Retinopathy and microalbuminuria in type II diabetic patients (original) (raw)
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Annals of Pakistan Institute of Medical Sciences, 2021
To evaluate the association of microalbuminuria with the severity of diabetic retinopathy. Methodology: This is a cross-sectional study that was conducted at Combined Military Hospital Lahore from Dec 2019 to Dec 2020. All Patients having type II diabetes mellitus fulfilling the inclusion and exclusion criteria were selected for this study. All patients underwent complete ocular examination including fundoscopy to grade the stage of diabetic retinopathy using the ETDRS chart. To assess the extent of microalbuminuria, a urine albumin to creatinine ratio was carried out using the urine spot test and classified as mild, moderate and severe according to KIDGO 2012 clinical practice guidelines. Results: Out of 300 patients 104 (34.6%) had some stage of diabetic retinopathy. Microalbuminuria was present in all (104) patients with diabetic retinopathy and in 55 (28.06%) patients with no diabetic retinopathy. The severity of microalbuminuria correlates with the advancement in stages of retinopathy with a p value < 0.001 as the number of patients with moderate and severe microalbuminuria had higher stages of diabetic retinopathy. None of the patients with very mild diabetic retinopathy had moderately or severely increased microalbuminuria whereas 88% of patients with advanced diabetic retinopathy had moderately increased microalbuminuria and 4% had severely increased microalbuminuria. Furthermore, 76% of the patients had moderately increased and 12% had severely increased microalbuminuria in patients >7 HbA1c and only 28% of patients had moderately increased microalbuminuria and none had severely increased microalbuminuria in patients with ≤ 7 HbA1c. Conclusion: This study showed that the degree of microalbuminuria increases with each higher stage of diabetic retinopathy.
Study of Prevalence of Diabetic Retinopathy in Diabetics with Microalbuminuria
2019
Background: The concordance of microalbuminuria and diabetic retinopathy (DR) has been well reported in persons with type 1 diabetes; however, for type 2 diabetes, there is paucity of data especially from population based studies. The aim of this study was to estimate the prevalence of microalbuminuria among persons with type 2 diabetes. Methods: A population-based cross sectional study was conducted in cohort of 160 subjects with type 2 diabetes. All the subjects underwent comprehensive eye examination with the help of indirect ophthalmoscope by the practicing ophthalmologist. A morning urine sample was tested for albuminuria. Subjects were considered to have microalbuminuria, if the urinary albumin excretion was between 30 and 300 mg/24 hours. The statistical software used was SPSS for Windows and X test, to compare proportions amongst groups were used. Results: The prevalence of microalbuminuria in the study subjects was 27.5% (44/160). Overall prevalence of Diabetic Retinopathy ...
Brazilian Journal of Medical and Biological Research, 2006
Diabetic retinopathy is one of the leading causes of blindness in working-age individuals. Diabetic patients with proteinuria or those on dialysis usually present severe forms of diabetic retinopathy, but the association of diabetic retinopathy with early stages of diabetic nephropathy has not been entirely established. A cross-sectional study was conducted on 1214 type 2 diabetic patients to determine whether microalbuminuria is associated with proliferative diabetic retinopathy in these patients. Patients were evaluated by direct and indirect ophthalmoscopy and grouped according to the presence or absence of proliferative diabetic retinopathy. The agreement of diabetic retinopathy classification performed by ophthalmoscopy and by stereoscopic color fundus photographs was 95.1% (kappa = 0.735; P &amp;lt; 0.001). Demographic information, smoking history, anthropometric and blood pressure measurements, glycemic and lipid profile, and urinary albumin were evaluated. On multiple regression analysis, diabetic nephropathy (OR = 5.18, 95% CI = 2.91-9.22, P &amp;lt; 0.001), insulin use (OR = 2.52, 95% CI = 1.47-4.31, P = 0.001) and diabetes duration (OR = 1.04, 95% CI = 1.01-1.07, P = 0.011) were positively associated with proliferative diabetic retinopathy, and body mass index (OR = 0.90, 95% CI = 0.86-0.96, P &amp;lt; 0.001) was negatively associated with it. When patients with macroalbuminuria and on dialysis were excluded, microalbuminuria (OR = 3.3, 95% CI = 1.56-6.98, P = 0.002) remained associated with proliferative diabetic retinopathy. Therefore, type 2 diabetic patients with proliferative diabetic retinopathy more often presented renal involvement, including urinary albumin excretion within the microalbuminuria range. Therefore, all patients with proliferative diabetic retinopathy should undergo an evaluation of renal function including urinary albumin measurements.
Frequency of Microalbuminuria in Patients with TYPE-2 Diabetes Mellitus Having Diabetic Retinopathy
2018
Objective; To determine the frequency of microalbuminuria in patients with type 2 diabetes mellitus with retinopathy. Methodology:- This descriptive study was carried out in the Out Patient Department Nishtar Hospital Multan from June 2017 to December 2018. Sample size of 296 was calculated according to formula. Results:- Of these 300 study cases, 179 (59.7%) were male while 121 (40.3%) were female patients. Mean age of our study cases was 52.10 ± 5.65 years (with minimum age was 42 years while maximum age was 60 years). Majority of our study cases had low educational level such as illiterate i.e. 60 (20%), primary education in 71 (23.7%) secondary education53% while only 3 % had bachelors degree or above. Mean duration of diabetes was 14.18 ± 2.73 years (with minimum duration of disease 10 years and 19 years was maximum duration of the disease). Among these patients Grade III diabetic retinopathy was more prevalent i.e. 149 (49.7%) followed by grade IV retinopathy i.e. 100 (33.3%) ...
Frequency of Microalbuminuria in Patients with Diabetic Retinopathy
2018
Background; The magnitude of damage caused by these microvascular complications of diabetes stresses the need for sensitive markers of screening for retinopathy and nephropathy. This study was done to determine the frequency of microalbuminuria in patients with diabetic retinopathy. Material and methods; A total of 300 patients’ type 2 diabetic patients with diabetic retinopathy presenting in Diabetes OPD of Nishtar Hospital, Multan were selected. After taking informed written consent, all patients underwent retinal imaging using Non Mydriatic Fundus Camera (NIDEK ® Model # AFC-330). Urine sample of each patient was sent to the institute pathology laboratory for measuring albumin / creatinine ratio. Grades of retinopathy and microalbuminuria. Collected Data was entered into SPSS version 17.0 and was analyzed through its statistical package. Results; Of these 300 study cases, 179 (59.7%) were male patients while 121 (40.3%) were female patients. Mean age of our study cases was 52.10 ...
Diabetic Retinopathy Among Type II Diabetics; with and without Microalbuminuria
2019
Objective: To determine the frequency of diabetic retinopathy among type ii diabetics, with and without microalbuminuria at tertiary care Hospital. Study Design: Cross-sectional study. Settings: Diabetes Management Centre, Services Hospital Lahore-Pakistan. Duration: Six months duration from May 2015 to November 2015. Methodology: Patients with type II diabetes mellitus diagnosed for >10 years and whose random blood sugar level was >200 mg/dl or fasting blood sugar level is >126 mg/dl at the time of diagnosis, both gender and age between 25 to 70 years were included. Patient were said to have diabetic retinopathy if any one of the following changes were seen on his/her fundoscopy by retinal camera: Microaneurysm, blot and dot hemorrhages, hard exudates, beading, and venous looping, soft exudates, maculopathy and formation of fresh vessel. All the data was recorded in the proforma. Results: Total 300 patients were studied; their age range was 35-70 years. 43% were male and 5...
International Journal of Ophthalmic Research
Opaque/hazy ocular media preventing fundus visualization, Coexisting ocular disorders likely to mask the findings of diabetic retinopathy, Patients with presence of any of the confounding factors, like fever, active systemic infections, exercise, high protein intake, accelerated hypertension, congestive heart failure, patients not willing to participate in the study were excluded from the study. RESULTS: 444 subjects of either gender were included in our study, out of which 236 patients were females and the rest were males. Majority of the patients lied in the age group of 41-60 years (54.73%) followed by 61-80 years (29.28%) and 20-40 years (15.09%), while only 4(0.90%) patients were aged > 80 years. A statistically significant association with severity of retinopathy and the age of the patients was observed. Proportion of Group I (No retinopathy) was higher in younger patients i.e. 20-40 (74.6%) and 41-60 (54.3%) as compared to elderly cases i.e. 61-80 (46.2%) and this difference was found to be statistically significant (p < 0.001). Statistically significant association was found between the severity of retinopathy and duration of diabetes (p < 0.001). Proportion of severe to very severe retinopathy and proliferative diabetic retinopathy were higher in higher grade of microalbuminuria (Grade II and Grade III). A statistically significant association between microalbuminuria grade and severity of retinopathy was observed (p < 0.001). Total cholesterol was found to be high (240 mg/dl) in 13.74%patients. Prevalence of retinopathy was 60.7%, in patients having high total cholesterol levels. Proportional difference in severity of retinopathy in patients with different total cholesterol levels was found to be statistically significant (p = 0.002). Trivariate analysis between severity of retinopathy, microalbuminuria and serum cholesterol levels, revealed that in microalbuminuria grade 0, difference in prevalence of retinopathy in patients with different serum cholesterol levels was not found to be statistically significant. CONCLUSION: Duration of diabetes and microalbuminuria have been found to be the independent risk factors for diabetic retinopathy, but serum cholesterol levels did not show an independent role in our study. The findings in present study endorsed the view that microalbuminuria poses a risk for diabetic retinopathy which is affected by duration of diabetes, level of glycemic control and lipid levels.
Journal of diabetes and its complications
PURPOSE: To determine the incidence and relationship of diabetic retinopathy (DR), microalbuminuria and overt nephropathy (ON). METHOD: A 20-year prospective study, in a cohort of 110 consecutive type 1 diabetes mellitus (DM) patients, without diabetic retinopathy or microalbuminuria at enrolment in 1990. RESULTS: The 20-year incidence of any DR was 70.91%, microalbuminuria 42.72%, and ON was 23.63%. Regarding the risk factors: pre pubertal age at diagnosis was significant for DR and ON, LDL-cholesterol and CT/HDL-cholesterol were significant for DR but not for microalbuminuria or ON. The relationship between DR and ON demonstrated that DR was a significant risk factor for ON, but ON was significant for sight-threatening DR. At the end of the study, two major groups of patients were formed: patients with DR only and patients with DR and ON. For the development of only DR we can assume that the most important risk factor is the duration of DM, followed by the high levels of HbA1c, pr...
Correlative Study of Diabetic Retinopathy with HbA1c and Microalbuminuria
International Journal of Ophthalmic Research
Department of Medicine of our facility. All cases were subjected to complete ocular examination after taking demographic and medical history. Diabetic Retinopathy was graded as per ETDRS categories. Biochemical investigations like serum creatinine, serum urea, urine microalbumin levels, Blood sugar (fasting/post prandial), HbA1c were done. RESULTS: Out of 444 cases, Male to female ratio was 0.88: 1, where majority (54.73%) were aged between 41-60 years. 246 patients who did not suffer from retinopathy were grouped as Group I, while the rest of 198 patients having retinopathy were categorized as Group II. This was further divided into IIA suffering from Very mild to moderate NPDR (58.59%), IIB suffering from Severe to very severe NPDR (29.29%), and those suffering from Proliferative diabetic retinopathy were grouped as IIC (12.12%).A statistical significant association with severity of diabetic retinopathy and duaration of diabetes was observed. A statistically significant association between severity of diabetic retinopathy and HbA1c values was found (p < 0.001). A statistically significant association between grade of microalbuminuria and severity of diabetic retinopathy was observed (p < 0.001). On trivariate analysis of severity of diabetic retinopathy, HbA1C level and microalbuminuria grade, a statistically significant difference in prevalence of diabetic retinopathy in different HbA1c levels with microalbuminuria Grade 0 was found (p < 0.001). The difference in proportion of patients suffering from very mild to moderate diabrtic retinopathy with duration of diabetes was found to be statistically significant (p < 0.001) in grade I microalbuminuria. Difference in proportion of patients suffering from diabetic retinopathy with duration of diabetes was found to be statistically significant in grade II microalbuminuria (p < 0.001). In grade III microalbuminuria, this difference was not found to be statistically significant (p = 0.093). CONCLUSION: Microalbuminuria poses a risk for diabetic retinopathy which is affected by duration of diabetes and level of glycemic control. Microalbuminuria of higher grades is a strong predictor for occurrence and severity of diabetic retinopathy.