Abstract
Purpose :
Whilst it is known that knowledge of diabetes, life style and self-help are important for the control of diabetes, a recent Cochrane review suggests that evidence demonstrating their influence on sight-threatening retinopathy (STR) has not been shown. We explored whether these non-clinical parameters were associated with STR in patients attending eye clinics in three tertiary care hospitals in India and Nepal.
Methods :
600 patients with type 2 diabetes were recruited from three hospitals (200 consecutive patients from Pokhara, Nepal, and 200 patients each from Chennai and Darjeeling, India). All three sites had similar referral pathways. Using a structured questionnaire we investigated various parameters including self-help (checking blood sugar, compliance to treatment), life style (exercise, smoking), awareness (does diabetes affect eyes?) and the frequency with which they had seek medical help due to uncontrolled diabetes (episodes of uncontrolled diabetes). Clinical parameters including HBA1c, blood pressure and levels of fasting blood sugar were obtained. Proliferative retinopathy and macular oedema were classified as Sight Threatening Diabetic Retinopathy (STDR). Univariate and multivariate logistic regression were performed with STR as dependent variable.
Results :
Univariate analysis showed that STR was associated significantly (p<0.05) with treatment type (insulin or not), age, duration and HbA1 levels. In addition, self-help, levels of physical activity, episodes of uncontrolled diabetes were also shown to be significant. Multiple regression retained treatment type, duration, HbA1c and episodes of uncontrolled diabetes as significant variables. The frequency for which they had to seek help was significantly associated with compliance and adherence to treatment. This was significant in patients who were on insulin, and for those who had longer duration of diabetes (>5 years).
Conclusions :
In addition to the well-known clinical parameters, poor control of diabetes as a result of inadequate self-help requiring frequent intervention is also associated with STR.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.