Retinopathy and risk factors in diabetic patients from Al-Madinah Al-Munawarah in the Kingdom of Saudi Arabia

Abstract

BackgroundDiabetes mellitus is accompanied by chronic and dangerous microvascular changes affecting most body systems, especially the eye, leading to diabetic retinopathy. Diabetic retinopathy without appropriate management is emerging as one of the leading causes of blindness. Therefore, it is necessary to improve the early diagnosis of diabetic retinopathy, reduce the risk of blindness, and identify relevant risk factors.MethodsThis descriptive study was designed to estimate the prevalence of retinopathy and its staging in diabetic patients attending the diabetes clinic at King Fahd Hospital in Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia, from 2008 to 2010. Patients completed a questionnaire, underwent a full medical assessment carried out by the treating clinicians, and were examined for evidence of diabetic retinopathy using standard ophthalmic outpatient instruments.ResultsIn total, 690 randomly selected diabetic patients of mean age 46.10 ± 11.85 (range 16–88) years were included, comprising 395 men (57.2%) of mean age 46.50 ± 11.31 years and 295 women (42.8%) of mean age 45.55 ± 12.53 years. The mean duration of diabetes mellitus was 11.91 ± 7.92 years in the women and 14.42 ± 8.20 years in the men, and the mean total duration of known diabetes mellitus was 13.35 ± 8.17 years. Glycated hemoglobin was higher in men (8.53% ± 1.81%) than in women (7.73% ± 1.84%), and this difference was statistically significant (P ≤ 0.0001). Of the 690 diabetic patients, 249 (36.1%) had retinopathy. Mild nonproliferative diabetic retinopathy was present in 13.6% of patients, being of moderate grade in 8% and of severe grade in 8.1%. A further 6.4% had proliferative diabetic retinopathy.ConclusionRegular screening to detect diabetic retinopathy is strongly recommended because early detection has the best chance of preventing retinal complications.

The Impact of Expanding the Screening Interval for Diabetic Retinopathy in Primary Care Centers

“…Hypertension has a strong association with DR (P-value 0.0001), and this was well documented in most of the other studies [24,32,33,37,38]. Like other studies, smoking was not associated with DR (P-value 0.992) [5,9,11,24,39]. The relationship between dyslipidemia and nephropathy has been proven in this study and other studies in Saudi Arabia and worldwide [8,21,[25][26][27][28]40].…”

“…Although a positive correlation of obesity with DR has been found in some studies [3,9,24,[32][33][34], it was found to be protective in another studies [9)]. Controlling blood sugar is a protective factor [5,8,11,32,33,35], and this association was proven in this study. Glycemic level was controlled in only 2.6% of the DR cases, while 97.4% of the DR cases were uncontrolled and had HBA1C level >8.1 (P-value 0.005); the relative risk was 0.25 (95% CI 0.113-0.586).…”

“…The severe form is characterized by hemorrhages and microaneurysms in four quadrants, with venous beading in at least two quadrants and intraretinal microvascular abnormalities in at least one quadrant. Proliferative diabetic retinopathy (PDR) is characterized by neovascularization, preretinal hemorrhages, hemorrhage into the vitreous, traction retinal detachments or macular edema (ME) [5]. Diabetic retinopathy is considered a frequent and leading cause of blindness, especially among the most productive age group between 20 and 60 years of age, with approximate estimates for the prevalence of retinopathy and vision-threatening retinopathy at 40.3% and 8.2%, respectively (6).…”

“…In Saudi Arabia, nephropathy, neuropathy, insulin use, poor glycemic control, hypertension and male gender significantly increased the risk for diabetic retinopathy, while smoking, hyperlipidemia and obesity significantly were associated with reduced risk for diabetic retinopathy among Saudi type 2 diabetics [9]. Regular screening is the best method for the early detection of diabetic retinopathy and is strongly recommended since early detection has the best chance of preventing retinal complications and blindness [5,7,11,12]. In the primary care setting, patients should be referred by a healthcare professional to an ophthalmologist or an optometrist who should perform a comprehensive eye examination including a dilated fundoscopy.…”

Prevalence of Diabetes and Diabetic Retinopathy in a Brazilian Population

“…[1][2][3] Diabetes is the leading cause of blindness among the economically active. [4][5][6] The problem worsens in locations further from large urban centers, mainly due to a lack of information among people with diabetes regarding the possibility of developing DR and blindness.…”