit lamp examination, fundus examination, IOP and Gonioscopy were recorded. INVESTIGATIONS Blood sugar (F) and (PP), Lipid profile, Hb1ac. STATISTICAL ANALYSIS Chi-square test and Fisher exact test. Crude Odds' ratio for strength of association. RESULTS Prevalence of DR was found to be 72%: NPDR (59.3%), PDR (5.4%) and maculopathy (7.3%). Chances of retinopathy were found to be more with increased duration of diabetes. Males were found to have more chances of developing retinopathy. No significant association with increased IOP, hypertension or altered lipid profile was found. CONCLUSION Diabetic retinopathy risk in diabetic patients depends on age, sex, duration of diabetes, blood sugar (F) levels, altered renal function and also on types of diabetes.
2015
The objective of the study is to assess the prevalence of diabetic retinopathy and determine the correlation of incidence and severity of retinopathy with systemic risk factors in type 2 diabetes mellitus. 500 subjects of both sexes, with the mean age of 55± 8years, with type 2 diabetes mellitus were included in the study. Patients were screened for presence of associated risk factors including duration and control of hyperglycemic status, hypertension, hyperlipidemia, HbA1C, nephropathy, neuropathy and anemia. Ophthalmoscopic examination was performed after pupillary dilatation and staging of diabetic retinopathy is done. 334 out of 500 patients (66.8%) had diabetic retinopathy and the prevalence was higher in elderly above 60 years and those with severe grades of systemic risk factors. Amongst the 1000 eyes studied, 573 were classified as non-proliferative diabetic retinopathy (NPDR) and 33 as proliferative diabetic retinopathy (PDR). Prevalence of mild non-proliferative, moderate...
Journal of medicine, 2016
Backgr Backgr Backgr Backgr Background: ound: ound: ound: ound: Diabetic retinopathy is the commonest cause of blindness in the working age group of both developed and developing countries. It is the indicator of all micro-vascular complications of diabetes mellitus. This study was aimed to find out the frequency and pattern of diabetic retinopathy among hospitalized adult type 2 diabetic patients. Methodolog Methodolog Methodolog Methodolog Methodology: y: y: y: y: This cross-sectional study was carried out in the Department of Medicine and Endocrinology of BIRDEM General Hospital, Dhaka over a period of six months. Retinopathy was determined by fundoscopic examination in dilated pupil. Data were collected in preformed questionnaire including demographic characteristics, fundoscopic findings, and laboratory investigation reports with prior informed consent of the patients. Results: Results: Results: Results: Results: Total patients were 94, male were 52 and female were 42. Mean age of the patients was 52.2 ± 11.12 years. Hypertension was the most common (42.8%) co-morbid condition followed by dyslipidemia (33%), nephropathy (34%), neuropathy (21.3%), ischemic heart disease (9.6%) and stroke (5.3%). Study showed 37.23% Patient had good glycemic control (HbA1C <7%) and 62.77% had poor glycemic control. The frequency of retinopathy of any form was present in 36.2% patients. Among them, non-proliferative diabetic retinopathy (NPDR) was present in 78.79%, proliferative diabetic retinopathy (PDR) 6.06%, maculopathy 6.06%, both maculopathy and PDR in 9.09% diabetic patients. Among NPDR, 46.15 % was mild, 26.92% was moderate and 26.92% was severe NPDR. This study also revealed retinopathy was more with increase in duration of diabetes (66.6% vs. 17.3% p=0.01), in poorly controlled diabetic than good control (52.54% vs. 8.5%, p=0.01), those with hypertension (55% vs. 22%, p=0.02), and those having diabetic nephropathy (78.12% vs. 14.51%, p=0.01). Conclusion: Conclusion: Conclusion: Conclusion: Conclusion: This study showed frequency of diabetic retinopathy was 36.2% and among retinopathy NPDR was predominate. Poor glycemic control, increase duration of diabetes, presence of other microvascular complication i.e. nephropathy found to be significant risk factors for developing retinopathy.
Clinical spectrum of diabetic retinopathy and its correlation with risk factors
International Journal of Medical Ophthalmology, 2021
Objectives: To study the clinical spectrum of diabetic retinopathy and its correlation with its risk factors.Material and Methods: A prospective, cross sectional and unmasked study was done in patients of diabetes mellitus presenting in OPD of RIO, PGIMS Rohtak. Total 60 patients were included in the study which were divided into 3 groups each of 20 patients, based on the duration of DM: Group A 10 years. Staging of retinopathy was done on the basis of International diabetic retinopathy and diabetic macular edema severity scale. Demographical factors like age and sex were correlated with duration of DM. Various clinical forms of diabetic retinopathy ranging from no apparent DR to severe NPDR to PDR were correlated to different laboratory parameters like degree of hyperglycemia, Hb, lipid profile, blood pressure, renal function tests to ascertain correlation between them.Results: Total prevalence of diabetic retinopathy in our study was 56.66%. Males were at higher risk in comparison...
IOSR Journals , 2019
Introduction: The rise in prevalence of diabetes mellitus, especially type 2 diabetes, is a global health and economic problem. Diabetic retinopathy is a frequent complication of the disease and the leading cause of blindness among working-age populations in the developed world. Type 2 diabetes is characterized by a long, often asymptomatic, period of hyperglycaemia. Therefore, end-organ damage, such as diabetic retinopathy, may already be present in individuals who are unaware that they have type 2 diabetes, and the likelihood of this increases with the duration of the diabetes. Materials and Methods: It was a cross-sectional study conducted over a period of 1 year from January 2018 to December 2018. Among 400 eyes, 200 patients were diagnosed as new case of type II Diabetes mellitus attending the Outpatient Department of Ophthalmology in M.G.M Medical College Hospital, Jamshedpur and Jharkhand. Both male and female patients of age group between 30-60 years were taken up in this study. The patients were selected non-randomly and the sample was taken for convenience. Type I diabetes mellitus, chronic renal failure, pregnant women, patients with opaque media and patients who did not give consent for the study were excluded from our analysis. Special emphasis was laid in categorizing age, sex incidence, presence of DR, staging of DR, presentation of complications and associated comorbid conditions. Results: The predominantly affected group was aged between 40 and 50 years (42.5%). The male: female ratio was 2.1:1. The majority of patients had visual acuity between 6/9 and 6/18 on first presentation (43.5%). 12% of patients had positive family history. 33% of the patients were exposed to risk factors like smoking, alcohol and anaemia. 12% of the patients had bilateral diabetic retinopathy. Of the 400 eyes evaluated 62 eyes had NPDR and 2 had PDR, while 336 had no features of diabetic retinopathy. Among the NPDR, majority (38 eyes) fell under moderate NPDR. One patient had vitreous haemorrhage at the time of presentation. Conclusion: Incidence of DR is common among middle-aged working population. Both eyes were usually affected, though asymmetrically. In conclusion DR including sight threatening complications was found even at the time of diagnosis of diabetes mellitus type II. Early diagnosis and treatment of DR helps to stabilize the visual acuity and prevent further vision loss. Diagnosis of complications of diabetic retinopathy at the earliest helps to control progression of proliferative diabetic retinopathy. Increased awareness of the ophthalmological complication in diabetes is necessary in the society to prevent unnecessary visual morbidity in diabetic patients.