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Ningpu Liu, Na Li, Xiufen Yang, Yu Deng, Hong Gu, Xuetao Ren, Jun Xu, Kai Ma; Diabetic self-management and its association with diabetic retinopathy in patients with type 2 diabetes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2430.
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To investigate the association of diabetic self-management with the risk of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus.
A total of 1100 patients with type 2 diabetes mellitus were recruited in the Desheng community of urban Beijing. All patients were surveyed using a standardized questionnaire and underwent detailed ophthalmic examination. Patients were classified into DR group or no diabetic retinopathy (NDR) group according to the ETDRS standard grading protocol. The overall levels of diabetes self-management were assessed and compare for the differences between DR and NDR groups.
In the study population, the prevalence of DR was 32.1%. Sixty-three percent (63.0%) of the patients had the glycated hemoglobin (HbA1C) level less than <7.0%. Majority of patients (85.4%) conducted a diet control, 77.3% had exercise, 56.0% monitored blood glucose regularly, 41.5% detected blood glucose more than three times a month, 40.8% detected HbA1C more than one time every six months, 71.7% had ophthalmologic examination after the diagnosis of diabetes mellitus, and 68.5% had mydriatic check-up. Increased risk of DR was associated with higher HbA1C levels of ≥7.0% (OR=3.23, 95%CI: 2.44-4.28), insulin therapy (OR=7.48, 95%CI: 4.48-12.76), lower obedience to diet control (OR=1.72, 95%CI: 1.22-2.43), no exercise (OR=1.42, 95%CI: 1.04-1.94), change of therapeutic protocol during the last five years (OR=1.78, 95%CI: 1.32-2.41), lower level of education (OR=1.9, 95%CI: 1.39-2.62), male gender (OR=1.41, 95%CI: 1.08-1.84), lower monthly income (OR=1.46, 95%CI: 1.12-1.91), and family history of diabetes (OR=1.62, 95%CI: 1.1~2.37). In the multifactor logistic regression model, male gender (OR=2.21,95%CI:1.57-3.11), lower level of education (OR=1.98,95%CI:1.33-2.94), lower monthly income (OR=1.66,95%CI:1.15-2.39), duration of diabetes more than 10 years (OR=2.46, 95%CI: 1.77-3.41), HbA1C ≥7.0% (OR=2.24, 95%CI: 1.64-3.07) and insulin therapy (OR=3.38, 95%CI: 2.38-4.8) were associated with higher risk of DR.
The prevalence of DR in the study population was 32.1%. Longer duration of diabetes, insulin therapy, higher HbA1C level, male gender, and lower level education are associated with higher risk of DR, suggesting that lower level of diabetic self-management increased the risk of DR.
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