Retinopathy among patients with diabetes in Ramallah Governorate: a clinic-based study

Abstract

BackgroundIn 2010, diabetes mellitus was the fourth cause of death in West Bank, causing 9% of deaths. Few reliable data on diabetes complications exist. We aimed to estimate prevalence of diabetic retinopathy and determinants in a clinic-based sample in Ramallah Governorate, West Bank. MethodsThe study was done in 11 clinics (four United Nations Relief and Works Agency [UNRWA], five Ministry of Health, two joint Ministry of Health and non-governmental organizations). It was approved by ethics committee at Institute of Community and Public Health (Birzeit University), Ministry of Health, and UNRWA and oral witnessed consent was obtained from patients. Patients with type 2 diabetes older than 25 years were identified in clinics or from clinic databases and were invited to participate in a slit lamp eye exam by a licensed ophthalmologist. Questionnaire, physical examination, and lab tests (glycated haemoglobin [HbA1c], lipid profile) were done. We classified retinopathy using International Clinical Diabetic Retinopathy Disease Severity Scale. Data were collected between Feb 28, 2012, and June 7, 2012, and analysed using the statistical package for social sciences (SPSS) version 22. FindingsMost eligible patients (517) consented to participate and were referred for eye exam; 376 (73%) underwent eye exam (127 men and 249 women). Mean age was 57·8 years (SD 9·0) and mean duration of diabetes was 8·9 years (SD 7·0). Only 21% (77) of patients had controlled diabetes (HbA1c<7%) and 37% (138) had never had an eye exam. The prevalence of retinopathy was 37% (138 patients, 52 [41%] men and 86 [35%] women). 26% (98) had mild-to-moderate non-proliferative retinopathy, 3% (11) had severe non-proliferative retinopathy, and 8% (29) had proliferative retinopathy. Multivariate regression showed that HbA1c, diabetes duration, and systolic blood pressure were associated with retinopathy (p<0·001). Patients with uncontrolled diabetes (HbA1c >7%) were four times more likely to have retinopathy compared with patients with controlled disease (odds ratio [OR] 4·16, 95% CI 1·76–9·85). Patients with diabetes duration more than 7 years were eight times more likely to have retinopathy than were patients whose diabetes duration was 7 years or less (OR 7·7, 95% CI 4·30–13·79). There was a 2% increase in risk of retinopathy per 1 mm Hg increase in systolic blood pressure (OR 1·02, 95% CI 1·01–1·04). InterpretationA third of patients with diabetes had retinopathy. Early regular screening might help early diagnosis and control of diabetic retinopathy, especially among high-risk patients (ie, those with uncontrolled diabetes, high systolic blood pressure, and long diabetes duration). FundingSwedish International Development Agency (SIDA); Umeå Centre for Global Health Research, Umeå University, Sweden.