Global Prevalence and Major Risk Factors of Diabetic Retinopathy

Abstract

OBJECTIVETo examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes.RESEARCH DESIGN AND METHODSA pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20–79 years.RESULTSA total of 35 studies (1980–2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5–34.8) for any DR, 6.96% (6.87–7.04) for proliferative DR, 6.81% (6.74–6.89) for diabetic macular edema, and 10.2% (10.1–10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A1c, and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes.CONCLUSIONSThere are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.

Effects of glucose-lowering agents on vascular outcomes in type 2 diabetes: A critical reappraisal

“…It has a major impact on the quality of life but also reduces life expectancy, especially when diabetic nephropathy is present [58]. All diabetic retinopathy end points (including proliferative retinopathy, macular edema, and vision-threatening retinopathy) increases with diabetes duration and poor glucose control (assessed by high HbA1c), although their prevalence is higher in people with T1DM compared with T2DM [59]. Diabetic nephropathy remains a major clinical burden [60].…”

Risk factors for development and progression of diabetic retinopathy in Dutch patients with type 1 diabetes mellitus

“…2012). Diabetic retinopathy (DR) is characterized by retinal microvascular damage, based on ischaemic changes and increased capillary permeability.…”

“…2004; Ding & Wong 2012; Yau et al. 2012). Risk of development and progression of DR is furthermore influenced by a number of non‐modifiable risk factors, such as duration of diabetes, pregnancy, puberty and population‐based diversity (Raymond et al.…”

Recent novel approaches to limit oxidative stress and inflammation in diabetic complications

“…Retinal vasculopathies are a major contributor to impaired vision, leading to blindness. Diabetic retinopathy (DR) creates a major health burden, affecting 93 million people globally 81. Approximately 25% of patients with T1D develop retinal vasculopathies after 5 years of diabetes, increasing to 60% after 10 years.…”

“…Patients with T2D often present with background retinopathy at the time of diagnosis. After 20 years of diabetes, more than 60% of patients will have DR 81. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR 81.…”