Factors Influencing the Severity of Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus in Korea

Abstract

Background: To prevent the progression of diabetic retinopathy (DR), patients with Type 2 diabetes mellitus (T2DM) should take the lead in their health behaviors by understanding physiological indicators such as blood sugar, blood pressure, lipids, smoking cessation, and regular ophthalmologic examinations. The health provider's role is important in motivating diabetic retinopathy patients to practice healthy behaviors since they provide treatment information and feedback to the patient. Therefore, it is necessary to educate diabetic patients on their knowledge of diabetic mellitus (DM) to raise awareness of desirable health behaviors and to continue self-management through motivation with the support from family and health care providers. This is a descriptive survey research to identify whether patients’ knowledge about diabetes, family support, and health care provider's support for autonomy impacted the severity of diabetic retinopathy of patients with type 2 diabetes mellitus. Objectives/Significance: The aim of this study is to determine the effects of diabetic knowledge, family support, and health care provider's support for autonomy on the severity of diabetic retinopathy among diabetic patients and use this information as primary data for developing health behavior practice programs to prevent and manage diabetic retinopathy. Methodology: Cross-sectional data were collected in South Korea in 2019. Participants were 136 patients who had T2DM who attended an outpatient endocrinology clinic. A chi-square test and analysis of variance (ANOVA) were conducted using SPSS software (version 24.0), and Cronbach's coefficient was used to measure the reliability of each test. A linear multiple regression analysis was performed to determine the predictors of diabetic retinopathy. The scale for knowledge about diabetes had 26 items, the scale for family support had 12 items, and the scale for the severity of DR was classified according to the international clinical diabetic retinopathy severity measurement standards. Results: The comparisons of the severity of diabetic retinopathy depended on general and disease-related characteristics, and there was a statistically significant difference between DR and diabetic complications (t=4.07, p<.001). Significant correlations with SBP (r=.35 and p<.001), DBP (r=.37, p<.001), HbA1c (r=.29, p=.001), LDL- cholesterol (r=.18, p=.036), and triglyceride (r=.28, p=.001) were identified. Also, health care provider's support for autonomy was significantly correlated with the severity of DR (r=-.17, p=.048). As a result of analyzing the influence of independent variables on diabetic retinopathy, DBP (ß=.281, p=.018), DM complications (ß=.188, p=.024), and health care provider's support for autonomy (ß=- .207, p=.002) were found to affect the severity of diabetic retinopathy (F=5.725, p=.018). As a result of analyzing the influence of independent variables on diabetic retinopathy, DBP (ß=.281, p=.018), DM complications (ß=.188, p=.024), and healthcare provider's support for autonomy (ß=- .207, p=.002) were found to affect the severity of diabetic retinopathy (F=5.725, p=.018). The explanation power of this regression model was 29.6%, and it was statistically significant (F=5.725, p=.018).