LBODP058 Evaluation Of Factors Associated With The Development Of Diabetic Retinopathy Based On A Case-control Study

Abstract

Abstract Objectives Diabetic Retinopathy (DR) is a microvascular complication of diabetes mellitus (DM) and one of the leading causes of irreversible vision loss, particularly in the most productive age group. Several epidemiological studies have found that diabetics worldwide and in India have a high prevalence of DR. Risk estimation of various factors has been performed earlier however there is dearth of case control studies among the diabetics who developed DR and those who were unaffected. This study was planned to identify the sociodemographic, disease related and lifestyle related risk factors for development of DR among diabetics which could broadly be categorized under modifiable and non-modifiable factors. Findings from the study could help clinicians develop predictors and risk-based screening programs for early detection of DR. Material & Methods In this age and gender matched case control study, total 256 diabetes mellitus patients (96% type 2) were recruited equally in groups with diabetic retinopathy (DR) and without it. Diagnosis of DR was done by fundal examination as per the Early Treatment for Diabetic Retinopathy Study (ETDRS) standard. Adherence to diabetes medications was measured using four items in vernacular language adapted from the MMAS-4 (Morisky Medication Adherence Scale). Univariate and multivariate binary logistics regression was performed to find the independent risk (Odd's ratio) and modified Odd's ratio respectively. Results There was parity between cases and controls in terms of gender distribution and age. Mean age of DR and non-DR group was 63.7 ± 9.5 and 63.3 ± 10.4 years respectively. Independent risk factors for development of DR were presently on insulin therapy (OR=2.87,p=0. 0001), smoking (OR=1.92,p=0. 02), alcoholism(OR=2.62,p=0. 03), sedentary lifestyle(OR=2.72,p=0. 0008), non-adherence to diabetes medications (OR=14. 08,p=0. 0001), non-adherence to dietary advice (OR=4.41,p=0. 0001), presence of other microvascular complications (OR=3.79,p=0. 0001), dyslipidemia (OR=1.85,p=0. 02) and hypertension (OR=5.91,p=0. 0001). On multivariate logistics regression analysis, non-adherence to medicine (Exp(B)=7.89,p=0. 0001) and hypertension (Exp(B)=1.16,p=0. 0001) were predictors of development of DR . Type of occupation, education, socioeconomic status and type of diabetes did not have any correlation with development of DR among diabetics. Conclusion Diabetics under insulin therapy and with hypertension have a seriously increased risk of developing DR. Smoking, alcohol abuse, sedentary lifestyle, failure to take diabetes medications, and failure to follow dietary advice are independent risk factors for developing DR that can be modified through lifestyle changes in diabetics. DR should be monitored more closely in patients with other microvascular complications and dyslipidemia. Presentation: No date and time listed