Proportion of diabetic retinopathy and its risk factors

Proportion of diabetic retinopathy and its risk factors among type 2 diabetic patients attending eye outpatient department of BIRDEM Hospital Dr. Nadira Mehriban

INTRODUCTION �Diabetic retinopathy (DR) is one of the major micro vascular complications of diabetes and most significant cause of visual impairment and blindness, thereby reducing the quality of life. Diabetic retinopathy affects 1. 8 billion people, and represents 4. 8% of the world’s blindness. �Diabetic Retinopathy occurs both in type 1 and type 2 diabetes mellitus and has been shown that nearly all type 1 and 75 per cent of type 2 diabetes will develop Diabetic Retinopathy after 15 yr duration of diabetes as shown in earlier epidemiological studies

�The pathogenesis of DR is multi-factorial, but is primarily caused by the metabolic effects of chronic hyperglycemia. Chronic hyperglycemia is thought to be the primary cause of diabetic retinopathy. Many studies have demonstrated that duration of diabetes, chronic hyperglycemia, as well as hyperlipidemia and hypertension, contribute to the pathogenesis of DR

Study Objective �In this study we aim to estimate the proportion of DR among Type 2 DM patients and investigate the variety of risk factors, including years since DM diagnosis, Hb. A 1 c levels, the coexistence of hypertension, age and gender.

METHODOLOGY �Study Design � It was a cross sectional study. The subjects were selected on the availability of patients. � 3. 2 Study area: �The study was conducted at Eye OPD of BIRDEM Hospital, Dhaka, Bangladesh. BIRDEM is the tertiary level hospital and has specialized care system for diabetes, quite a significant number of patients with diabetes come to BIREDEM hospital from all over the country including Dhaka city.

� Target population � The target population of the study was all registered Diabetic patients of BIRDEM Hospital, who also attended at Eye OPD of BIRDEM Hospital, Dhaka. � 3. 4 Study period: � This study was carried out during the period of January 2015 to May 2015. � � 3. 5 Inclusive criteria � 1. Only the registered diabetic patients who were willing to participate in the study. � 2. Patients who attended the Eye OPD of the selected hospital. � 3. 6 Exclusion criteria: � Patients those who had mental, physical and social impairment. � Patient with serious co morbid disease (infection, stroke, myocardial infarction, major surgery, etc.

�Sampling Technique: �Purposive sampling technique was applied during data collection �Data collection Method �Data were collected by face to face interview with the use of questionnaire and hospital records (patients guide book).

�Data collection tools �Pretested semi-structured questionnaire comprising of three parts, socio-demographic factors, risk factors and health education factors and Hospital records (patients guide book) were used for data collection. Socio demographic, anthropometric, medical history, clinical and laboratory findings and treatment on diabetes are recorded systematically in this book developed by Diabetic Association of Bangladesh. A detailed history of disease onset & the illness were taken from this patient’s diabetic guide book. Diabetic retinopathy was diagnosed through a comprehensive eye examination - testing, with special emphasis on evaluation of the retina and macula like visual acuity test, refraction, pupil dilatation, fundoscopy

RESULT �A total of 129 diabetic patients were interviewed and mean age was 50. 16 with STd 12. 901

Table 1: Socio demographic characteristics of the respondent (n=129) Variable Frequency Percentage Age group <30 yrs 30 -40 yrs 40 -50 yrs 50 -60 yrs >60 yrs 6 28 35 31 29 4. 7 21. 7 27. 1 24. 0 22. 5 Sex Male female 63 66 48. 8 51. 2 Residential status Urban Rural 46 83 35. 7 64. 3

Distribution of the respondent by their family income ( n=129) 37. 2% 48 38. 8% 50 40 35 30 21. 7% 28 25 20 15 10 5 0 2. 3% 3

Distribution of the patient according to educational qualification (n=129) 35 34. 1% 28. 7% 22. 5% 30 25 14. 7% 20 15 10 5 0 Primary level Secondary level Degree and above Illiterate

Table 2: Clinical characteristics of respondent ( n=129) Variables Mean Standard Deviation BMI Of the patients 24. 27 5. 85 Fasting blood sugar 9. 10 4. 1 2 H after breakfast blood sugar 10. 99 3. 9 Blood pressure Systolic blood pressure 126. 74 16. 4 Diastolic blood pressure 81. 94 8. 5

Table 3: Diabetic related risk factors of the respondent ( n=129) Variables Frequency Percentage Smoking history Yes no 37 92 28. 7 71. 3 9 74 33 13 7. 0 57. 4 25. 6 10. 1 70 59 54. 3 45. 7 BMI category Under weight (<18. 5) Normal ( 18. 5 -24. 9) Overweight 25 -30 Obese >30 Family history of diabetes Yes no

CONTD. Variables Frequency Percentage Duration of Diabetes < 10 yrs 10 -15 yrs >15 yrs 54 43 32 41. 9 33. 3 24. 8 Insulin use Yes no 99 30 76. 7 23. 3 Hb. A 1 C of the patients < 6. 0 >6. 0 51 78 39. 5 60. 5

CONTD…. Variables Frequency Percentage Urine for albumin Yes No 10 119 7. 8 92. 2 History of Hypertension Yes 69 no 60 Duration Hypertension <10 yrs >10 yrs 53. 5 46. 5 of 43 26 33. 3 20. 2

Variables Total cholesterol level High Normal TG level High Normal LDL level High Normal HDL Level High Normal Frequency Percentage 43 86 33. 3 66. 7 70 59 54. 3 45. 7 14 115 10. 9 89. 1 12 117 9. 3 90. 7

Distribution of respondent according to Hb. A 1 C ( n= 129) 39. 5% 51 HBA 1 C of the patients < 6. 0 60. 5%78 >6. 0

: Distribution of respondent according to prevalence of Diabetic Retinopathy (n=129) Diabetic Yes retinopathy 0% Diabetic Retinopathy No 81 62. 8% Yes 48 37. 2%

Table 5: Association between socio demographic characteristics and Diabetic related risk factors regarding Diabetic retinopathy (n=129) Variable Diabetic Retinopathy P Value* yes no Smoking history Yes no 21 27 16 65 . 004 BMI category Under weight(<18. 5) Normal(18. 5 -24. 9) Overweight 25 -30 Obese >30 2 25 10 11 7 49 23 2 . 002 Duration of diabetes < 10 yrs 10 -15 yrs >15 yrs 11 15 22 43 28 10 . 000 6 42 45 36 . 000 Hb. A 1 C < 6. 0 >6. 0

Vari Diabetic Retinopathy able Hypertension history Yes no Duration Hypertension <10 yrs >10 yrs yes no 37 11 32 49 . 000 18 19 25 7 . 012 32 16 11 70 . 000 39 9 31 50 . 000 of Total cholesterol level High Normal TG Level High Normal P Value*

�The prevalence of diabetic retinopathy in this study was found to be 37. 2 percent. Diabetic Retinopathy was found to be significantly associated with smoking history, BMI, duration of diabetes, Hb. AIC, history of hypertension, duration of hypertension and Total cholesterol level and TG (P<0. 05).

Conclusion �Diabetes Mellitus (DM) is considered to be a major health problem that is predicted to turn into a global epidemic. In developing countries, the number of people with diabetic gradually increasing day by day; as well as complication like diabetic retinopathy will continue to rise. Retinopathy is the potential sight threatening condition; it is a significant public health problem all over the world. Adequate treatment of the risk indicators might prevent and reduce the burden of these diseases and improve the quality of health care services.