Abstract
Purpose Diabetic retinopathy (DR) is the leading cause of vision loss among active adults in industrialized countries. We aimed to investigate the prevalence of diabetes mellitus (DM), DR and its different grades, in patients with DM in the Csongrád County, South-Eastern region, Hungary. Furthermore, we aimed to detect the risk factors for developing DR and the diabetology/ophthalmology screening patterns and frequencies, as well as the effect of socioeconomic status- (SES-) related factors on the health and behavior of DM patients. Methods A cross-sectional study was conducted on adults (>18 years) involving handheld fundus camera screening (Smartscope Pro Optomed, Finland) and image assessment using the Spectra DR software (Health Intelligence, England). Self-completed questionnaires on self-perceived health status (SPHS) and health behavior, as well as visual acuity, HbA1c level, type of DM, and attendance at healthcare services were also recorded. Results 787 participants with fundus camera images and full self-administered questionnaires were included in the study; 46.2% of the images were unassessable. T1D and T2D were present in 13.5% and 86.5% of the participants, respectively. Among the T1D and T2D patients, 25.0% and 33.5% had DR, respectively. The SES showed significant proportion differences in the T1D group. Lower education was associated with a lower DR rate compared to non-DR (7.7% vs. 40.5%), while bad/very bad perceived financial status was associated with significantly higher DR proportion compared to non-DR (63.6% vs. 22.2%). Neither the SPHS nor the health behavior showed a significant relationship with the disease for both DM groups. Mild nonproliferative retinopathy without maculopathy (R1M0) was detected in 6% and 23% of the T1D and T2D patients having DR, respectively; R1 with maculopathy (R1M1) was present in 82% and 66% of the T1D and T2D groups, respectively. Both moderate nonproliferative retinopathy with maculopathy (R2M1) and active proliferative retinopathy with maculopathy (R3M1) were detected in 6% and 7% of the T1D and T2D patients having DR, respectively. The level of HbA1c affected the attendance at the diabetology screening (HbA1c > 7% associated with >50% of all quarter-yearly attendance in DM patients, and with 10% of the diabetology screening nonattendance). Conclusion The prevalence of DM and DR in the studied population in Hungary followed the country trend, with a slightly higher sight-threatening DR than the previously reported national average. SES appears to affect the DR rate, in particular, for T1D. Although DR screening using handheld cameras seems to be simple and dynamic, much training and experience, as well as overcoming the issue of decreased optic clarity is needed to achieve a proper level of image assessability, and in particular, for use in future telemedicine or artificial intelligence screening programs.
Highlights
Diabetes mellitus (DM) is a major medical and societal challenge due to its rapid increase in global prevalence and devastating late complications [1, 2]
In 2016, 1.6 million deaths were directly attributed to DM, with more than half of them occurring in the lower- and middle-income countries
The aim of this study was to investigate the prevalence of diabetic retinopathy (DR) and its different grades in patients with DM in the Csongrád County—a South-Eastern region in Hungary, using for the first time in this country a handheld fundus camera (Smartscope Pro Optomed, Finland)
Summary
Diabetes mellitus (DM) is a major medical and societal challenge due to its rapid increase in global prevalence and devastating late complications [1, 2]. According to the WHO forecast, DM will be the seventh leading cause of death in 2030, while diabetic retinopathy (DR) will be the leading cause of vision loss among active adults in industrialized countries [4]. DR is the most common late complication of DM in people aged 20 to 64 years—the working-age population, and except for where effective screening programs have been implemented, it is the leading cause of blindness and reduced vision in this group in the developed world [5, 6]. In a study comparing data from 35 populations, the global prevalence of sightthreatening retinopathy (STR) was estimated at 10.2% for all DM patients [6]
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