Diabetic retinopathy among patients with type 2 diabetes mellitus at Moi Teaching and Referral Hospital, Eldoret, Kenya

Musawa MS, Karoney MJ, Kwobah CM, Oduor C, Owino C

Abstract


Background: Diabetic Retinopathy (DR) accounts for 5% of the 39 million causes of blindness occurring worldwide and is estimated to contribute 3% of blindness in Kenya. Dyslipidemia, poor control of sugar, hypertension and obesity increase the risk of DR in patients with diabetes. This study addresses the gap in information on the
magnitude of DR and its associated factors in patients with type 2 diabetes at Moi Teaching and Referral Hospital (MTRH).
Objectives: To determine the prevalence and severity of DR and its associated factors in patients with type 2 diabetes mellitus.
Methods: This cross sectional study was conducted amongst patients with type 2 diabetes mellitus in MTRH. Randomly selected participants underwent anthropometric, laboratory and visual acuity testing. Direct ophthalmoscopy was used to assess DR and macula edema. Grading of DR was done using international clinical diabetic retinopathy severity scale. A univariate and multivariate logistic regression model was used to assess associations of the variables with DR.
Results: Of the 329 participants enrolled, 187 (57%) were female with a mean age of 56.8 (10.99) years. One hundred and three (31%) had diabetic retinopathy and 39 (12%) had diabetic macula edema. Mild to moderate non proliferative diabetic retinopathy was the most prevalent grade at 79 (25%). One hundred and eighty four (56%) of participants had hypertension (133/80; IQR 120/70-150/89) mmHg and 158 (48%) had glycated
haemoglobin between 7-10%. The median for the other assessed factors were as follows: duration of diabetes 5 (9) years, total cholesterol 4.6 (1.3) mmol/l and low density lipoprotein 3.0 (1.5) mmol/l. Increase in duration of diabetes by 5 years {OR 2.02(95% CI 1.11-3.69); p 0.02}, glycated haemoglobin > 6.5% {OR 2.13(95% CI 1.02-4.42);
p 0.04}, systolic hypertension >160 mmHg {OR 1.02(95% CI 1.01-1.03); p 0.01} were associated with increased risk of diabetic retinopathy while male gender and body mass index did not. Only 15% of the participants in this study reported having had previous eye check-up.
Conclusion: A third of patients with type 2 diabetes on follow up at MTRH have DR. Systolic hypertension, increased duration of diabetes and high glycated haemoglobin were positively associated with increased risk of developing DR.
Key words: Diabetic retinopathy, Type 2 diabetes mellitus


Full Text:

PDF

References


Centre for Disease Control. Diabetes surveillance

system. National diabetes fact sheet. Atlanta,

Georgia. 2003; 302: 43-97.

International Diabetes Federation. Diabetes Atlas

rd Edition. 2006; 10: 5.

Ting DS, Cheung GC, Wong TY. Diabetic retinopathy:

global prevalence, major risk factors, screening

practices and public health challenges: a review. Clin

Exper Ophthalmol. 2016; 44(4):260-277.

Cheung N, Mitchell P, Wong TY. Diabetic retinopathy.

Lancet (London, Engl). 2010; 376(9735):124-136.

Ministry of Health National Strategic plan for eye

care in Kenya 2005-2010, Division of Ophthalmic

Services, Nairobi, Kenya 2005.

Lee R, Wong TY, Sabanayagam C. Epidemiology

of diabetic retinopathy, diabetic macular edema and

related vision loss. Eye Vision. 2015; 2:17.

Control TD, Group CTR. The effect of intensive

treatment of diabetes on the development and

progression of long-term complications in insulindependent

diabetes mellitus. New Engl J Med. 1993;

(14):977-986.

Mbanya JC, Sobngwi E. Diabetes in Africa. Diabetes

microvascular and macrovascular disease in Africa.

J Cardiovas Risk. 2003; 10(2):97-102.

Kohner EM, Aldington SJ, Stratton IM, et al. United

Kingdom Prospective Diabetes Study, 30: diabetic

retinopathy at diagnosis of non-insulin-dependent

diabetes mellitus and associated risk factors. Archives

Ophthalmol (Chicago, Ill.: 1960). 1998; 116(3):297-303.

Mathenge W, Bastawrous A, Peto T, et al. Prevalence

and correlates of diabetic retinopathy in a populationbased

survey of older people in Nakuru, Kenya.

Ophthalmic Epidemiol. 2014; 21(3):169-177.

Njambi L. Prevalence of diabetic retinopathy and

barriers to uptake of diabetic retinopathy screening

at Embu Provincial General Hospital, Central

Kenya. J Ophthalmol East Central South Afr. 2013;

(1):5-11.

Kariuki MM, Kollmann KHM, Adala HS. The

prevalence, pattern and associations of diabetic

retinopathy among black African diabetics attending the

medical diabetes clinic at the Kenyatta National Hospital.

MMed Dissertation, University of Nairobi. 1999.

Bertelsen G, Peto T, Lindekleiv H, et al. Tromso eye

study: prevalence and risk factors of diabetic retinopathy.

Acta ophthalmologica. 2013; 91(8):716-721.

Roy MS, Klein R, O’Colmain BJ, Klein BE, Moss SE,

Kempen JH. The prevalence of diabetic retinopathy

among adult type 1 diabetic persons in the United

States. Archives Ophthalmol (Chicago, Ill. : 1960).

; 122(4):546-551.

Rema M, Premkumar S, Anitha B, Deepa R, Pradeepa

R, Mohan V. Prevalence of diabetic retinopathy in

urban India: the Chennai Urban Rural Epidemiology

Study (CURES) eye study, I. Invest Ophthalmol

Visual Sci. 2005; 46(7):2328-2333.

Effect of intensive blood-glucose control with

metformin on complications in overweight patients

with type 2 diabetes (UKPDS 34). UK Prospective

Diabetes Study (UKPDS) Group. Lancet (London,

England). 1998; 352(9131):854-865.

Stratton IM, Cull CA, Adler AI, Matthews DR, Neil

HA, Holman RR. Additive effects of glycaemia and

blood pressure exposure on risk of complications in

type 2 diabetes: a prospective observational study

(UKPDS 75). Diabetologia. 2006; 49(8):1761-1769.

Klein R, Klein BE, Moss SE, Cruickshanks KJ.

The Wisconsin Epidemiologic Study of Diabetic

Retinopathy: XVII. The 14-year incidence and

progression of diabetic retinopathy and associated

risk factors in type 1 diabetes. Ophthalmology. 1998;

(10):1801-1815.

Ramachandran A, Snehalatha C, Vijay V, Viswanathan

M. Diabetic retinopathy at the time of diagnosis of

NIDDM in south Indian subjects. Diabetes Res Clin

Practice. 1996; 32(1-2):111-114.

Harris MI, Klein R, Welborn TA, Knuiman MW. Onset

of NIDDM occurs at least 4–7 years before clinical

diagnosis. Diabetes Care. 1992; 15(7):815-819.

Dowse G, Humphrey A, Collins V, et al. Prevalence

and risk factors for diabetic retinopathy in the

multiethnic population of Mauritius. Amer J

Epidemiol. 1998; 147(5):448-457.

Burgess P, MacCormick I, Harding S, Bastawrous A,

Beare N, Garner P. Epidemiology of diabetic retinopathy

and maculopathy in Africa: a systematic review. Diabetic

Med. 2013; 30(4):399-412.

Ding J, Wong TY. Current epidemiology of diabetic

retinopathy and diabetic macular edema. Current

Diab Republican J. 2012; 12(4): 346–354.

Salinero-Fort MA, San Andres-Rebollo FJ, de Burgos-

Lunar C, Arrieta-Blanco FJ, Gomez- Campelo P.

Four-year incidence of diabetic retinopathy in a

Spanish cohort. The Madrid diabetes study. Lancet.

;46: 376-384.


Refbacks

  • There are currently no refbacks.