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

Incidence of diabetic retinopathy and its predictors among adult patients with diabetes in Ethiopia: a frailty model

Background

Diabetic retinopathy (DR) is becoming a more widespread public concern worldwide, leading to visual impairments. It has become the leading cause of blindness among working-age adults globally, despite established treatments that can reduce the risk by 60%.

Objective

This study aimed to determine the incidence of diabetic retinopathy and its predictors among adult patients with diabetes in public hospitals in Central and Southern Ethiopia.

Methods

A hospital-based follow-up study was conducted in selected public hospitals in Central and Southern Ethiopia. A total of 376 participants of newly diagnosed adult diabetes were enrolled from 2015-2023 and the follow-up the date was from date of enrolment to the development of events. The data were collected by reviewing their records and entered in Epi-data version 4.6.0.2 and exported to STATA version 14 for analysis. Descriptive statistics of the variables were obtained. The Weibull model with gamma frailty distribution was fitted. Bivariable and multivariable analyses were done, and variables with a p-value less than 0.05 and a corresponding 95% confidence interval in the final model were used. The model of adequacy was checked.

Results

376 adult diabetic patient records were reviewed with the mean baseline age (± standard deviation) of 34.8±10 years. The univariate frailty was statistically significant (Theta=0.236 (0.131, 0.496)). A total of 376 adult patients with diabetes were followed for 682.894 person-years. Overall, an incidence rate of 14.06/100 person-years. Proteinuria (AHR = 2.21: 95% CI: 1.45, 3.57), cardiovascular disease (AHR = 2.23: 95% CI: 1.34, 4.03), and type II DM (AHR = 2.87: 95% CI: 1.30, 6.13) were identified as significant predictors of diabetic retinopathy.

Conclusion

Overall incidence rate of diabetic retinopathy was high. The most effective way to protect our vision from diabetic retinopathy is to manage diabetes effectively and offer support to high-risk individuals with diabetes. Therefore, healthcare professionals and relevant health authorities should target on addressing these factors in their initiatives to prevent diabetic retinopathy in diabetic patients.

Awareness and knowledge of diabetic retinopathy in diabetics and non-diabetics: A descriptive cross-sectional study

BACKGROUND AND AIMS

Early diagnosis and management of the ever-increasing global consequences of diabetes is of concern to all nations. The populations of developing countries in particular, account for about 75% of the estimated total number of those afflicted. The Middle East and North Africa Region have around 35.4 (24.3-47.4) million diabetics with a prevalence of around 10.5% in the Middle East. A high proportion of these are undiagnosed. The aim of this study was to assess the awareness of and knowledge about the ocular impacts of diabetes as diabetic retinopathy (DR) in Jordanians by comparing those with and those without diabetes.

METHODS

In this cross-sectional study, diabetic and non-diabetic patients attending different clinics at the National Center for Diabetes, Endocrinology and Genetics (NCDEG) were interviewed face-to-face using a questionnaire, to assess the level of knowledge about diabetic retinopathy (DR). The questionnaire was assessed beforehand by ophthalmologists from the School of Medicine, the University of Jordan, in Amman Results: A total of 214 subjects participated in this study (108 males:106 females). The mean age was 58.2 ± 10.6 years; (28 to 88 years) ~70% were diabetic. More than 98% were aware that diabetes can have ocular consequences. Only 17.3% however, had an adequate knowledge of DR. Around 40% did not know the treatment options although 75.7% of the diabetics carried out regular blood sugar checks in <6 months, and 73.4% had their last eye checkups in

CONCLUSIONS

The participants in this study had good awareness of DR but their knowledge of this ocular condition and treatment options is limited. Health-education programs and awareness campaigns should be initiated at health and eye care centers. Enrichment of social media and internet websites with evidence-based information by medical professionals are promising options for upgrading knowledge about this common global cause of blindness.

Collapse

Key Words

• Jordan
• awareness
• blindness
• complication
• diabetes
• diabetic retinopathy
• knowledge
• ocular consequences

Collapse

MESH Headings Collapse

Grants Collapse

Affiliation(s)

Diala Walid Abu-Hassan Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Amman, 11942 Jordan
Mona Freihat School of Medicine, The University of Jordan, Amman, 11942 Jordan Jordan University Hospital, Amman, 11942 Jordan
Ibraheem Saleh School of Medicine, The University of Jordan, Amman, 11942 Jordan Jordan University Hospital, Amman, 11942 Jordan
Iman Aolymat Department of Anatomy, Physiology and Biochemistry, Faculty of Medicine, The Hashemite University, Zarqa, 13133 Jordan
Manar Zraikat School of Medicine, The University of Jordan, Amman, 11942 Jordan
Muawyah Dawoud Al-Bdour School of Medicine, The University of Jordan, Amman, 11942 Jordan Jordan University Hospital, Amman, 11942 Jordan The National Centre for Diabetes, Endocrinology and Genetics, Amman, 11942 Jordan

Collapse

YAP1 overexpression aggravates the progress of diabetic retinopathy by activating the TUG1/miR-144-3p/VEGFA signaling pathway in the hypoxia-induced DR MRMECs model

Diabetic retinopathy (DR) has been proven to be a leading cause of blindness. This study aimed to investigate the effect of Yes-associated protein 1 (YAP1) on the hypoxia-induced DR mice retinal microvascular endothelial cells (MRMECs) model. The hypoxia-induced DR MRMECs model was generated by treating in hypoxia circumstance (5 % CO2 and 3 % O2) for 48 h. This study constructed YAP1 overexpression and taurine-upregulated gene 1 (TUG1) silencing lentiviral vectors, both of which were used to infect the DR MRMECs model. Quantitative real-time PCR (qRT-PCR) was used to amplify the YAP1, TUG1, vascular endothelial growth factor A (VEGFA), and miR-144-3p gene. Western blot was used to identify the expression of YAP1 and VEGFA. The CCK-8 assay was used to evaluate proliferation and the flow cytometry assay was used to determine apoptosis of MRMECs. Cell migration and tube formation were also evaluated. The results showed that YAP1 overexpression and TUG1 silencing lentivirus were successfully constructed. YAP1 overexpression significantly promoted, but TUG1 silence inhibited cell proliferation and migration compared to DR MRMECs model (P<0.05). YAP1 markedly promoted TUG1/VEGFA and reduced miR-144-3p gene transcription compared to those of the DR MRMECs model (P<0.05). YAP1 overexpression and TUG1 silence demonstrated the opposite effects on VEGFA expression. YAP1 overexpression obviously promoted tube formation of MRMECs. In conclusion, overexpression of YAP1 promoted cell proliferation, cell migration, TUG1 and VEGFA expression, and reduced the transcription of the miR-144-3p gene in DR MRMECs. Overexpression of YAP1 aggravated the progress of DR in MRMECs by activating the TUG1/miR-144-3p/VEGFA signaling pathway.

Incidence of diabetic retinopathy and predictors among adult patients with diabetes in central and southern Ethiopia: a multicentre retrospective cohort study

OBJECTIVES

This study aimed to determine the incidence of diabetic retinopathy (DR) and predictors among adult patients with diabetes in central and southern Ethiopia.

DESIGN

A hospital-based retrospective cohort study was conducted.

SETTING

The study was conducted in selected public hospitals in central and southern Ethiopia.

PARTICIPANTS

A total of 376 adult participants newly diagnosed with diabetes were enrolled from 2015 to 2023, and the follow-up date was from the date of enrolment to the development of events.

OUTCOME MEASURES

The data were collected by reviewing their records and entered in EpiData V.4.6.0.2 and exported to STATA V.14 for analysis. Descriptive statistics of the variables were obtained. The Cox proportional hazards assumption was checked. The Cox regression model was used to determine the median time to develop DR and identify predictors of DR. Bivariable and multivariable analyses were done; variables with a value of p<0.05 and a corresponding 95% CI in the final model were used. The model of adequacy was checked.

RESULTS

Records of a total of 376 adult patients with diabetes were reviewed with a mean baseline age (±SD) of 34.8±10 years. Of the total study participants, half (189, 50.3%) were female. A total of 376 adult patients with diabetes were followed for 45 752 person-months (PMs). Overall, the incidence rate was 11.7 per 1000 PMs of observation. Positive proteinuria (adjusted HR (AHR)=2.19; 95% CI 1.18 to 4.08), hypertension (HTN) (AHR=2.23; 95% CI 1.39 to 3.55) and type 2 diabetes mellitus (AHR=2.89; 95% CI 1.19 to 7.05) were independently significant predictors of DR.

CONCLUSION

The overall incidence rate of DR (type 1 and type 2) was high. Adult patients with diabetes with HTN, proteinuria and type of diabetes were independent predictors of DR. The best strategy to protect our eyesight from DR is to control high glucose level and giving due attention to high-risk individuals with diabetes. Thus, health professionals and concerned health authorities should target these factors in their efforts to prevent DR among diabetics.

Scoring and validation of a simple model for predicting diabetic retinopathy in patients with type 2 diabetes based on a meta-analysis approach of 21 cohorts

AIM

To develop and validate a model for predicting diabetic retinopathy (DR) in patients with type 2 diabetes.

METHODS

All risk factors with statistical significance in the DR prediction model were scored by their weights. Model performance was evaluated by the area under the receiver operating characteristic (ROC) curve, Kaplan-Meier curve, calibration curve and decision curve analysis. The prediction model was externally validated using a validation cohort from a Chinese hospital.

RESULTS

In this meta-analysis, 21 cohorts involving 184,737 patients with type 2 diabetes were examined. Sex, smoking, diabetes mellitus (DM) duration, albuminuria, glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and TG were identified to be statistically significant. Thus, they were all included in the model and scored according to their weights (maximum score: 35.0). The model was validated using an external cohort with median follow-up time of 32 months. At a critical value of 16.0, the AUC value, sensitivity and specificity of the validation cohort are 0.772 ((95% confidence interval (95%CI): 0.740-0.803), p < .01), 0.715 and 0.775, respectively. The calibration curve lied close to the ideal diagonal line. Furthermore, the decision curve analysis demonstrated that the model had notably higher net benefits. The external validation results proved the reliability of the risk prediction model.

CONCLUSIONS

The simple DR prediction model developed has good overall calibration and discrimination performance. It can be used as a simple tool to detect patients at high risk of DR.

Prevalence of diabetic retinopathy and its risk factors in rural patients with type 2 diabetes referring to Beijing Huairou Hospital, China

BACKGROUND

China has the largest population of diabetic patients worldwide. A diverse population and regional discrepancy in access to health care and diabetes management may lead to unique risk factors for diabetic retinopathy (DR) in different regions of China. This study aimed to evaluate the prevalence and risk factors of DR in rural patients with type 2 diabetes.

METHODS

This hospital-based cross-sectional study recruited a sample of 704 type 2 diabetic patients from rural areas referred to Beijing Huairou Hospital, China, from June 1, 2022, to June 1, 2023. The medical history, demographic information, and results of laboratory examinations of patients were collected and analyzed. The diagnosis of DR were performed by experienced ophthalmologists using mydriatic fundus photography.

RESULTS

Out of all patients, 53.8% were male and 46.2% were female. The mean age of patients and duration of diabetes were 54.9 ± 13.0 and 6.2 ± 4.5 years, respectively. The DR prevalence was 16.8%. The independent risk factors for DR in multivariate analysis were diabetes duration > 10 years (OR = 9.16, 95%CI = 5.49-15.30), fasting plasma glucose ≥ 7.2 mmol/L (OR = 3.25, 95%CI = 1.42-7.42), glycosylated hemoglobin ≥ 7% (OR = 6.49, 95%CI = 2.59-16.23), hypertension (OR = 1.59, 95%CI = 1.05-2.40), hyperlipidemia (OR = 2.16, 95%CI = 1.30-3.59), diabetic nephropathy (OR = 1.95, 95%CI = 1.17-3.23), high uric acid level (OR = 3.57, 95%CI = 1.56-8.15), high albumin to creatinine ratio (OR = 2.48, 95%CI = 1.06-5.82), and insulin treatment (OR = 1.79, 95%CI = 1.12-2.88).

CONCLUSIONS

This study evaluated the DR prevalence and its associated risk factors among type 2 diabetic patients from rural areas in Beijing's Huairou District, China. Paying attention to these risk factors may be useful in screening high-risk diabetic patients for DR and adopting early preventive and therapeutic interventions.

Diabetic retinopathy incidence, predictors and its association with longitudinal fasting blood sugar level changes among diabetes mellitus patients in Ethiopia: joint model

Background

Diabetes mellitus (DM) is a global public health problem characterized by an elevated blood glucose level. Monitoring blood sugar levels is vital for effective diabetes management and preventing complications. However, the association between longitudinal biomarkers and the incidence of diabetic complications is often overlooked. Therefore, this study aimed to assess the incidence of diabetic retinopathy, predictors, and association with longitudinal fasting blood sugar level changes among diabetes mellitus patients in Ethiopia.

Methods

A multicenter retrospective follow-up study was carried out in referral hospitals in Amhara region, Ethiopia. A random sample of 462 newly diagnosed DM patients was selected. The proportional hazard assumption was checked for the survival sub-model, and for the longitudinal sub-model, the normality assumption was checked. Then the joint modeling with time-dependent lagged parameterizations was fitted. Model assumptions and comparisons were checked. Finally, the hazard ratio with a 95% confidence interval (CI) with a corresponding P-value<0.05 was used to identify predictors.

Results

In this study, Overall, 54 patients developed DR, and the incidence rate was 2.33 per 1000 person-months over the follow-up period, with a 95% CI of [1.78, 3.05]. Rural residence (AHR = 2.21, 95% CI: [1.21, 4.05]), hypertension co-morbidity (AHR = 3.01, 95% CI: [1.85, 6.53]), and longer duration of DM (>5 years) (AHR = 2.28, 95% CI: [1.91, 5.15]) were important predictors for the incidence of DR. In addition, the incidence of DR was substantially correlated with the time-dependent lagged value of FBS change (AHR = 4.20, 95% CI [1.62, 10.85]).

Conclusions

In this study, the incidence of diabetic retinopathy was somewhat high when compared to prior similar studies in Ethiopia. A joint model of longitudinal fasting blood sugar level changes was significantly associated with an increased risk of DR. Besides, being rural residence, hypertension co-morbidity, and a longer duration of DM were significant predictors for the incidence of DR. Therefore, public awareness, an integrated care approach, and prioritizing glycemic control are highly recommended.

Genomic profile of diabetic retinopathy in a north indian cohort

BACKGROUND

Diabetic Retinopathy (DR) is one of the major microvascular complications of diabetes. Being a complex disease, it is important to delineate the genetic and environmental factors that influence the susceptibility to DR in a population. Therefore, the present study was designed to investigate the role of genetic and lifestyle risk factors associated with DR susceptibility in a North-Indian population.

METHODS

A total of 848 subjects were enrolled, comprising of DR cases (n = 414) and healthy controls (n = 434). The Sequenom MassARRAY technology was used to perform target genome analysis of 111 SNPs across 57 candidate genes and 14 intergenic region SNPs that are involved in the metabolic pathways associated with type 2 diabetes (T2D) and DR. Allele, genotype and haplotype frequencies were determined and compared among cases and controls. Logistic regression models were used to determine genotype-phenotype and phenotype-phenotype correlations.

RESULTS

The strongest association was observed with TCF7L2 rs12255372 T allele [p < 0.0001; odds ratio (OR) = 1.81 (1.44-2.27)] and rs11196205 C allele [p < 0.0008; OR = 1.62 (1.32-1.99)]. Genotype-phenotype and phenotype-phenotype correlations were found in the present study.

CONCLUSION

Our study provides strong evidence of association between the TCF7L2 variants and DR susceptibility.

Risk factor analysis and clinical decision tree model construction for diabetic retinopathy in Western China

BACKGROUND

Diabetic retinopathy (DR) is the driving force of blindness in patients with type 2 diabetes mellitus (T2DM). DR has a high prevalence and lacks effective therapeutic strategies, underscoring the need for early prevention and treatment. Yunnan province, located in the southwest plateau of China, has a high pre-valence of DR and an underdeveloped economy.

AIM

To build a clinical prediction model that will enable early prevention and treatment of DR.

METHODS

In this cross-sectional study, 1654 Han population with T2DM were divided into groups without (n = 826) and with DR (n = 828) based on fundus photography. The DR group was further subdivided into non-proliferative DR (n = 403) and proliferative DR (n = 425) groups. A univariate analysis and logistic regression analysis were conducted and a clinical decision tree model was constructed.

RESULTS

Diabetes duration ≥ 10 years, female sex, standing- or supine systolic blood pressure (SBP) ≥ 140 mmHg, and cholesterol ≥ 6.22 mmol/L were risk factors for DR in logistic regression analysis (odds ratio = 2.118, 1.520, 1.417, 1.881, and 1.591, respectively). A greater severity of chronic kidney disease (CKD) or hemoglobin A 1c increased the risk of DR in patients with T2DM. In the decision tree model, diabetes duration was the primary risk factor affecting the occurrence of DR in patients with T2DM, followed by CKD stage, supine SBP, standing SBP, and body mass index (BMI). DR classification outcomes were obtained by evaluating standing SBP or BMI according to the CKD stage for diabetes duration < 10 years and by evaluating CKD stage according to the supine SBP for diabetes duration ≥ 10 years.

CONCLUSION

Based on the simple and intuitive decision tree model constructed in this study, DR classification outcomes were easily obtained by evaluating diabetes duration, CKD stage, supine or standing SBP, and BMI.

Time to Diabetic Retinopathy and Its Risk Factors among Diabetes Mellitus Patients in Jimma University Medical Center, Jimma, Southwest Ethiopia

Background

Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the eye. Globally, diabetic retinopathy affects more than 103.12 million people. Diabetic retinopathy is among the leading causes of vision loss at the global level, including in Ethiopia. Therefore, the study aimed to assess the time to develop diabetic retinopathy and identify factors associated with diabetic retinopathy among diabetes patients.

Methods

A retrospective study was conducted from September 1, 2021 to January 30, 2022. Data was collected using semistructured questionnaire. The Cox proportional hazard model were used to determine the median time to develop diabetic retinopathy and identify predictors of diabetic retinopathy. Data was analyzed using R software.

Results

A total of 373 diabetes patients were included in this study. The prevalence of diabetic retinopathy was 41.3%. The median time was 41 months, ranging from 39 to 73 months. Elder age (HR=3.17, 95%CI: 1.53, 6.58), being male (HR=2.34, 95%CI: 1.35, 6.15), previous family history of diabetes (HR=4.16, 95%CI: 2.19, 8.37), longer duration of diabetes (HR=2.86, 95%CI: 1.41, 5.31) received only insulin therapy (HR=3.91, 95%CI: 1.36, 7.94), and high systolic blood pressure(HR=2.32; 95%CI: 1.12, 4.39) were statistically significant factors related to development of diabetes retinopathy.

Conclusions

More than half of diabetic patinets in this study were developed retinopathy diabetes within a few months of being diagnosed. As a result, we advocate that the best way to preserve our vision from diabetic retinopathy is to maintain our diabetes under control, and the high-risk population receive early screening for diabetes.

Awareness of Diabetic Retinopathy Among Patients With Type 2 Diabetes Attending the Outpatient Clinic in the General Hospital in Rabigh, Saudi Arabia: A Cross-Sectional Study

Introduction: Diabetic retinopathy (DR) is a common microvascular complication of type 2 diabetes (T2D) and a major cause of blindness. DR awareness is important for early identification and management in patients with T2D. This study aimed to estimate the level of awareness of DR and its risk factors among patients with T2D in Saudi Arabia.

Methods: We conducted a cross-sectional study to analyze data collected from 291 patients with T2D attending outpatient clinics in the General Hospital in Rabigh during 2020-2021. We collected demographic information and level of awareness about T2D and DR.

Results: Among 291 patients with T2D, 42.3% had T2D for more than five years, and 37.8% had T2D for two to five years. In our study population, 32.3% of participants obtained high school education, and 42.3% had moderate income. Over half of respondents (56.4%) had their last eye exam within the past year, and 68.4% of participants believed high blood glucose levels might cause vision problems. The mean ± standard deviation of the DR awareness score was 7.23 ± 2.74. Most participants had moderate level of awareness (39.5% of participants), 31.6% had good level of awareness, and 28.9% had poor level of awareness about T2D and DR. Participants without DR or who had DR for less than two years and those who had their eyes checked by a doctor last year had a significantly higher DR awareness level. 

Conclusion: We asked patients with T2D to assess their level of DR awareness. Most patients had moderate awareness levels, indicating a need for improved awareness of T2D complication on retina and treatment options. Patients should also be motivated for retinal screening to reduce the risk of visual complications. Furthermore, DR screening programs should not be limited to eye care centers. Improved awareness and access to screening programs will help patients and their healthcare providers achieve optimal outcomes in prevention of DR.

Incidence, progression and regression of diabetic retinopathy in a northeastern Chinese population

AIM

To determine the incidence, progression and regression of diabetic retinopathy (DR), with corresponding risk factors, in a northeastern Chinese population of patients with type 2 diabetes.

METHODS

Among 2006 patients who completed baseline examinations in 2012-2013 and underwent re-examination after a mean interval of 21.2 months, 1392 patients with gradable fundus photographs for both baseline and follow-up examinations were included. Incidence was defined as new development of any DR among patients without DR at baseline. An increase of ≥2 scales (concatenating Early Treatment Diabetic Retinopathy Study levels of both eyes) in eyes with DR at baseline was defined as progression, while a reduction of ≥2 scales was defined as regression.

RESULTS

The age- and sex-standardised incidence, progression and regression were 5.8% (95% CI 4.7% to 6.9%), 26.8% (95% CI 24.8% to 28.8%) and 10.0% (95% CI 8.6% to 11.3%), respectively. In addition to poor blood glucose control, wider central retinal venular equivalent was associated with both incidence (relative risk (RR) 2.17, 95% CI 1.09 to 4.32, for ≥250 µm vs <210 µm) and progression (RR 2.00, 95% CI 1.02 to 3.96, for ≥250 µm vs <210 µm). Patients without insulin therapy (RR 0.64, 95% CI 0.43 to 0.97) and patients with wider central retinal arteriolar equivalent (RR 1.14, 95% CI 1.02 to 1.26, per 10 µm increase) were likely to exhibit DR regression.

CONCLUSION

We determined the incidence, progression and regression of DR among northeastern Chinese patients with type 2 diabetes. Retinal vessel diameters, in addition to blood glucose level, influence the natural evolution of DR.

Tribbles homolog 3 contributes to high glucose-induced injury in retinal pigment epithelial cells via binding to growth factor receptor-bound 2

Diabetic retinopathy (DR) is the most typical complication of diabetes, which severely threatens sight. Tribbles homolog 3 (TRB3), a kind of pseudokinase, is discovered to be highly expressed in diabetes and retinas after retinal detachment. TRB3 expression in human retinal pigment epithelial (hRPE) cells exposed to different concentrations of glucose was tested by RT-qPCR and western blot. Then, cells were induced with 30 mM high glucose (HG) to establish a DR cell model. Following TRB3 knockdown, cell viability estimation employed CCK-8 assay. The mRNA levels of inflammatory factors were detected by RT-qPCR. Reactive oxygen species (ROS) level was measured by DCFH-DA assay, and levels of oxidative stress markers were evaluated applying corresponding kits. Cell apoptosis was assayed by TUNEL assay and western blot. Following, the growth factor receptor-bound 2 (GRB2) expression was also examined by RT-qPCR and western blot. The interaction between TRB3 and GRB2 was verified by Co-IP assay. After GRB2 was overexpressed in HG-induced hRPE cells transfected with shRNA-TRB3, functional experiments were conducted again. The results manifested that TRB3 expression was elevated under HG conditions. Deficiency of TRB3 enhanced the viability while alleviated inflammation, oxidative stress, and apoptosis in HG-induced hRPE cells. GRB2 was also increased in HG-exposed hRPE cells. Moreover, GRB2 had a strong affinity with TRB3 and positively regulated by TRB3. After GRB2 overexpression, the effects of TRB3 knockdown on HG-stimulated hRPE cells were all reversed. Briefly, this study confirmed the promoting role of TRB3/GRB2 axis in the progression of DR.

Joint modeling of time to diabetic retinopathy and change in fasting blood sugar among type 2 diabetic patients, Northwest Ethiopia

This study aimed to assess changes in fasting blood sugar (FBS) levels, time to diabetic retinopathy (DR) and its predictors among type 2 diabetes patients in Ethiopia. An institution-based retrospective follow-up study was conducted at the University of Gondar Comprehensive Specialized Hospital. The linear mixed effect model and Cox proportional hazard models were fitted separately, and later, the two models were fitted jointly using R software. Variables with a p value < 0.05 were considered significant predictors in the adjusted analysis. The incidence rate of DR was 2 per 100-person year of observation with a median follow-up time of 90.8 months (IQR 63.4). The current value and rate of change in FBS level were significant predictors of time to DR (AHR = 1.35; 95% CI 1.12-1.63) and (AHR = 1.70; 95% CI 1.21-2.39), respectively. Hypertension (AHR = 2.49; 95% CI 1.32-4.66), taking > 1 antidiabetic oral agent (AHR = 4.90; 95% CI 1.07-20.0) and more than 10 years duration (AHR = 0.17, 95% CI 0.06-0.46) were predictors of time to DR. This study revealed that the current value of FBS and the rate of FBS change were significantly associated with the time to DR.

Incidence and risk factors of severe non-proliferative/proliferative diabetic retinopathy: More than a decade follow up in the Tehran Lipids and Glucose Study

AIMS/INTRODUCTION

To examine the incidence rate of severe non-proliferative and proliferative diabetic retinopathy (severe-NPDR/PDR) and determine its potential risk factors.

MATERIALS AND METHODS

The study consisted of 1,169 participants (675 women) with type 2 diabetes mellitus, aged ≥20 years. A trained interviewer collected information about the history of pan-retinal photocoagulation as a result of diabetic retinopathy. Multivariable Cox proportional hazards regression models were applied.

RESULTS

We found 187 cases (126 women) of severe-NPDR/PDR during a median follow-up period of 12.7 years; the corresponding incidence rate was 13.6 per 1,000 person-years. Being overweight (hazard ratio [HR], 95% confidence interval [CI] 0.60, 0.39-0.92) and obese (HR 0.48, 95% CI 0.27-0.83) were associated with lower risk, whereas being smoker (HR 1.75, 95% CI 1.12-2.74), having fasting plasma glucose levels 7.22-10.0 mmol/L (HR 2.81, 95% CI 1.70-4.62), fasting plasma glucose ≥10 mmol/L (HR 5.87, 95% CI 3.67-9.41), taking glucose-lowering medications (HR 2.58, 95% CI 1.87-3.56), prehypertension status (HR 1.65, 95% CI 1.05-2.58) and newly diagnosed hypertension (HR 1.96, 95% CI 1.06-3.65) increased the risk of severe-NPDR/PDR. Among newly diagnosed diabetes patients, being male was associated with a 59% lower risk of severe-NPDR/PDR (HR 0.41, 95% CI 0.21-0.79). Furthermore, patients who had an intermediate level of education (6-12 years) had a higher risk of developing PDR (HR 1.86, 95% CI 1.05-3.30) compared with those who had <6 years of education.

CONCLUSIONS

Among Iranians with type 2 diabetes mellitus, 1.36% developed severe-NPDR/PDR annually. Normal bodyweight, being a smoker, out of target fasting plasma glucose level, prehypertension and newly diagnosed hypertension status were independent risk factors of severe-NPDR/PDR. Regarding the sight-threatening entity of advanced diabetic retinopathy, the multicomponent strategy to control diabetes, abstinence of smoking and tight control of blood pressure should be considered.

Awareness of diabetic retinopathy among diabetes mellitus patients visiting a hospital of North India

Context:

Diabetic retinopathy (DR) is a major cause of visual disability leading to irreversible blindness. Awareness of diabetes and its ocular co-morbidities may help in preventing vision loss.

Aim:

To assess the awareness of diabetic retinopathy among diabetic mellitus patients visiting a hospital in North India.

Setting and Design:

Cross-sectional study conducted at an outpatient clinic of ophthalmology department of a hospital.

Materials and Methods:

An interviewer-administered, pre-tested, semi-structured questionnaire was used to evaluate the awareness of DR for the period from July 2020 to January 2021.

Results:

A total of 272 patients with diabetes mellitus (44.4% females and 55.5% males) were included in the study. The mean age of the study population was 53.4 ± 10 years. Of the 272 patients, 79% were aware that diabetes can affect the eyes, and 69.5% knew that DR can lead to blindness. Regarding prevention and treatment of DR, 58.1% of patients were aware that good glycemic control prevents DR and 52.6% knew that DR can be treated. Physicians were the main source of information in 47.4% of patients. The participants were not compliant with a routine retinal assessment with only 26.5% of them having previous fundus examination for DR screening.

Conclusion:

Most of the participants were aware of DR but there existed major deficits in the knowledge and behavior of diabetic patients toward management of DR. There is a need to create awareness about DR and emphasize the importance of retinal screening to reduce visual disability caused by diabetes.

The Prevalence and Risk Factors of Diabetic Retinopathy: Screening and Prophylaxis Project in 6 Provinces of China

PURPOSE

To investigate the prevalence and associated factors of diabetic retinopathy (DR) and advanced DR in Chinese adults with diabetes mellitus (DM).

PATIENTS AND METHODS

A cross-sectional study was performed on 4831 diabetic patients from 24 hospitals from April 2018 to July 2020. Non-mydriatic fundus of patients were interpreted by an artificial intelligence (AI) system. Fundus photos that were unsuitable for AI interpretation were interpreted by two ophthalmologists trained by one expert ophthalmologist at Beijing Tongren Hospital. Medical history, height, weight, body mass index (BMI), glycosylated hemoglobin (HbA1c), blood pressure, and laboratory examinations were recorded.

RESULTS

A total of 4831 DM patients were included in this study. The prevalence of DR and advanced DR in the diabetic population was 31.8% and 6.6%, respectively. In multiple logistic regression analysis, male (odds ratio [OR], 1.39), duration of diabetes (OR, 1.05), HbA1c (OR, 1.11), farmer (OR, 1.39), insulin treatment (OR, 1.61), region (northern, OR, 1.78; rural, OR, 6.96), and presence of other diabetic complications (OR: 2.03) were associated with increased odds of DR. The factors associated with increased odds of advanced DR included poor glycemic control (HbA1c >7.0%) (OR, 2.58), insulin treatment (OR, 1.73), longer duration of diabetes (OR, 3.66), rural region (OR, 4.84), and presence of other diabetic complications (OR, 2.36), but overweight (BMI > 25 kg/m²) (OR, 0.61) was associated with reduced odds of advanced DR.

CONCLUSION

This study shows that the prevalence of DR is very high in Chinese adults with DM, highlighting the necessity of early diabetic retinal screening.

Incidence of Diabetic Retinopathy and Its Predictors Among Newly Diagnosed Type 1 and Type 2 Diabetic Patients: A Retrospective Follow-up Study at Tertiary Health-care Setting of Ethiopia

BACKGROUND

With an increasing number of diabetes patients in developing countries, the burden of diabetes-related blindness is undoubtedly posing a massive challenge to the sustainable health care system due to the cost of care. Despite this fact, to date, most of the epidemiological research on diabetic retinopathy (DR) in eastern Africa, including Ethiopia, has been limited to survey studies. Thus, we determined the incidence of retinopathy and its predictors among diabetic patients in Jimma University Medical Center, Southwest Ethiopia.

METHODS

A retrospective follow-up study was conducted on 402 randomly selected diabetic patients of aged ≥15 years. A preliminary reviewed checklist was used to obtain information on the demographics, clinical and physiological attributes. Data were entered using EpiData version 4.6 and analyzed using Stata version 14. All variables at P-values less than 0.2 in bivariable analysis were exported to multivariable analysis. Multivariable accelerated failure time (AFT) regression analyses using Weibull distribution were used to examine the predictors of DR at a 5% level of significance.

RESULTS

Throughout a median follow-up period of 5.9 years, the cumulative incidence of DR was 20.15% (95%CI: 16.50-24.37) and the incidence rate was 36.9 per 1000 person years (PY) (95%CI: 29.7-45.9). Multivariable Weibull AFT regression analyses showed that type two diabetes mellitus (T2DM) (adjusted time ratio (ATR) 0.4095%CI: 0.20-0.78), hypertension (HTN) (ATR 0.54; 95%CI: [0.35, 0.82]), low high density lipoprotein cholesterol (HDL-C) (ATR 0.51; 95%CI: 0.36-0.73), and borderline high total cholesterol (TC) (ATR 0.63; 95%CI: 0.42-0.94) were a predictor of time to DR.

CONCLUSION

The overall incidence of DR among patients with diabetes mellitus was estimated to be 20.15% and is becoming a public health burden in Ethiopia. Our results indicate that T2DM, HTN, low HDL-C and borderline high TC independently predicts an increased incidence/decreased survival time of retinopathy among diabetes patients. The low HDL-C, HTN, and high TC are modifiable risk factors that should be managed along with diabetes.

A Cohort Study on Associations between Fundus/intraocular Pressure Abnormality and Medical Check-up Items

PURPOSE

To evaluate the associations between medical check-up items (MCI) for fundus and intraocular pressure abnormality (FIPA) diseases in the Department of Health Management Centre, the Fifth Affiliated Hospital of Sun Yat-sen University (DHMC-FHS).

PATIENTS AND METHODS

Individuals who visited DHMC-FHS and underwent MCI between June 2017 to May 2019 were included, 3237 subjects. A total of 356 participants were diagnosed as FIPA and enrolled. The general clinical characteristics were collected. Diseases for FIPA diagnosed included five cohort, high intraocular pressure, diabetic retinopathy, hypertension fundus arteriosclerosis, large eye cup, and high myopia fundus changes. Possible impact factors of MCI included blood routine, B-ultrasound, heart rate, hypertension, hyperlipidemia, standard vision, cerebral arteriosclerosis, body mass, arterial/carotid arteriosclerosis, etc. Further, the Pearson's correlation coefficients and logistic regression analyses were used to examine associations between MCI and FIPA.

RESULTS

The weighted study population who belonged to FIPA included 356 subjects. There were significant differences in age, IOP, habitual exercise, smoking, sleep duration (P˂0.05) between FIPA and without FIPA. And RBC, Hemoglobin, B-ultrasound abnormal event, heart rate, systolic pressure, diastolic pressure, TC, LDL-C, standard vision, cerebral arteriosclerosis, body mass index, carotid arteriosclerosis were positively correlated with high intraocular pressure, hypertension fundus arteriosclerosis and high myopia fundus changes (P < .05). Possible prognosis risk factors, higher IOP, habitual exercise and more frequent smoking affect FIPA prognosis significantly [Odds ratio (OR) = 0.53, P = .01; OR = 0.13, P = .03; OR = 0.83; P = .04, respectively].

CONCLUSION

Of FIPA participants, high intraocular pressure, hypertension fundus arteriosclerosis and high myopia fundus changes were shown a positive relationship with MCI. Control IOP, habitual exercise and less frequent smoking were regarded as positive associations with decreased FIPA. These findings could help us prevent and diagnose FIPA diseases in time via MCI.

Relationship between Clinical Features of Diabetic Retinopathy and Systemic Factors in Patients with Newly Diagnosed Type II Diabetes Mellitus

BACKGROUND

We investigated the relationship between clinical features of diabetic retinopathy (DR) and systemic factors in patients with newly diagnosed type II diabetes mellitus (T2DM).

METHODS

Retrospective review of newly diagnosed T2DM-patients who underwent complete ophthalmic examinations at the time of T2DM diagnosis were conducted. We reviewed DM related systemic factor data and investigated systemic factors related to the presence of DR at T2DM diagnosis. In DR patients, the relationship between DR severity and systemic factors was analyzed.

RESULTS

Of 380 patients, forty (10.53%) patients had DR at the initial ophthalmologic examination. Glycated hemoglobin (HbA_1C), fasting plasma glucose (FPG), urine albumin to creatinine ratio (UACR), and urine microalbumin level were significantly higher in DR patients than in patients without DR. In the multivariate logistic regression analysis, high HbA_1C was a significant risk factor for the presence of DR at new T2DM diagnosis (odds ratio, 2.372; P < 0.001). HbA_1C, FPG, UACR, and urine microalbumin level showed significantly positive correlations with DR severity .

CONCLUSION

In patients with newly diagnosed T2DM, 10.53% have DR at initial ophthalmologic examination and high HbA_1C, FPG, UACR and urine microalbumin levels. These factors are significantly positively correlated with DR severity. Therefore, more careful fundus examination is needed for newly diagnosed T2DM patients with high HbA_1C, FPG, UACR, and urine microalbumin levels.

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.

Health literacy and exercise-focused interventions on clinical measurements in Chinese diabetes patients: A cluster randomized controlled trial

BACKGROUND

The diabetes patients in China have low health literacy and low levels of physical activities which may result in the poor glycemic control and other clinical outcomes. This study is designed to evaluate the effectiveness of health literacy and exercise-focused interventions on clinical outcomes among Chinese patients with type 2 diabetes (T2DM).

METHODS

In this cluster randomized controlled trial, 799 T2DM patients with the most recent A1c ≥ 7·5% (58 mmol/mol, or fasting glucose level ≥10 mmol/L) were recruited from 35 clinics in 8 communities in Shanghai, China, and randomized into one standard care (control) arm and three intervention arms receiving interventions focused on health literacy, exercise or both. A1c (primary outcome), blood pressure and lipids (secondary outcomes) were measured at baseline, 3-, 6-, 12-months of intervention period and 12-months after completion of the interventions. This trial is registered with the International Standard RCT Number Register, number ISRCTN76130594.

FINDINGS

The three intervention groups had more reductions in A1c than the control group, with 0·90% reduction in the health literacy, 0·83% in the exercise and 0·54% in the comprehensive group at 12-months (p<0·001) and these improvements remained even after a 1-year follow-up period post intervention. The risk of suboptimal A1c (≥7·0% or 53 mmol/mol) was also significantly lower in three intervention groups than control group at each follow-up visit, with adjusted risk ratios (RR) ranging from 0.06 to 0.16. However, the control group has greater reductions in low-density lipoprotein (LDL) than the health literacy group from baseline to 12-months (β=0·55, p<0·0001) and from baseline to 24-months (β=0·62, p<0·0001). A higher risk of abnormal LDL was also observed for the health literacy group at 12-months [adjusted risk ratio (RR): 2·22, 95%CI: 1·11-4·44] and 24-months [adjusted risk ratio (RR): 2·37, 95%CI: 1·16-4·87] compared to the control group. No significant benefits in systolic blood pressure (SBP), diastolic blood pressure (DBP) and low-density lipoprotein (HDL) were observed from the interventions compared to the usual care.

INTERPRETATION

The health literacy and exercise interventions result in significant improvements in A1c. However, no significant benefits in blood pressure and lipids control were observed. These effective interventions may have potential of scaling up in China and other countries to help diabetes patients manage their blood glucose levels.

FUNDING

This Study was supported by the China Medical Board (CMB) Open Competition Project (No.13-159) and the Social Science Fund of China National Ministry of Education (No.14YJAZH092).

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

OBJECTIVE

To determine the incidence, progression, and regression rates of diabetic retinopathy (DR), as well as their associated factors, in Chinese type 2 diabetic patients.

METHODS

Diabetic patients who participated in a previous survey were recruited for a 1-year follow-up study. Nonmydriatic fundus photographs were acquired to assess the severity of DR as per the International Clinical Diabetic Retinopathy Disease Severity Scale (2002). Factors that potentially influence DR outcomes, including its incidence, progression, and regression, were identified via statistical analyses.

RESULTS

We initially recruited 2453 subjects, among whom 2331 were followed and included in the final analysis. The incidences of new and progressed (ie, ≥2 scale steps) DR were 10.6% and 6.1%, respectively. Moreover, 7.3% of patients with established DR at baseline experienced complete regression. Multivariate logistic regression analysis revealed that high glycosylated haemoglobin (HbA1c) (odds ratio [OR] = 1.50, P = .021) and hyperlipidaemia (OR = 1.46, P = .025) were independent predictors of DR development, high HbA1c (OR = 4.16, P = .027) and macroalbuminuria (OR = 5.60, P = .010) predicted DR progression, and low HbA1c (OR = 0.20, P = .001) and low triglyceride levels (OR = 0.34, P = .026) were associated with DR regression.

CONCLUSIONS

Albumin and HbA1c levels should be closely monitored as signs of progressive retinal damage in diabetic subjects. Optimized control of glucose and triglyceride levels is vital for reducing the incidence of DR or promoting its regression in afflicted patients.

Association of the Serum Total Cholesterol to Triglyceride Ratio with Diabetic Retinopathy in Chinese Patients with Type 2 Diabetes: A Community-Based Study

INTRODUCTION

The relationship of total cholesterol (TC) or triglyceride (TG) to diabetic retinopathy (DR) has proven difficult to determine. In addition, there is no report of any study of the correlation between the TC/TG ratio and DR. This study was therefore undertaken to investigate the relationship between the TC/TG ratio and DR in Chinese adults with type 2 diabetes mellitus.

METHODS

A community-based study was conducted from August to October 2014 in Fengyutan, Shenyang, China. DR was assessed based on the modified Airlie House classification of DR. Multivariable logistic regression models were used to evaluate the association between the TC/TG ratio and the presence of DR.

RESULTS

Among the 420 diabetic participants in the study (157 men; mean (SD) age 61.7 (10.0) years), 76 (18.1%) presented with DR. When the TC/TG ratio was analyzed categorically, participants with T2DM in tertile 2 (i.e., TC/TG 2.91-4.00) were more likely (OR 2.01; 95% CI 1.01-3.99) to suffer from DR than patients in tertile 1 (i.e., TC/TG < 2.91) in multivariable models. Similarly, participants in tertile 3 (TC/TG > 4.00) were more likely (OR 2.59; 95% CI 1.11-3.14; P = 0.011) to suffer from DR than patients in tertile 1. This association persisted when the TC/TG ratio was analyzed continuously (P = 0.014).

CONCLUSION

We found a novel positive association between TC/TG ratio and presence of DR in Chinese individuals with T2DM. Although longitudinal data are needed, this finding contributes to the accumulating evidence that a high TC/TG ratio may be implicated in DR.

Multivariable Logistic Regression And Back Propagation Artificial Neural Network To Predict Diabetic Retinopathy

BACKGROUND

Monitoring and prediction of diabetic retinopathy (DR) is necessary in patients with diabetes for early discovery and timely treatment of disease. We aimed to analyze the association between DR and biochemical and metabolic parameters, and develop a predictive model for DR.

METHODS

A total of 530 Chinese residents including 423 with type 2 diabetes (T2D) aged 18 years or older participated in this study. The association between DR and biochemical and metabolic parameters was analyzed by the univariate and multivariable logistic regression (MLR). According to the MLR results, we developed a back propagation artificial neural network (BP-ANN) model by selecting tan-sigmoid as the transfer function of the hidden layers nodes, and pure-line of the output layer nodes, with training goal of 0.5×10^-5.

RESULTS

There were 51 (9.6%) diabetic participants with DR. After univariate and MLR analysis, duration of diabetes, waist to hip ratio, HbA₁c and family history of diabetes were independently associated with the presence of DR (all P < 0.05). Based on these parameters, the area under the receiver operating characteristic (ROC) curve for the BP-ANN model was significantly higher than that by MLR (0.84 vs. 0.77, P < 0.001).

CONCLUSION

Our evaluation demonstrated the potential role of BP-ANN model to identify DR in screening practice. The presence of DR was well predictable using the proposed BP-ANN model based on four related parameters (duration of diabetes, waist to hip ratio, HbA₁c and family history of diabetes).

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, knowledge, and practices related to diabetic retinopathy among diabetic patients in primary healthcare centers at Riyadh, Saudi Arabia

Context

Diabetic retinopathy (DR) is a microvascular complication for diabetes mellitus (DM), with around 35% of diabetic patients developing some form of DR.

Aims

This study assessed the awareness toward DR, practice of regular eye examination, and DM control among diabetic patients.

Settings and Design

This was a cross-sectional study among diabetics at two primary healthcare centers in Riyadh, Saudi Arabia, who were selected by convenience sampling.

Methods and Materials

The questionnaire contained sections for demography, knowledge, attitude, and practice toward DR, and compliance to DM treatment. The association of awareness about retinopathy with demographics was compared.

Statistical Analysis Used

The association of awareness about retinopathy and education level with demographics and compliance with treatment were compared using Chi-square test.

Results

In total, 280 diabetic patients were included, 187 (67%) were males, mean age was 58.9 ± 10.1 years, and median duration of diabetes was 10 years. There was good awareness about DR, diabetes was well controlled in 170 (61%) patients, but less than half (45%) had their eyes checked within 1 year. Patients with education level of high school and above had higher awareness than those with no formal education (P < 0.001). Also, those with income level >10,000 SR had higher awareness than those with income ≤5,000 SR (P < 0.05).

Conclusion

There was high awareness among the diabetic patients regarding DR but annual check-up was done in less than half of the patients. Improvement is required for scheduling annual eye examinations for the early detection of DR.

Association between lipid accumulation product and diabetic retinopathy based on a community-based survey in Chinese with type 2 diabetes

Purpose: Abnormal levels of lipid accumulation product (LAP) have been associated with risk of cardiovascular disease and diabetes. However, it is not clear whether LAP index is associated with diabetic retinopathy (DR). We investigated the association between LAP index and DR in Chinese adults with diabetes. Patients and methods: We included 427 Chinese patients with type 2 diabetes aged 18-year over who participated in a community-based cross-sectional study in Shenyang. DR was addressed on retinal photographs graded using the modified Airlie House classification. LAP was defined as (waist circumference [cm]-65) × (triglycerides [mmol/L]) in men, and (waist circumference [cm]-58) × (triglycerides [mmol/L]) in women and analyzed continuously (per SD change) and categorically (quartile 1, <30; quartile 2, 30-50; and quartile 3, >50). Results: Prevalence of DR among the study population was 17.8%. The mean level of LAP was 52.96±44.01. Compared to quartile 1 level, both quartile 2 and 3 levels were associated with DR with multivariable odds ratio (95% CI) of 0.23 (0.12-0.46) and 0.27 (0.14-0.54), respectively. These associations persisted when LAP was analyzed continuously (0.57 [0.35-0.92]). Conclusion: Higher central lipid accumulation in Chinese diabetics is related to the lower risk of DR, suggesting that LAP may be useful for identifying type 2 diabetes mellitus patients who are at risk for DR.

Association of FokI, TaqI, BsmI and ApaI polymorphisms with diabetic retinopathy: a pooled analysis of case-control studies

Background

To assess synthetically the association between polymorphisms in the vitamin D receptor (VDR) gene (FokI, BsmI, ApaI, and TaqI) and diabetic retinopathy (DR).

Methods

Pubmed, Embase, ISI Web of Science, Google-scholar and CBMDisc, CNKI and Chongqing VIP databases were searched. A meta-analysis was performed.

Results

Six studies with 636 cases and 1,035 controls were included in this meta-analysis. The outcomes showed that the FokI polymorphism (F allele) of VDR gene had no statistical protective relationship with DR in overall studies. Interestingly, stratification analysis showed that the FokI polymorphism (Fallele) was significantly associated with decreased DR risk in the Chinese population, among included studies without publication bias, during a comparison analysis between normal subjects and DR patients, and among articles published after 2010. However, the TaqI, BsmI and ApaI polymorphisms of VDR gene had no significant association with the risk of DR.

Conclusion

This meta-analysis of case-control studies revealed that the VDR-FokI polymorphism (F allele) decreased the risk of DR in Chinese people, among included studies without publication bias, during a comparison analysis between normal subjects and DR patients, and among articles published after 2010. Further rigorous and prospective studies with large sample size are needed to confirm our findings.

Burden of diabetic retinopathy in mainland China: Protocol for an updated systematic review and meta-analysis of prevalence and risk factors to identify prevention policies

BACKGROUND

Diabetic retinopathy (DR) is the leading cause of vision loss in adults of working age. Although existing systematic reviews of the prevalence of DR for mainland China have been reported, but several studies have been newly reported. Further some potential factors for DR are still discrepant and inconclusive. The aim of current research is to identify relevant literature regarding the prevalence of DR and DR-related factors in mainland China. In addition, we will project the number of individuals affected with DR in mainland China in years 2030 and 2050.

METHODS

This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. To identify publications in English or Chinese languages on the prevalence of DR in mainland China, a comprehensive step-by-step search of the PubMed, Embase, Web of Science, VIP Chinese Periodical, and China National Knowledge Infrastructure (CNKI) databases will be performed. Two reviewers will independently review the studies for eligibility according to the predefined inclusion and exclusion criteria. The quality of the included studies will be evaluated according to the National Health Institute Quality Assessment tool and Quality Assessment Manual. A random-effect model (DerSimonian-Laird method) will be used for the meta-analysis. Heterogeneity and publication bias among studies will be estimated by the I statistic and Begg funnel plot, respectively.

RESULTS

This systematic review study will provide an evidence of prevalence, risk factors, and national burden for DR in mainland China.

CONCLUSION

The study will give an explicit evidence to provide preventative measures of DR.PROSPERO registration number: CRD42018094565.

Development of diabetic retinopathy after cataract surgery

This study explored whether cataract surgery precipitates diabetic retinopathy (DR) development in diabetic patients without previous DR. Patients with the diagnosis of type II diabetes but without DR were selected from the Longitudinal Health Insurance Database 2000. Patients who received cataract surgery between January 1, 2000, and December 31, 2010, were included in the case group, and the control group was matched to the case group by age, sex, and index year. The postoperative incidence rates of nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), and diabetic macular edema (DME) were the main outcomes studied and were adjusted by age, sex, comorbidities, and statin, fibrate, angiotensin-converting-enzyme inhibitor (ACEI), oral hypoglycemic agents (OHA), and insulin use. In our cohort, patients who had dyslipidemia and used statins were more likely to undergo cataract surgery. Among diabetic patients without previous DR, patients receiving cataract surgery had a higher risk of NDPR development (adjusted hazard ratio = 1.48, 95% confidence interval = 1.15–1.91). No statistical difference was observed in PDR or DME development between operative and nonoperative groups. In additional stratified analyses, female sex, older age, comorbidities, surgery within 5 years, statin, ACEI, OHA, and insulin use increased the risk of NPDR development. In an adjusted Cox regression model, cataract surgery, OHA and insulin use were found to be risk factors for NPDR development. Cataract surgery with complications increased post-operative risks for NPDR were even higher, and the significant influence from cataract surgery persisted 5 years after surgery.

Incidence of diabetes retinopathy and determinants of time to diabetes retinopathy among diabetes patients at Tikur Anbessa Hospital, Ethiopia: a retrospective follow up study

OBJECTIVE

Data regarding diabetes retinopathy and associated factors are currently lacking in Ethiopia. The study aims to determine the incidence and determinants of time to diabetes retinopathy among diabetes mellitus patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

RESULTS

The incidence of diabetes retinopathy is a rapidly growing burden of disease in Ethiopia. The incidence rate of diabetes retinopathy was 2.65 (95% CI 2. 54, 4.05) per 1000 person-years observation. Moreover, 70 (18.57%, 95% CI 14.63, 22.5) DM patients developed diabetes retinopathy. The median time was 74.07 months (with IQR 53.60, 89.88). Male sex (AHR = 1.94, 95% CI = 1.10, 3.39), type 2 DM (AHR = 4.01, 95% CI = 1.34, 12.00), creatinine (AHR = 2.59, 95% CI = 1.91, 3.52), borderline triglyceride (AHR = 2.87, 95% CI 1.33, 6.21) and high triglyceride levels (AHR = 2.59, 95% CI = 1.31, 4.97) were positively correlated factors to diabetes retinopathy occurrence. Multisectoral, population-based approaches are needed to reduce type 2 DM complications.

Prevalence and associated factors of diabetic retinopathy in Beijing, China: a cross-sectional study

OBJECTIVES

The study aimed to determine the exact risk factors for diabetic retinopathy (DR) in the Chinese population using a cohort of 17  985 individuals from Beijing, China.

DESIGN

Cross-sectional study.

SETTING

A hospital.

PARTICIPANTS

17  985 individuals from Beijing, China.

PRIMARY AND SECONDARY OUTCOME MEASURES

This was a cross-sectional study of permanent residents from the Changping area (Beijing, China) recruited from July 2010 to March 2011 and from March 2014 to February 2015 during a routine health examination at the Tongren Hospital of Beijing. Eye examinations were conducted by experienced ophthalmologists. Medical history, height, weight, body mass index (BMI) and blood pressure were recorded. Routine laboratory examinations were performed.

RESULTS

The prevalence of DR was 1.5% in the general study population and 8.1% among individuals with diabetes. Compared with the non-DR group, individuals in the DR group in the diabetes population had longer disease duration, higher systolic blood pressure (SBP), fasting plasma glucose (FPG) and uric acid (UA) (in men) and lower UA (in women) (all p<0.05). The multivariate analysis showed that disease duration (p<0.001), BMI (p=0.046), SBP (p=0.012), creatinine clearance rate (CCR) (p=0.014), UA (p=0.018) and FPG (p<0.001) were independently associated with DR in patients with diabetes.

CONCLUSION

The prevalence of DR was 8.1% among patients with diabetes. Disease duration, BMI, SBP, CCR, UA and FPG were independently associated with DR.

Geographic area-based rate as a novel indicator to enhance research and precision intervention for more effective HIV/AIDS control

Ending the HIV epidemic needs additional methods to better assess the incidence and prevalence of HIV infection. In this study, a new indicator - G-rate was developed for the evaluation of HIV epidemics across regions with regard to geographic area size. Different from the commonly used incidence and prevalence rates that assess the HIV epidemic with reference to population (termed as P rate in this study), G rate measures the number of new infections (incidence) or cases (prevalence) over a unit land area in one year. We demonstrated the utility of G rates using officially reported data on new HIV infections and persons living with HIV in the United States during 2000-2012. Findings of our analysis indicate that relative to P rates, G rates indicated a quicker increase in the HIV epidemic in the United States during the study period. In 2012, 4.6 persons were newly infected and 101.4 persons lived with HIV per 1000 km2 land area. The five states with both highest P prevalence rates and highest G prevalence rates were Florida, Maryland, New York, New Jersey and Washington DC, which included New Jersey ranked 8th by P rate and excluded Massachusetts ranked 5th by G rate. In conclusion, adding G rates extends the conventional measurement system that consists of case count and P rate. Combining G rates with P rates provides a new approach for information extraction to support precision intervention strategy toward the goal of creating an AIDS-Free Generation.

Prevalence of diabetic retinopathy among 13473 patients with diabetes mellitus in China: a cross-sectional epidemiological survey in six provinces

OBJECTIVE

To describe the prevalence and severity of diabetic retinopathy (DR) and sight-threatening DR (STDR) among Chinese adults with diabetes.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional epidemiological survey across Mainland China (N=13 473). Participants were diagnosed with diabetes mellitus by physicians and transferred to our screening clinics (1/3 from hospital patients, 1/3 from city residents, the other 1/3 from rural residents). 2 fundus photographs were taken of each eye with a colourful, non-mydriatic and non-stereoscopic camera and were graded according to the UK guidelines.

MAIN OUTCOMES AND MEASURES

The prevalence and severity of DR and STDR.

RESULTS

Of the 13 473 participants with diabetes participating in the study, 4591 had DR and 1769 had STDR, for an overall prevalence of 34.08% (95% CI 33.28% to 34.88%) and 13.13% (95% CI 12.56% to 13.70%), respectively. Among these, gradable photographs were available for 12 780 participants (94.86%). Participants who were aged >65 years were less likely to suffer from DR or STDR (p<0.001; age distribution). No gender-related differences were present (p>0.05). Participants with STDR suffered from more severe visual impairment compared with those without STDR (p<0.001). The prevalence of DR and STDR in the northern region was higher than in the southern region (p<0.001). The prevalence of DR was closely related to duration of disease (OR 2.63; 95% CI 2.42 to 2.86; p<0.001) and diabetes onset age (OR 0.38; 95% CI 0.35 to 0.41; p<0.001).

CONCLUSIONS

The prevalence of DR and STDR in Mainland China appeared a little high, and varied according to area. Non-proliferative DR was more common, but STDR needed prompt treatment, especially in economically less developed areas. This study highlights the necessity for DR screening and treatment in Mainland China.

Awareness of diabetic retinopathy among patients with type 2 diabetes mellitus in Jordan

BACKGROUND

Increasing the level of awareness of diabetic retinopathy among individuals with type 2 diabetes mellitus is considered an important factor for early diagnosis and management of diabetic retinopathy. The aim of this study was to evaluate awareness of diabetic retinopathy among a sample of type 2 diabetes mellitus patients in Jordan.

PATIENTS AND METHODS

The study period was from August to December 2015. The sample was selected randomly from patients with type 2 diabetes mellitus from the general population in three main cities of Jordan (Amman, Irbid, and Zarqa). A questionnaire was distributed to 237 participants with diabetes to assess their awareness and knowledge of diabetes and diabetic retinopathy. The questionnaire included questions to assess awareness about diabetic retinopathy, sources of knowledge about the disease, and patients' knowledge and compliance with available treatments and routine eye examinations. Patients were also questioned about the barriers that may interfere with early eye examination.

RESULTS

A total of 237 participants (107 [45.1%] females and 130 [54.9%] males) with type 2 diabetes were interviewed. Mean age±SD for the study population was 54.51±10.28 years. Of the study population, 88.2% were aware that diabetes can affect the eyes and 81% reported that diabetic retinopathy can lead to blindness. Higher level of patients' awareness of diabetic retinopathy was related to higher level of formal education (p<0.05). The main source of information about diabetic retinopathy as reported by 47.3% patients was general practitioners. Patients' compliance with diabetes management was relatively high; however, their compliance with routine retinal assessment was poor, with only a total of 29.5% of participants having had an eye examination in the previous year.

CONCLUSION

Awareness of the nature and consequences of diabetic retinopathy among patients with diabetes in Jordan is relatively high. However, patients' motivation to undergo retinal assessment was poor in the sample, thus hindering early diagnosis and management.

Association of genetic variants in the receptor for advanced glycation end products gene with diabetic retinopathy: A meta-analysis

BACKGROUND

Diabetic retinopathy (DR) is a major sight-threatening diabetic complication. Previous studies have examined the association of DR with multiple genetic variants in the receptor for advanced glycation end products (RAGE) gene, with inconsistent results.

OBJECTIVE

To perform a systematic literature search and conduct meta-analyses to examine the association of genetic variants in RAGE with DR.

DATA SOURCES

PubMed, Cochrane Library, Embase, Google Scholar, and HuGE.

STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS

Studies were on human subjects; the studies were case-control ones and included subjects who had DR and those who did not have DR; and the studies provided genotype data for genetic variants in RAGE, separately for subjects who had and did not have DR, or provided odds ratios (ORs) and the 95% confidence intervals (CIs), or provided sufficient data for the calculation of OR and the 95% CI.

STUDY APPRAISAL AND SYNTHESIS METHODS

We used OR as a measure of association, and used random-effects model in all the meta-analyses. Between-study heterogeneity was assessed using I, and publication bias was evaluated using Egger test.

RESULTS

A total of 13 studies met the eligibility criteria and were included in our analyses. We found that Gly82Ser was significantly associated with DR (OR = 2.40, 95% CI: 1.46-3.97; P = 0.001) using a recessive model. -374T/A also showed significant association with DR under a dominant model (OR = 1.21, 95% CI: 1.03-1.43; P = 0.023). We did not find a significant association of DR with other genetic variants in RAGE.

LIMITATIONS

The number of included studies is small for some genetic variants; duration of diabetes varied across studies; most studies were conducted in Asia; and it is not clear whether the observed association can be generalized to other ethnicities; and we could not control for other potential confounding factors.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

We found that Gly82Ser in RAGE showed significant association with DR. More studies with larger sample sizes that control for important risk factors, such as duration of diabetes, are needed to validate our findings.

Pterostilbene impact on retinal endothelial cells under high glucose environment

Diabetic retinopathy (DR) has complicated pathogenic factors. Studies showed that DR belongs to chronic inflammatory disease, and retinal endothelial cells oxidation by free radicals is one of its mechanisms. Pterostilbene, as the homologous derivative of resveratrol, has obvious antioxidant effect. Its influence on the DR has not been studied. This study intended to investigate the effect and mechanism of pterostilbene on human retinal endothelial cells (hRECs) under high glucose environment to illustrate pterostilbene impact on DR and provide basis for DR clinical treatment. hRECs cultured in high glucose environment were treated by 1.0 mmol/L pterostilbene. MTT assay was applied to test cell proliferation. ELISA was used to detect inflammatory factor TNF-α and IL-1β content. Real time PCR and Western blot were performed to examine NF-κB mRNA and protein expression. ROS and SOD activities were analyzed. Under high glucose environment, hRECs proliferation increased, TNF-α and IL-1β expression elevated, and NF-κB protein level upregulated significantly. On the other side, ROS production increased and SOD activity decreased obviously (P < 0.05). Pterostilbene can suppress hRECs over proliferation, decrease TNF-α and IL-1β, inhibit NF-κB protein expression, reduce ROS production, and increase SOD activity markedly compared with high glucose group (P < 0.05). Pterostilbene may delay DR progress through alleviating inflammation and antioxidation to suppress hRECs over proliferation.

Effect of miR-200b on retinal endothelial cell function under high glucose environment

As one of the important complications of diabetes, diabetic retinopathy (DR) presented high incidence worldwide. Hyperglycemia is an important promoting factor for DR occurrence and development. It can damage retinal endothelial cell, resulting in retinal structure and function disorder. Studies have shown that miR-200b may involve in regulating DR occurrence and development, but its specific function and mechanism have not been elucidated. This study aimed to investigate miR-200b effect and mechanism on human retinal endothelial cells (hRECs) under high glucose environment. hRECs were cultured under high glucose or normal environment. Real time PCR was applied to detect miR-200b expression. MiR-200b was transfected to hRECs and MTT was used to detect its effect on hRECs proliferation under high glucose environment. Real time PCR and Western blot were performed to determine VEGF and TGFβ1 expression in the retina endothelial cells. MiR-200b expression decreased significantly under high glucose environment, whereas hRECs proliferated obviously. Compared with normal control, VEGF and TGFβ1 mRNA and protein expression increased markedly (P < 0.05). After miR-200b transfection, miR-200b expression increased, while VEGF and TGFβ1 mRNA and protein expression decreased obviously. Compared with high glucose group, hRECs proliferation was inhibited (P < 0.05). MiR-200b can regulate RECs growth and proliferation by changing VEGF and TGFβ1 expression to delay DR.