Abstract
BackgroundAt present there are no large scale nationally-representative studies from Sri Lanka on the prevalence and associations of Diabetic Retinopathy (DR). The present study aims to evaluate the prevalence and risk factors for DR in a community-based nationally-representative sample of adults with self-reported diabetes mellitus from Sri Lanka.MethodsA cross-sectional community-based national study among 5,000 adults (≥18 years) was conducted in Sri Lanka, using a multi-stage stratified cluster sampling technique. An interviewer-administered questionnaire was used to collect data. Ophthalmological evaluation of patients with ‘known’ diabetes (previously diagnosed at a government hospital or by a registered medical practitioner) was done using indirect ophthalmoscopy. A binary-logistic regression analysis was performed with ‘presence of DR’ as the dichotomous dependent variable and other independent covariates.ResultsCrude prevalence of diabetes was 12.0% (n = 536), of which 344 were patients with ‘known’ diabetes. Mean age was 56.4 ± 10.9 years and 37.3% were males. Prevalence of any degree of DR was 27.4% (Males-30.5%, Females-25.6%; p = 0.41). In patients with DR, majority had NPDR (93.4%), while 5.3% had maculopathy. Patients with DR had a significantly longer duration of diabetes than those without. In the binary-logistic regression analysis in all adults duration of diabetes (OR:1.07), current smoking (OR:1.67) and peripheral neuropathy (OR:1.72) all were significantly associated with DR.ConclusionsNearly 1/3rd of Sri Lankan adults with self-reported diabetes are having retinopathy. DR was associated with diabetes duration, cigarette smoking and peripheral neuropathy. However, further prospective follow up studies are required to establish causality for identified risk factors.
Highlights
At present there are no large scale nationally-representative studies from Sri Lanka on the prevalence and associations of Diabetic Retinopathy (DR)
One hundred clusters were selected to represent the seven provinces and clusters were divided amongst the provinces using a probability-proportional to-size (PPS) technique based on the total population of each province
The results indicate that the duration of diabetes (OR: 1.07), current smoking (OR: 1.67) and peripheral neuropathy (OR: 1.72) all were associated with significantly increased risk of having DR (Table 3)
Summary
At present there are no large scale nationally-representative studies from Sri Lanka on the prevalence and associations of Diabetic Retinopathy (DR). The present study aims to evaluate the prevalence and risk factors for DR in a community-based nationally-representative sample of adults with self-reported diabetes mellitus from Sri Lanka. The majority of the current 382 million people with diabetes are aged between 40 and 59, and 80% of Diabetic Retinopathy (DR) is a common complication of diabetes mellitus It is one of the leading cause of blindness worldwide, often affecting working-aged adults [3]. The principal causes of visual impairment are uncorrected refractive errors (43%) and cataracts (33%), followed by glaucoma (2%), age related macular degeneration (1%) and diabetic retinopathy (1%) [4] It is characterized by signs of retinal ischemia and/or increased retinal vascular permeability, with loss of vision due to neo-vascularization, hemorrhage, retinal detachment, macular edema and/or retinal capillary non-perfusion [3]. Common risk factors for the development of DR include duration of diabetes, poor glycaemic control, elevated blood pressure, presence of diabetic nephropathy and dyslipidaemia [5,6]
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