Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, Sri Lanka.
BMC Endocr Disord. 2014 Mar 4;14:20. doi: 10.1186/1472-6823-14-20.
Diabetic retinopathy (DR) is one of the leading causes for complete loss of vision among working-aged adults around the world. The present study aims to evaluate the rate of DR and its risk factors among the adults with young-onset diabetes from a tertiary care setting in Sri Lanka.
A consecutive sample of 1,007 individuals referred from multiple centers, were invited for the study. Ophthalmological evaluation was done, with dilated indirect ophthalmoscopy by an Ophthalmologist. Retinopathy was classified according to the International Clinical DR Disease Severity Scale. An interviewer-administered questionnaire was used to collect socio-demographic and anthropometric details. Seated blood pressure, Fasting Blood Glucose (FBG), HbA1c and urine microalbumin were also measured. Data were analysed using SPSSv14. A binary logistic regression analysis was performed in all patients, with 'presence of DR' as the dichotomous dependent variable and other independent covariates.
Sample size was 684 (response rate-67.9%), mean age was 37.1 ± 5.9 years and 36.0% were males. Mean duration of diabetes was 5.2 ± 4.0 years. Previous retinal screening had been done in 51.0% by a non-specialist doctor and in 41.5% by a consultant ophthalmologist. Rate of any degree of DR in the study population was 18.1% (Males 16.4%, Females 20.0%; P = NS). In patients with DR, majority had mild Non-Proliferative DR (NPDR) (57.2%), while 32.2% had moderate NPDR, 0.8% had severe NPDR and 9.7% had maculopathy. Mean age, duration of diabetes, systolic (SBP) and diastolic blood pressure (DBP), FBG, HbA1c and urine microalbumin levels were significantly higher amongst the patients with DR. The results of the binary logistic regression indicate that the duration of diabetes (OR:1.24), HbA1c (OR:1.19), age (OR:1.11), urine Microalbumin (OR:1.11) and DBP (OR:1.04) all were significantly associated with DR.
In this large multi center study, nearly one in five adults with young-onset diabetes was found to have retinopathy. Age, duration of diabetes, HbA1C and urine Microalbumin levels were significantly associated with the presence of retinopathy, while HbA1c was also a significant factor determining severity. Nearly 50% of the study population has never undergone retinal screening by an ophthalmologist, highlighting the need for well organized screening programs.
糖尿病视网膜病变（DR）是全球工作年龄段人群失明的主要原因之一。本研究旨在评估斯里兰卡一家三级护理机构中年轻起病糖尿病患者的 DR 发生率及其危险因素。
从多个中心连续抽取了 1007 名患者作为研究对象。由眼科医生进行散瞳间接检眼镜检查。根据国际临床 DR 疾病严重程度量表对视网膜病变进行分类。采用问卷调查收集社会人口学和人体测量学资料。测量坐位血压、空腹血糖（FBG）、糖化血红蛋白（HbA1c）和尿微量白蛋白。数据采用 SPSSv14 进行分析。对所有患者进行二元逻辑回归分析，以“存在 DR”为二分类因变量和其他独立协变量。
样本量为 684 例（应答率 67.9%），平均年龄为 37.1±5.9 岁，男性占 36.0%。糖尿病病程平均为 5.2±4.0 年。51.0%的患者曾由非专科医生、41.5%的患者由顾问眼科医生进行过视网膜筛查。研究人群中任何程度的 DR 发生率为 18.1%（男性 16.4%，女性 20.0%；P=NS）。DR 患者中，大多数为轻度非增殖性 DR（NPDR）（57.2%），中度 NPDR 占 32.2%，重度 NPDR 占 0.8%，黄斑病变占 9.7%。DR 患者的平均年龄、糖尿病病程、收缩压（SBP）和舒张压（DBP）、FBG、HbA1c 和尿微量白蛋白水平均显著升高。二元逻辑回归分析结果表明，糖尿病病程（OR：1.24）、HbA1c（OR：1.19）、年龄（OR：1.11）、尿微量白蛋白（OR：1.11）和 DBP（OR：1.04）均与 DR 显著相关。
在这项大型多中心研究中，近五分之一的年轻起病糖尿病患者被发现患有视网膜病变。年龄、糖尿病病程、HbA1C 和尿微量白蛋白水平与视网膜病变的发生显著相关，而 HbA1c 也是决定严重程度的重要因素。近 50%的研究人群从未接受过眼科医生的视网膜筛查，这突显了需要组织良好的筛查计划。
