Factors Associated With Progression Of Diabetic Retinopathy, A Multi-Centric Study In Kuwait

Abstract

Background: Diabetic retinopathy (DR) is a progressive sight threatening diabetic complication. The prognosis seems to be related to largely modifiable risk factors. Objectives: The aim of the study was to identify factors that could be associated with progression of DR. among adult diabetic patients attending primary health care centers in Kuwait. Methods: The current study is a part of a larger multi-centric one that included 704 diabetic patients. A nested case-control study was used whereas all patients with proliferative diabetic retinopathy (PDR) (case group, n = 33) were compared with all other diabetic patients with non-proliferative diabetic retinopathy (NPDR) (control group, n = 183) to determine the associated factors with cases. A pre-designed questionnaire included socio-demographic, clinical data, laboratory investigations, in addition to health care characteristics and personal practice. Basically univariate analyses were followed by multiple logistic regression analysis. Results: Out of 704 diabetic patients participated in the study 216 were diagnosed as having DR with an overall 30.7% prevalence rate. Among 216 patients with DR, 33 were diagnosed as PDR (4.7%) and 183 were diagnosed as NPDR (26.0%). Of the personal factors examined, nationality was the only significant determinant of PDR (OR = 0.8, 95% CI: 0.71 – 0.9). Among clinical factors, patients with type 2 – insulin treated diabetes were more prone to have PDR as compared to type 1 (OR = 1.2, 95% CI: 1.1 – 1.4). Duration of diabetes > 20 years was a significant predictor of PDR (OR = 1.3, 95% CI: 1.1 – 1.5). Also, poor hyperglycemia and hypertension were significantly modifiable risk factors (OR = 1.2, 95% CI: 1.1 – 1.3) and (OR = 1.2, 95% CI: 1.1 – 1.4) respectively. Ex-smoking was significantly associated with PDR (OR = 8.3, 95% CI: 3.3 – 23.8). Conclusion: Hyperglycemia and hypertension are the strongest modifiable risk factor for PDR. Patients with longer duration of diabetes particularly those with type 2-insulin treated diabetes were more prone for PDR and should be regularly screened for DR. Keywords: Diabetic retinopathy - progression - associated factors