A summary continuation analysis evaluating the prevalence and predictors of diabetic retinopathy in newly diagnosed type 2 diabetic patients.

Year : 2025 | Volume : 14 | Issue : 02 | Page : 21 30
    By

    Dipak Paudel,

  • Tshetiz Dahal,

  1. Consultant Physician, Department of Internal Medicine Civil Service Hospital, Kathmandu, Nepal
  2. General Physician, General Physician, Clinical Researcher, Lugansk State Medical University, Ukraine

Abstract

Context: Diabetic retinopathy (DR), the leading cause of acquired blindness in adults, affects approximately 93 million people globally. It is a serious complication of type 2 diabetes, resulting from prolonged damage to the blood vessels in the retina. Although largely preventable and treatable, DR continues to be the main cause of vision loss among working-age adults and significantly impacts quality of life. While most studies on DR in Nepal have focused on its prevalence through cross-sectional methods, this study aimed to assess the incidence of DR and explore the risk factors associated with its development in individuals with type 2 diabetes. Methods : Between January 5, 2023, and November 2024, a hospital-based retrospective follow-up study was conducted involving 420 individuals newly diagnosed with type 2 diabetes. Data from medical records were extracted, entered into Epi Info version 7.2.2.6, and subsequently analyzed using Stata 14. To identify factors associated with diabetic retinopathy, both bivariate and multivariable Cox proportional hazards models were applied. Variables with a p-value less than 0.05 in the multivariable Cox model were considered significant predictors of diabetic retinopathy. Results : A median survival duration of 30.4 months was associated with the development of diabetic retinopathy in 19.5% (95% CI: 16.2-23.8) of the study population. Diabetic retinopathy was found to be predicted by congestive heart failure [AHR: 2.53 (95% CI; 1.49, 4.29)], chronic renal disease [AHR: 5.02 (95% CI; 2.73, 9.26)], hypertension [AHR: 2.07 (95% CI; 1.17, 2.89)], and HBA1c [AHR: 10.5 (95% CI; 5.6, 19.6)]. Conclusion: In the study setting, the incidence of diabetic retinopathy among individuals with type 2 diabetes was notably high. Special care should be given to patients with heart failure, chronic kidney disease, elevated baseline blood pressure (over 140/90 mmHg), and high baseline HbA1c levels (≥ 7%).

Keywords: Diabetic retinopathy; Type 2 diabetes; Incidence; Risk factors; Cox proportional hazards model; HbA1c; Hypertension; Chronic kidney disease.

[This article belongs to Research and Reviews : A Journal of Medical Science and Technology ]

How to cite this article:
Dipak Paudel, Tshetiz Dahal. A summary continuation analysis evaluating the prevalence and predictors of diabetic retinopathy in newly diagnosed type 2 diabetic patients.. Research and Reviews : A Journal of Medical Science and Technology. 2025; 14(02):21-30.
How to cite this URL:
Dipak Paudel, Tshetiz Dahal. A summary continuation analysis evaluating the prevalence and predictors of diabetic retinopathy in newly diagnosed type 2 diabetic patients.. Research and Reviews : A Journal of Medical Science and Technology. 2025; 14(02):21-30. Available from: https://journals.stmjournals.com/rrjomst/article=2025/view=208742


References

  1. World Health Organization. WHO classification of diabetes mellitus, 2019. Geneva: World Health Organization; 2019.
  2. World Health Organization. Classification of diabetes mellitus. Geneva: World Health Organization; 2019.
  3. Ting DSW, Cheung GC, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol. 2016;44(4):260–77.
  4. International Diabetes Federation. IDF Diabetes Atlas, 10th ed. Brussels, Belgium: International Diabetes Federation; 2021.
  5. Yau JWY, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556–64.
  6. Sivaprasad S, Gupta B, Crosby-Nwaobi R, Evans J. Prevalence of diabetic retinopathy in various ethnic groups: a worldwide perspective. Surv Ophthalmol. 2012;57(4):347–70.
  7. Thapa R, Bajimaya S, Paudyal G, et al. Prevalence and risk factors of diabetic retinopathy among diabetic patients in tertiary care center in Nepal. Nepal J Ophthalmol. 2012;4(2):152–60.
  8. Sapkota YD, Pokharel GP, Nirmalan PK, et al. Prevalence of diabetic retinopathy in people with diabetes in Nepal: a hospital-based study. Nepal Med Coll J. 2008;10(3):160–3.
  9. Acharya P, Pathak R, Ghimire U, Shrestha S. Prevalence and determinants of diabetic retinopathy among patients with type 2 diabetes in Nepal: a hospital-based study. J Diabetes Res. 2020;2020:4689208.
  10. Flaxman SR, Bourne RRA, Resnikoff S, et al. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(12):e1221–34.
  11. Zhang X, Saaddine JB, Chou CF, et al. Prevalence of diabetic retinopathy in the United States, 2005–2008. JAMA. 2010;304(6):649–56.
  12. Raman R, Rani PK, Reddi Rachepalle S, et al. Prevalence of diabetic retinopathy in India: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study report 2. Ophthalmology. 2009;116(2):311–8.
  13. Rani PK, Raman R, Agarwal S, Paul PG, Uthra S, Gayathree R, Sharma T. Diabetic retinopathy screening model for rural population: a pilot project. Indian J Ophthalmol. 2005;53(1):45–8.
  14. Scanlon PH. The English National Screening Programme for diabetic retinopathy 2003–2016. Acta Diabetol. 2017;54(6):515–25.
  15. Mbanya JC, Sobngwi E. Diabetes microvascular and macrovascular disease in Africa. J Cardiovasc Risk. 2003;10(2):97–102.
  16. Gadkari SS, Maskati QB, Nayak BK. Prevalence of diabetic retinopathy in India: The All India Ophthalmological Society Diabetic Retinopathy Eye Screening Study 2014. Indian J Ophthalmol. 2016;64(1):38–44.
  17. Wilkinson CP, Ferris FL III, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110(9):1677–82.
  18. Zhang X, Beckles GL, Bullard KM, et al. Access to eye care and use of eye care services among visually impaired adults: United States, 2002. MMWR Morb Mortal Wkly Rep. 2004;53(17):375–8.Tseng ST, Chou ST, Low BH, Su FL. Risk factors associated with diabetic retinopathy onset and progression in diabetes patients: A Taiwanese cohort study. Int J Clin Exp Med. 2015;8(11):21507–15.
  19. Pezzullo L, Streatfeild J, Simkiss P, Shickle D. The economic impact of sight loss and blindness in the UK adult population. BMC Health Serv Res. 2018;18(1):63.
  20. Bunce C, Wormald R. Leading causes of certification for blindness and partial sight in England and Wales. BMC Public Health. 2006;6:58.
  21. Debele GR, Kanfe SG, Weldesenbet AB, Ayana GM, Jifar WW, Demissie BW, et al. Incidence of diabetic retinopathy and its predictors among newly diagnosed type 1 and type 2 diabetic patients: A retrospective follow-up study at a tertiary healthcare setting of Ethiopia. Diabetes Metab Syndr Obes. 2021;14:1305–13.
  22. World Health Organization. The use and interpretation of anthropometry: report of a WHO Expert Committee. Geneva: World Health Organization; 1995. (WHO Technical Report Series No. 854).
  23. International Agency for the Prevention of Blindness. Diabetic Retinopathy: A Silent Public Health Crisis. London: IAPB; 2020.
  24. Thapa R, Sapkota YD, Paudyal G, et al. Risk factors of diabetic retinopathy among patients attending a tertiary eye care center in Nepal. BMC Ophthalmol. 2013;13:9.
  25. Fenwick EK, Rees G, Pesudovs K, et al. Social and emotional impact of diabetic retinopathy: a review. Clin Exp Ophthalmol. 2012;40(1):27–38.
  26. Mwangi N, Macleod D, Tewari A, et al. Diabetic retinopathy screening in low- and middle-income countries: a review. Indian J Ophthalmol. 2021;69(11):3190–7.
  27. Gupta N, Mansoor S, Sharma A, et al. Diabetic retinopathy: A comprehensive update. Indian J Ophthalmol. 2020;68(4):563–83.
  28. Kandel RP, Thapa SS, Pant SR, et al. Prevalence of diabetic retinopathy in Nepalese population: a hospital-based study. Nepal J Ophthalmol. 2012;4(1):90–4.
  29. Rema M, Premkumar S, Anitha B, et al. Prevalence of diabetic retinopathy in urban India: The Chennai Urban Rural Epidemiology Study (CURES) Eye Study, I. Invest Ophthalmol Vis Sci. 2005;46(7):2328–33.
  30. Burgess PI, MacCormick IJC, Harding SP, et al. Epidemiology of diabetic retinopathy and maculopathy in Africa: A systematic review. Diabet Med. 2013;30(4):399–412.
  31. Rani PK, Raman R, Agarwal S, Paul PG, Uthra S, Sharma T. Incidence of sight-threatening diabetic retinopathy in India: A 3-year follow-up study. Eye (Lond). 2010;24(5):787–94.
  32. Looker HC, Nyangoma SO, Cromie DT, et al. Diabetic retinopathy at diagnosis of type 2 diabetes in Scotland. Diabetologia. 2012;55(9):2335–42.
  33. Sabanayagam C, Yip W, Ting DSW, et al. Ten-year incidence and progression of diabetic retinopathy: The Singapore Malay Eye Study. Ophthalmology. 2019;126(8):1187–94.
  34. Thomas RL, Halim S, Gurudas S, et al. IDF Diabetes Atlas: A review of studies estimating the prevalence of diabetic retinopathy. Diabetes Res Clin Pract. 2019;157:107840.
  35. Roy MS, Janal MN. High-density lipoprotein cholesterol and retinopathy in African Americans with type 1 diabetes: A 6-year follow-up study. Arch Ophthalmol. 2010;128(5):687–91.
Regular Issue Subscription Original Research
Volume 14
Issue 02
Received 07/04/2025
Accepted 08/04/2025
Published 25/04/2025
Publication Time 18 Days
249

Login


My IP

PlumX Metrics