Researchers study frequency of retinopathy in patients diagnosed with type 2 diabetes mellitus

According to researchers, diabetes mellitus (DM) is caused by higher levels of blood glucose due to the lack of production of insulin by the body, resistance to insulin, or both. (Image courtesy of Adobe Stock)

A team of researchers conducted a study to estimate the prevalence of type 2 diabetic retinopathy in participants.The most prevalent microvascular consequence of diabetes mellitus on the eye is diabetic retinopathy, which is also one of the leading reasons for poor vision in the working-age population.

According to a news release, the Department of Medicine at the Hayatabad Medical Complex in Peshawar performed a six-month cross-sectional study from May to November 2022.¹ A total of 196 patients with type 2 diabetes mellitus were included in the research.

In the study, participants’ ages ranged from 18 to 60 years with a mean age of 37.59 ± 10.21 years, with the majority of the patients (n=16) belonging to the fourth decade. Thirty-one individuals (15.81%) with clinically diagnosed type 2 diabetes mellitus had diabetic retinopathy, of which 12 (6.12%) were females and 19 (9.69%) were males. Among patients with diabetic retinopathy, glycated haemoglobin (HbA1C) was determined to be 9.4 ± 1.5, and among those with other types of retinopathy, background retinopathy was detected in 11 (5.61%) men and seven (3.57%) female patients.

The majority of diabetic retinopathy patients in the current study were older than 40 years and were primarily males. In newly diagnosed type 2 diabetes mellitus participants, retinopathy occurred in 15.81% of cases (n = 31), with background retinopathy accounting for the majority of cases (n = 18, 9.18%).

Introduction

According to researchers, diabetes mellitus (DM) is caused by higher levels of blood glucose due to the lack of production of insulin by the body, resistance to insulin, or both. Over 451 million people have diabetes globally, and according to the second National Diabetes Survey of Pakistan and the International Diabetes Federation, the prevalence of diabetes is over 26% in Pakistan. Significant socioeconomic transition is predicted to lead to an increase in the proportion of diabetes patients in the upcoming years^2-6.

Materials & Methods

A six-month cross-sectional study from May to November 2022 was carried out in the Department of Medicine, Hayatabad Medical Complex, Peshawar, after the approval by the Research Evaluation Unit, College of Physicians and Surgeons Pakistan (approval number: CPSP/REU/MED-2017-21-12822), permission by the hospital ethics council, and written informed consent from the participants.

The researchers noted that participants in the study were between the ages of 18 and 60 and had been diagnosed with type 2 DM. The research excluded patients who had retinal artery occlusion, hypertension, retinal vein occlusion, and sickle cell retinopathy. Values of 200 mg/dl or higher on two consecutive fasting blood sugar, randomized blood sugar, and glycosylated haemoglobin (HBA1c) tests are considered diagnostic conditions of type 2 diabetes, according to WHO criteria released in 1999 and revised in 2007⁷.

After treating the eye with 1% tropicamide eye drop, skilled optometrists used a 90-diopter Volk lens and slit lamp bio-microscope to determine the presence of DR. The three ophthalmologists who were double-masked for their observations inspected each eye. A professional ophthalmologist was contacted in cases of disagreement to arrive at a consensus diagnostic of DR.

Results

According to the news release, the study took six months to complete, from May to November 2022. A total of 196 patients who fulfilled the requirements were included. Ages ranged from 18 to 60; the bulk of patients (n=116) were mostly in their fourth decade and had a mean age of 37.59 ± 10.21 years. Of the patients, 63.26% were males (n=124) and 36.74% were females (n=72).

The study noted DR was seen in 31 (15.81%) participants with type 2 DM. Of these, 12 (6.12%) were females and 19 (9.69%) were males. Also, among the 31 patients who had DR, the majority (n = 14) were in the age group of 41-50 years, followed by the age groups of 51-60 years (n = 12) and 18-40 years (n = 5). The cohort gap was not statistically significant (p-value = 0.8459). Those with DR had an HbA1C (%) of 9.4 ± 1.5, whereas those without DR had 7.3±2.4.

Researchers also found background retinopathy was discovered in 11 patients (5.61%) who were males and seven (3.57%) who were females. Preproliferative and proliferative retinopathy was discovered in five and three (2.55%; 1.53%) males, respectively, and three and two (1.53%; 1.02%) females, respectively.

Moreover, the researchers found the most prevalent endocrine metabolic condition is DM. In the current research, DR was found in 31 (15.81%) patients with type 2 DM. There were 12 females (6.12%) and 19 males (9.69%) among them. HbA1C was found to be 9.4±1.5 in patients with DR. In participants with other types of retinopathy, background retinopathy was found in 11 (5.61%) males and 7 (3.57%) females.

The researchers noted they performed a prospective study among type 2 DM patients who had just received a diagnosis, and we discovered that 15.81% of the individuals had DR. In a study conducted in the southern regions of Pakistan, DR was present in 12% of recently diagnosed diabetic patients8. Corresponding to this, a study from India claimed that this number was 11.2%, while a study from the United Kingdom showed that the percentage of people with diagnosed retinopathy there was 18%.

According to researchers, these variances may result from racial diversity, gender disparities, and age-group presentations. This may be shown by contrasting our findings with those of a study done similarly in Abbottabad9. The frequency was determined to be 16% in that study, which had an average age of 47.12 ± 3.2 years and was predominately female, compared to an average age of 37.59 ± 10.21 years in the current study and a predominately male population. We discovered that background retinopathy made up the majority of cases (9.18%), followed by pre-proliferative (4.08%) and proliferative (2.55%). These findings are roughly equivalent to those of Hayat et al.¹⁰

HbA1C (%) in our research group was 9.4 ± 1.5, and the fasting plasma sugar value in the participants with DR was 219 ± 36.5. The degree of retinopathy is correlated with HbA1c levels and systolic blood pressure.

Limitations

The researchers noted the study was limited to patient examinations at the Hayatabad Medical Complex in Peshawar. Researchers only used consenting participants with the requisite data were included in the study. Patients with retinal artery occlusion, hypertension, retinal vein occlusion, and sickle cell retinopathy were precluded from the study. Due to the limited number of diabetic participants, it is conceivable that the estimation does not accurately reflect the prevalence of DR.

Conclusions

Researchers noted the majority of DR patients were over the age of 40 and were predominantly men. Participants with newly diagnosed type 2 DM exhibited DR in 31 cases (15.81%), with background retinopathy comprising the majority of cases (n=18; 9.18%).

References

1 Khan W, Aslam T (March 22, 2023) Frequency of Retinopathy in Patients 1 Newly Diagnosed With Type 2 Diabetes Mellitus. Cureus 15(3): e36513. doi:10.7759/cureus.36513

2 Kharroubi AT, Darwish HM: Diabetes mellitus: the epidemic of the century. World J Diabetes. 2015, 6:850-67. 10.4239/wjd.v6.i6.850

3 Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, Malanda B: IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018, 138:271-81. 10.1016/j.diabres.2018.02.023

4 Azeem S, Khan U, Liaquat A: The increasing rate of diabetes in Pakistan: a silent killer. Ann Med Surg (Lond). 2022, 79:103901. 10.1016/j.amsu.2022.103901

5 Basit A, Fawwad A, Qureshi H, Shera AS: Prevalence of diabetes, pre-diabetes and associated risk factors: second National Diabetes Survey of Pakistan (NDSP), 2016-2017. BMJ Open. 2018, 8:e020961. 10.1136/bmjopen-2017-020961

6 Bishu KG, Jenkins C, Yebyo HG, et al.: Diabetes in Ethiopia: a systematic review of prevalence, risk factors, complications, and cost. Obes Med. 2019, 15:100132. 10.1016/j.obmed.2019.100132

7 Khan A., Nangrejo KM, Abbasi AM, et al.: Determination of diabetic retinopathy prevalence and major risk factors among type 2 diabetic patients in Nawabshah district. JPUMHS. 2021, 11:82-7.

8 Wahab S, Mahmood N, Shaikh Z, Kazmi WH: Frequency of retinopathy in newly diagnosed type 2 diabetes patients. J Pak Med Assoc. 2008, 58:557-61.

9 Hayat AS, Khan AQ, Baloch GH, Sheikh N: Frequency and pattern of retinopathy in newly diagnosed type 2 diabetic patients at tertiary care settings in abbottabad. J Ayub Med Coll Abbottabad. 2012, 24:87-9.

10 Hayat AS, Khan AH, Baloch GH, Shaikh N : Frequency and pattern of retinopathy in newly diagnosed type 2 diabetic patients at tertiary care settings in Abbottabad. J Ayub Med Coll Abbottabad. 2012, 24:87-9.