Microalbuminuria and low hemoglobin as risk factors for the occurrence and increasing severity of diabetic retinopathy

Mohan, VK Ajoy; Nithyanandam, Suneetha; Idiculla, Jyothi

doi:10.4103/0301-4738.81029

Cited by 43 publications

(26 citation statements)

References 16 publications

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“…The duration of diabetes is regarded as a marker for long-term exposure to hyperglycemia. Therefore, longer duration of diabetes may contribute the prevalence of DR. Lower hemoglobin levels were an independent predictor for the occurrence and severity of DR in the previous studies [21,25]. There is no clear evidence for the mechanism underlying the association of anemia with DR.…”

Section: Discussionmentioning

confidence: 80%

Predictors for diabetic retinopathy in normoalbuminuric people with type 2 diabetes mellitus

Yoo

Ban

et al. 2012

Diabetol Metab Syndr

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BackgroundPrevious studies have reported that microalbuminuria is an independent risk factor for the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (DM). For this reason, the clinical significance of DR in normoalbuminuric type 2 DM patients may be overlooked. The aim of this study was to investigate the prevalence of DR and predictors for DR in normoalbuminuric patients with type 2 DM.MethodsA total 310 patients with type 2 DM and normoalbuminuria, who were referred to the Department of Ophthalmology for screening of DR were included in this study. DR was clinically graded according to the International Clinical Diabetic Retinopathy guidelines. The urinary albumin excretion rate (UAER) was assessed via 24-hour urine collection and measured by immunoturbidimetric assay. Normoalbuminuria was defined as a UAER < 20 μg/min in 2 out of 3 consecutive tests taken within 2–3 months.ResultsDR of any grade was present in 64/310 (20.7 %) patients. Mild non-proliferative diabetic retinopathy (NPDR) was most prevalent in patients with DR of any grade (36/64, 56 %). The duration of diabetes (OR 1.01, 95 % CI, 1.01 – 1.02, p < 0.001), hemoglobin levels (OR 0.73, 95 % CI, 0.59 – 0.91, p = 0.004) and a higher tertile of UAER (OR 4.04, 95 % CI, 1.71 – 9.57, p = 0.001) had independently significant association with DR. NPDR as well as PDR was more prevalent in patients with higher tertile of UAER compared with those with lower tertile of UAER (NPDR, p = 0.002 and PDR, p = 0.027, respectively).ConclusionsOur findings suggest that patients with normoalbuminuric type 2 DM also require close monitoring for the early detection of DR, especially if they have a higher UAER, longer duration of diabetes, or lower hemoglobin levels.

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Section: Discussionmentioning

confidence: 80%

Predictors for diabetic retinopathy in normoalbuminuric people with type 2 diabetes mellitus

Yoo

Ban

et al. 2012

Diabetol Metab Syndr

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“…Low hemoglobin has been described as an independent baseline risk factor in the EDTRS for the development of DME and severe visual loss [27]. Other studies have corroborated this finding [18] and have also found improvement in the DME status following correction of anemia [28-30]. Correction of anemia (and also supplementation of erythropoietin) was noted to decrease the effects of retinopathy with structural improvement, possibly through improved oxygenation of the macula [28].…”

Section: Discussionmentioning

confidence: 89%

Association of systemic and ocular risk factors with neurosensory retinal detachment in diabetic macular edema: a case–control study

et al. 2014

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BackgroundDiabetic macular edema (DME) with neurosensory retinal detachment (NSD) remains an important cause of visual loss in patients with diabetes. The aim of the study was to elucidate the association of systemic and ocular risk factors with NSD in DME.MethodsIn a retrospective case–control study, we reviewed clinical records of all the subjects with DME seen between January 2010 and December 2010. Cases and controls were selected based on optical coherence tomography and stereoscopic biomicroscopy review. NSD was defined as subfoveal fluid accumulation under detached retina with or without overlying foveal thickening. The association between the presence of NSD, blood pressure, lipid status and various other biochemical parameters was evaluated.ResultsGroup I (cases) included 37 eyes of 33 patients having DME with NSD and Group II (controls) included 30 eyes of 21 patients having DME without NSD. Patients ranged in age (mean ± SD) from 50 to 62 years (56.6 +/-6.78) for cases and from 51 to 65 years (58.4+/-7.84) for controls. The duration of diabetes ranged from 4 to 15 year (mean 9.45+/-6.08) among cases and 4 to 14 years (9.7+/-5.12) among controls. Significant risk factors for NSD were high values of systolic and diastolic blood pressure (p = 0.039 and 0.043 respectively).ConclusionHigh systolic and diastolic blood pressures are independent and significant risk factors for NSD in DME.

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“…In the MDRS 24-month cohort study, lower hemoglobin was associated with the presence of STDR at baseline (previously reported 14 ) but not with the progression of DR. Cross-sectional (but not cohort) studies have demonstrated an association between the presence of DR and anemia in India32, 33, 34 and China 35 . Potential confounders of the association between hemoglobin and retinopathy are socioeconomic and nutritional status and decreased erythropoietin production due to diabetic nephropathy.…”

Section: Discussionmentioning

confidence: 99%

First Prospective Cohort Study of Diabetic Retinopathy from Sub-Saharan Africa

et al. 2016

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PurposeTo describe the prevalence, incidence, and progression of retinopathy and to report associations with demographic, clinical, and biochemical variables in people with diabetes in Southern Malawi.DesignProspective cohort study.ParticipantsSubjects were systematically sampled from 2 primary care diabetes clinics.MethodsWe performed the first prospective cohort study of diabetic retinopathy from Sub-Saharan Africa over 24 months. Visual acuity, glycemic control, blood pressure, human immunodeficiency virus (HIV) status, urine albumin-to-creatinine ratio, hemoglobin, and lipids were assessed. Retinopathy was graded at an accredited reading center using modified Wisconsin grading of 4-field mydriatic photographs.Main Outcome MeasuresIncidence of sight-threatening retinopathy and progression of retinopathy by 2 steps on the Liverpool Diabetic Eye Study Scale.ResultsA total of 357 subjects were recruited to the 24-month cohort study. At baseline, 13.4% of subjects were HIV positive and 15.1% were anemic. The 2-year incidence of sight-threatening diabetic retinopathy (STDR) for subjects with level 10 (no retinopathy), level 20 (background), and level 30 (preproliferative) retinopathy at baseline was 2.7% (95% confidence interval [CI], 0.1–5.3), 27.3% (95% CI, 16.4–38.2), and 25.0% (95% CI, 0–67.4), respectively. In a multivariate logistic analysis, 2-step progression of diabetic retinopathy was associated with glycosylated hemoglobin (odds ratio [OR], 1.27; 95% CI, 1.12–1.45), baseline grade of retinopathy (OR, 1.39; 95% CI, 1.02–1.91), and HIV infection (OR, 0.16; 95% CI, 0.03–0.78). At 2 years, 17 subjects (5.8%) lost ≥15 letters.ConclusionsIncidence of STDR was approximately 3 times that reported in recent European studies. The negative association of HIV infection with retinopathy progression is a new finding.

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Microalbuminuria and low hemoglobin as risk factors for the occurrence and increasing severity of diabetic retinopathy

Cited by 43 publications

References 16 publications

Predictors for diabetic retinopathy in normoalbuminuric people with type 2 diabetes mellitus

Predictors for diabetic retinopathy in normoalbuminuric people with type 2 diabetes mellitus

Association of systemic and ocular risk factors with neurosensory retinal detachment in diabetic macular edema: a case–control study

First Prospective Cohort Study of Diabetic Retinopathy from Sub-Saharan Africa

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