Retinopathy among Chinese subjects with type 2 diabetes mellitus in Shanghai: A community-based follow-up study

A meta-analysis of prevalence of diabetic retinopathy in Asia

INTRODUCTION

Diabetic retinopathy (DR) is a common microvascular complication of diabetes. This review reports the prevalence of DR in Asia and guides healthcare provision in screening and treatment.

EVIDENCE ACQUISITION

Medline was searched for articles describing the prevalence of DR in Asia. Statistical analysis was performed using Freeman-Tukey double arcsine transformation and the DerSimonian and Laird model. The prevalence of DR was estimated according to the following subgroups: Economic status (high, middle, and low income), country, and ethnicity. The risk of bias of the articles was also assessed.

EVIDENCE SYNTHESIS

A total of 66 studies were included, and out of 2,599,857 patients with diabetes, 201,646 were diagnosed with DR. The overall prevalence of DR, non-proliferative DR (NPDR), proliferative DR (PDR) and maculopathy were recorded at 21.7% (CI: 19.1-24.6%), 19.9% (CI: 17.3-22.8%), 2.3% (CI: 1.6-3.4%) and 4.8% (CI: 3.5-6.7%) respectively. Low-income countries had the lowest prevalence of DR, NPDR, PDR and maculopathy compared to the middle- and high-income countries. Middle-income countries had the highest prevalence of DR (23.9%; CI: 19.4-29.2%), NPDR (21.1%; CI: 17.0-25.9%), moderate NPDR (7.9%; CI: 5.7-11.0%), PDR (3.0%; CI: 1.8-4.9%) and maculopathy (4.7%; CI: 3.0-7.4%), while high-income countries had the highest prevalence of mild (10.3%; CI: 4.2-23.2%) and severe NPDR (3.0%; CI: 1.0-8.4%).

CONCLUSIONS

One in five people with diabetes have diabetic retinopathy. It is imperative that public healthcare take heeds to heighten the screening program to provide all patients with diabetes equitable access to DR screening and ophthalmology services.

Prevalence and risk factors of diabetic retinopathy in patients with type 2 diabetes in Shanghai

AIM

To investigate the prevalence of diabetic retinopathy (DR) in residents of Shanghai and analyze the risk factors of DR.

METHODS

This study involved 7233 patients with diabetes in 2016. The demographic data of the participants were collected using a questionnaire survey. Physical examination, laboratory tests, and ophthalmological examinations were conducted. Two professional ophthalmologists diagnosed and graded DR by fundus examination and then combined the results with fundus images. The unconditional multivariate Logistic regression analysis was used to determine the risk factors.

RESULTS

In total, 6978 patients with type 2 diabetes in Shanghai with a mean age of 68.33±8.40y were recruited, including 2975 males (42.6%) and 4003 females (57.4%). Overall, 1184 patients were diagnosed with DR, with a prevalence rate of 16.97%. Regression analysis showed that duration of diabetes (OR 1.061, 95%CI 1.049-1.073), high systolic blood pressure (SBP; OR 1.071, 95%CI 1.037-1.106), increased glycosylated hemoglobin level (OR 1.234, 95%CI 1.162-1.311), high blood glucose level (OR 1.061, 95%CI 1.023-1.099), increased neutrophil-to-lymphocyte ratio (NLR; OR 1.132, 95%CI 1.053-1.217) and mean platelet volume (MPV; OR 1.077, 95%CI 1.016-1.142) were risk factors of DR. Conversely, hematocrit (HCT; OR 0.971, 95%CI 0.954-0.988) and mean corpuscular volume (MCV; OR 0.980, 95%CI 0.965-0.994) were protective factors.

CONCLUSION

The prevalence rate of DR in Shanghai is 16.97%. The duration of diabetes, high SBP, increased glycosylated hemoglobin, NLR, and MPV were determined as risk factors of DR.