Abstract
Purpose :
To estimate the prevalence of diabetic retinopathy (DR) and macular edema and to assess the associated risk factors in patients with type 2 diabetes (T2DM) of short duration.
Methods :
We determined the prevalence of DR in patients age 18 years and older with T2DM of short duration (less than 5 years) from a comprehensive diabetes management program. T2DM was defined as fasting plasma glucose >7.8 mmol/l or 2-hr post load plasma glucose >11.1 mmol/l or previous medical diagnosis. Patients underwent a non-mydriatic fundus examination with a digital-fundus camera (DRS, centervue). Each eye was photographed 3 times (centered in the macula, centered in the optic disk, and temporal to the macula) with a field of view of 40ο × 45ο. DR and macular edema were classified according to the Scottish Diabetic Retinopathy Grading Scale.
Results :
Of 593 patients (311 women, 223 men; mean age 51.4 years, s.d. 10.4; mean T2DM duration 2.2 years, s.d. 1.6), 85 patients had DR (34 [40%] unilateral and 51 [60%] bilateral) and 17 patients had macular edema (bilateral in all cases). Age-sex adjusted prevalence of DR was 14.2% (95%CI 11.4-17.5). Prevalence increased with T2DM duration: <1 year, 6.1% (95%CI 3.4-11.0); 1-2 years, 9.3% (95%CI 6.9-12.6); ≥3 years, 13.9% (95%CI 10.1-19.0) (p trend=0.02). Age-sex adjusted prevalence of macular edema was 2.0 (95%CI 1.0-4.0). Prevalence increased with T2DM duration: <1 year, 1.3% (95%CI 0.5-3.9); 1-2 years, 1.9% (95%CI 1.0-4.0); ≥3 years, 2.8% (95%CI 1.2-6.5) (p trend=0.05). In multiple logistic regression, after adjustment for age, sex, hypertension, and T2DM duration, the prevalence of DR was higher in men (OR=1.81, 95%CI 1.08-3.05, p=0.025), subjects with T2DM duration ≥1 year (OR=1.30, 95%CI 1.06-2.29, p=0.05), subjects with HbA1c≥7 (OR=1.11, 95%CI 1.05-1.23, p=0.038), and subjects with hypertension (OR=1.79 (95%CI 1.05-3.04, p=0.032). As for the prevalence of macular edema, it was higher in men (OR=5.20, 95%CI 1.38-19.6, p=0.015); and in subjects with hypertension (OR=5.52, 95%CI 1.47-20.8, p=0.012).
Conclusions :
Retinopathy may occur in early stages of diabetes, even in patients with impaired glucose tolerance who may have early retinopathy. A systematic screening should be carried out to identify retinal changes and treat the disease in its preclinical stage.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.