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Prevalence, risk factors and awareness of diabetic retinopathy among admitted diabetic patients at a tertiary level hospital in Kathmandu  [PDF]
Raba Thapa,Deepak Man Joshi,Aparna Rizyal,Nhukesh Maharjan,Rajesh Dhoj Joshi
Nepalese Journal of Ophthalmology , 2014, DOI: 10.3126/nepjoph.v6i1.10760
Abstract: Introduction: Diabetic retinopathy (DR) is one of the commonest causes of visual impairment and blindness in Nepal. Objectives: The study aims to explore the prevalence, risk factors and awareness of DR among admitted diabetic patients. Materials and methods: A non-interventional case series study was conducted among the inpatient diabetic cases referred for ophthalmic consultation. The patients’ detailed demographics, awareness on DR, concurrent systemic problems, and glycemic control status were recorded. DR was graded using the Early Treatment Diabetic Retinopathy Study Criteria. Main outcome measures: The prevalence, risk factors and awareness of diabetic retinopathy among the study participants was analyzed. Results: A total of 277 diabetic patients were enrolled in the study. The mean age was 62.25 ± 13.26 years. Only one-third (34.6 %) of the cases were admitted for sugar control and newly diagnosed cases comprised of 19.49 %. Nearly half of the cases (46.6 %) were not aware of diabetic retinopathy and dilated fundus evaluation was done for the first time in 44.4 %. DR was found in 38.26 % of the cases and was diagnosed in 13 % of the new cases. Almost four-fifths (78 %) of the diabetics had had the disease for a duration of 16 to 20 years. Clinically significant macular edema was found in 5.78 % and proliferative DR in 2.52 %. DR was significantly associated with the duration of diabetes (P value = 0.001) and concurrent hypertension (P value = 0.004). Conclusion: The prevalence of DR was 38 % among the admitted diabetic cases and the DR was significantly associated with the duration of diabetes and systemic hypertension. Almost half of the cases had been unaware of DR before referral. This emphasizes the importance of the collaboration of the physician and the ophthalmologist for an early DR detection. ? DOI: http://dx.doi.org/10.3126/nepjoph.v6i1.10760 ? Nepal J Ophthalmol 2014; 6 (2): 24-30
Prevalence of Diabetic Retinopathy among Diabetics: A Hospital Based Study at Ashraff Memorial Hospital, Kalmunai
Mohammed Muzammil Al-Ameen Rizath, Jayasiri Deshapriya Dias, Hameem Mohammed Ismy Mohammed, Mohamed Meerasahib Maroozathul Ilahi, Athambawa Mohamed Razmy
Open Access Library Journal (OALib Journal) , 2015, DOI: 10.4236/oalib.1102230
Abstract: Diabetic Retinopathy and diabetics are two highly associated severe diseases in human. This study assesses the risk of getting Diabetic Retinopathy among the Diabetic patients in the Kalmunai region. In this hospital based cross sectional study, all the diabetic patients who were attending to the diabetic clinic of the Ashraff memorial hospital from January 2014 to December 2014 were screened for Diabetic Retinopathy and their demographic details were recorded. Obtained information was analyzed for estimating the risk for Diabetic Retinopathy among the diabetic patients and it was estimated as 13.16%. No difference in risk of getting Diabetic Retinopathy was observed among different age group, educated level and gender. Risk of getting Diabetic Retinopathy increases with the increase of the duration suffered by the diabetic. The relative risk of getting Diabetic Retinopathy for patients with diabetic for more 12 years is 3.55 times greater compared to the fresh diabetic patients.
A pilot study on awareness of diabetic retinopathy among non-medical persons in South India. The challenge for eye care programmes in the region.  [cached]
Namperumalsamy Perumalsamy,Kim Ramasamy,Kaliaperumal Kumarasamy,Sekar Alagarsamy
Indian Journal of Ophthalmology , 2004,
Abstract: This study was conducted to determine awareness and practices relating to diabetic retinopathy among non-medical persons in a south Indian population. In this population-based cross-sectional study, trained social workers conducted face-to-face interviews using a semi-structured questionnaire with 200 randomly selected paramedical personnel and 204 persons randomly selected from the community. Responses were graded on a five-point scale. Over half of respondents were not aware of risk factors for diabetic retinopathy. Only one-fifth of paramedics and one-tenth of persons from the community were aware that uncontrolled diabetes was a risk factor for retinopathy. Over 75% of respondents were not aware of either laser or surgery as an intervention for retinopathy. Although 80% of respondents from the community felt that yearly eye examinations were essential, only 43.5% had ever visited an ophthalmologist. Nearly three-fourths of paramedical personnel did not have any material related to diabetes for health education. It is evident that considerable effort is required to improve awareness of diabetic retinopathy, and to translate this improved awareness to actual utilisation of services.
Demographics and awareness of diabetic retinopathy among diabetic patients attending the vitreo-retinal service at a tertiary eye care center in Nepal  [PDF]
R Thapa,G Paudyal,N Maharjan,PS Bernstein
Nepalese Journal of Ophthalmology , 2012, DOI: 10.3126/nepjoph.v4i1.5844
Abstract: Introduction: Diabetic retinopathy (DR) is one of the leading causes of blindness in Nepal. Objective: To investigate the demographic characteristics and awareness of diabetic retinopathy among new cases of diabetes mellitus (DM) attending the vitreo-retinal service of a tertiary eye care centre in Nepal. Materials and methods: A hospital-based, cross-sectional study including all consecutive new cases of DM was carried out. Detailed demographics of the subjects and their awareness of potential ocular problems from diabetes mellitus were noted. Results: A total of 210 patients with a mean age of 57 ± 10.4 years were included. Brahmins (34.8 %) and Newars (34.3 %) were the predominant ethnic groups. Housewives (38.6 %) and office workers (18.6 %) were the major groups affected. Two-fifths (37 %) of the cases were unaware of DR and its potential for blindness. Awareness was significantly higher among literate patients (P = 0.006). Fundus evaluation was done for the first time in 48.6 %, although almost four-fifths had a duration of diabetes of five years or more. DR was found in 78 % of the cases, with 16.7 % already at the proliferative stage and about 40 % exhibiting clinically significant diabetic macular edema. Conclusion: A lack of awareness of DR coupled with a high proportion of cases already at a sight-threatening stage of retinopathy at their first presentation reflects the need for improved awareness programs to reduce the burden of blindness from DR in Nepal. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5844 NEPJOPH 2012; 4(1): 10-16
The Prevalence of diabetic retinopathy andrisk factors among diabetic patients attending to Imam Khomeini hospital in Sari
L. Shafiepour,A. Ahmadzadeh,V. Shafiepour,A.R. Khalilian
Journal of Mazandaran University of Medical Sciences , 2006,
Abstract: Background and purpose: Diabetes is a common disease with opthialmic complications which leads to partial vision loss and blindness. Diabetic retinopathy is one of the main causes of blindness in the world and the most common new blindness among 20-74 years-old patients in Westem countries. Diagnosis of ophthalmic complications in diabetic patients is an important priority of the health system and the purpose of this study was to determine the prevalence of retinopathy and risk factors in diabetic patients attending to Imam Khomeini hospital in Sari.Materials and Methods: Five hundred and forty diabetic patients attending to diabetics center of Imam Khomeini hospital enrolled for this study. Medical history was taken and the patients undergone physical exam with blood pressure control, height and weight and BMI, Laboratory tests (HbA1C) including serum urea and keratinin and proteinuria and serum lipid. Standard ophthalmic exams including: visual acuity, intra ocular pressure, slit lamp exam, dilated pupils were examed by ophthalmologist and ETDRS grading was done. Data were analyzed using t-test, x2 , Mann Withney test and regression analysis. P value of < 0.05 was considered for significancy.Results: Five hundred and forty diabetic patients including 150 men and 390 women were studied. One hundred and eighty five patients 5 with type one diabetes and 180 with type two diabetes had diabetic retinopathy.Conclusion: The prevalence of diabetic retinopathy was 34.3%. There were significant differences in range of risk factors such as BMI, duration of diabetes, diabetic control, blood sugar control, level of HbA1C, serum urea and keratinin, proteinuria, blood pressure, level of serum lipid
Healthcare costs associated with progressive diabetic retinopathy among National Health Insurance enrollees in Taiwan, 2000-2004
Lin-Chung Woung, Ching-Yao Tsai, Hsin-Kai Chou, Ming-Tsu Tsai, Wei-Her Tsai, Pesus Chou, Shih-Tsuo Shen
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-136
Abstract: A retrospective cohort study was conducted with 4,988 medication-using diabetic retinopathy subjects ≥ 40 years of age under National Health Insurance Program coverage between 2000 and 2004. Study cohort subjects were recorded as having diabetic retinopathy according to ICD-9-CM codes. States of diabetic retinopathy were strategically divided into stable and progressive categories according to subjects' conditions at follow-up in 2004. Expenditures were calculated and compared for the years 2000 and 2004.During the 4-year follow-up (2000 through 2004), 4,116 subjects (82.5%) of 4,988 diabetic subjects were in the stable category, and 872 (17.5%) were in the progressive category. Average costs of those in the normal category increased by US $48 from US $1921 in 2000 to US $1969 in 2004 (p = 0.594), whereas costs for those progressing from normal to non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) increased by US $1760, from US $1566 in 2000 to US $3326 in 2004 (p < 0.001). The PDR category had the highest average costs at US $3632 in 2000. The NPDR-to-PDR category experienced the greatest increase in costs at US $3482, from US $2723 in 2000 to US $6204 in 2004 (p = 0.042), and the greatest percentage of increase at 2.3% (2.2% when adjusted by comparing to normal category).This large-scale longitudinal study provides evidence that increased healthcare costs are associated with progressive diabetic retinopathy among diabetic NHI enrollees in Taiwan.Diabetes mellitus is a common, chronic disease among adults, with a worldwide prevalence estimated at 4% in 1995 and projected to rise to 5.4% by the year 2025 [1]. In Taiwan, diabetes is one of the most common chronic diseases, with a prevalence rate among adults estimated at between 4.9 and 8.0% from 1985 to 1995 [2-4]. As a result, both the demand for and the costs of medical care for diabetic patients is increasing [5].Healthcare costs for diabetics are more than double the costs
Hyperreflective Intraretinal Spots in Diabetics without and with Nonproliferative Diabetic Retinopathy: An In Vivo Study Using Spectral Domain OCT  [PDF]
Stela Vujosevic,Silvia Bini,Giulia Midena,Marianna Berton,Elisabetta Pilotto,Edoardo Midena
Journal of Diabetes Research , 2013, DOI: 10.1155/2013/491835
Abstract: Purpose. To evaluate the presence of hyperreflective spots (HRS) in diabetic patients without clinically detectable retinopathy (no DR) or with nonproliferative mild to moderate retinopathy (DR) without macular edema, and compare the results to controls. Methods. 36 subjects were enrolled: 12 with no DR, 12 with DR, and 12 normal subjects who served as controls. All studied subjects underwent full ophthalmologic examination and spectral domain optical coherence tomography (SD-OCT). SD-OCT images were analyzed to measure and localize HRS. Each image was analyzed by two independent, masked examiners. Results. The number of HRS was significantly higher in both diabetics without and with retinopathy versus controls ( ) and in diabetics with retinopathy versus diabetics without retinopathy ( ). The HRS were mainly located in the inner retina layers (inner limiting membrane, ganglion cell layer, and inner nuclear layer). The intraobserver and interobserver agreement was almost perfect ( ). Conclusions. SD-OCT hyperreflective spots are present in diabetic eyes even when clinical retinopathy is undetectable. Their number increases with progressing retinopathy. Initially, HRS are mainly located in the inner retina, where the resident microglia is present. With progressing retinopathy, HRS reach the outer retinal layer. HRS may represent a surrogate of microglial activation in diabetic retina. 1. Introduction An increasing body of evidence suggests that retinal neurodegeneration and inflammation occur in human diabetes even before the development of clinical signs of diabetic retinopathy (DR) [1]. Retinal neural cell loss (neurodegeneration) has already been demonstrated in vivo (as thinning of retinal nerve fiber and ganglion cell layers), both in type 1 and 2 diabetes [2–7]. Retinal microglia activation has been recognized as the main responsible for the initial inflammatory response, even though the exact mechanism through which inflammatory cytokines are released remains poorly known [8]. Some experimental studies have shown that retinal inflammation occurring during the course of diabetes mellitus is a relatively early event and that it precedes both vascular dysfunction and neuronal degeneration [1, 8]. Joussen at al. demonstrated in animal models of diabetes mellitus that ICAM-1- and CD18-mediated leukocyte adhesion is increased in the retinal vasculature and accounts for many of the signature lesions of DR [1]. Ibrahim et al. demonstrated in rats that the accumulation of Amadori-glycated albumin (AGA) within the 8-week diabetic retina elicits microglial
Awareness of diabetic and hypertensive eye disease in public  [PDF]
Rajani Kadri
International Journal of Biological and Medical Research , 2011,
Abstract: : OBJECTIVE: To assess the level of awareness of diabetic and hypertensive eye diseases in public. METHOD: A total of 653 patients took part in the study. They were requested to answer an interview based questionnaire which included questions regarding awareness of diabetic and hypertensive eye diseases. RESULTS: A total of 653 patients took part in this study. Mean age of the patient was 53.4 years and 51.6% were males. 147(22.5%) of the patients were diabetics and 294(32.8%) of the patients were hypertensive. Awareness of diabetic retinopathy was found in 182(27.9%). Only 5.1 %( 33) patients were aware of hypertension related eye diseases. 435(66.5%) of the patients were advised by the physicians for eye check up. Awareness of treatment for diabetic retinopathy was seen in 59(9%) patient’s only.CONCLUSION: There is a great need for health education in this Indian population to increase the level of awareness and knowledge of systemic disease related eye problems. This will help in early detection and treatment of eye diseases and reducing visual morbidity.
Quality of Life among Saudi Diabetics  [PDF]
Fahad S. Al-Shehri
Journal of Diabetes Mellitus (JDM) , 2014, DOI: 10.4236/jdm.2014.43032
Abstract:

Aim of study: To assess QOL among Saudi diabetics and to identify the possible risk factors associated with lower QOL. Patients and Methods: This study comprised 400 diabetic patients attending the Diabetes Clinic at theUniversityDiabetesCenterinRiyadh. They were interviewed using the Audit of Diabetes Dependent QOL (ADDQOL). Results: Most diabetic patients (78.7%) had negative (i.e., unfavorable) ADDQOL scores. Diabetic patients' age, education and occupation were not significantly associated with their QOL. Female patients had significantly worse QOL than male patients (p = 0.026). Married patients had significantly worse QOL compared with non-married patients (p = 0.012). Patients with type 2 diabetes had significantly worse QOL than those with type 1 diabetes (p = 0.029). Duration of diabetes was not significant factors as regard their QOL, with the worst QOL among those with more than 20 years of diabetes. The degree of diabetes control was significantly and directly associated with QOL score (p < 0.001). The worst QOL was expressed among poorly controlled diabetes while the best was among patients with excellent control. QOL of diabetics was less among those who had diabetes complications, i.e., neuropathy (p = 0.03), retinopathy (p < 0.001), and diabetic foot (p = 0.031). However, difference was not significant according to those with nephropathy. Conclusions: QOL of Saudi adult diabetic patients is not favorable. Personal characteristics associated with worse QOL among diabetics include female gender, and being married. Disease characteristics associated with worse QOL include being a type 2 diabetic and those with uncontrolled diabetes. Main complications associated with worse QOL among diabetics include retinopathy, diabetic foot and neuropathy.

RISK FACTORS FOR DIABETIC RETINOPATHY IN DIABETICS SCREENED USING FUNDUS PHOTOGRAPHY AT A PRIMARY HEALTH CARE SETTING IN EAST MALAYSIA
MALLIKA PS,LEE PY,CHEAH WL,WONG JS
Malaysian Family Physician , 2011,
Abstract: Introduction: This study reports on the prevalence of diabetic retinopathy (DR) and risk factors among diabetic patients, who underwent fundus photography screening in a primary care setting of Borneo Islands, East Malaysia. We aimed to explore the preliminary data to help in the planning of more effective preventive strategies of DR at the primary health care setting. Materials and Methods: A cross-sectional study on 738 known diabetic patients aged 19-82 years was conducted in 2004. Eye examination consists of visual acuity testing followed by fundus photography for DR assessment. The fundus pictures were reviewed by a family physician and an ophthalmologist. Fundus photographs were graded as having no DR, NPDR, PDR and maculopathy. The data of other parameters was retrieved from patient’s record. Bi-variate and multivariate analysis was used toelucidate the factors associated with DR. Results: Any DR was detected in 23.7% (95% CI=21 to 27%) of the patients and 3.2% had proliferative DR. The risk factors associated with any DR was duration of DM (OR =2.5, CI=1.6 to 3.9 for duration of five to 10 years when compared to <5 years)and lower BMI (OR=1.8, CI=1.1 to 3.0). Moderate visual loss was associated with DR (OR=2.1, CI=1.2 to 3.7). Conclusions: This study confirms associations of DR with diabetic duration, body mass index and visual loss. Our data provide preliminary findings to help to improve the screening and preventive strategies of DR at the primary health care setting.
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