Raman Rajiv, Ganesan Suganeswari, Pal Swakshyar Saumya, Gella Laxmi, Kulothungan Vaitheeswaran, Sharma Tarun
a Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya , Chennai , Tamil Nadu , India.
b Elite School of Optometry, St. Thomas Mount , Chennai , Tamil Nadu , India.
Ophthalmic Epidemiol. 2017 Oct;24(5):294-302. doi: 10.1080/09286586.2017.1290257. Epub 2017 Mar 23.
To evaluate the 4-year incidence and progression of and risk factors for diabetic retinopathy (DR) in an Indian population.
From a cross-sectional study of 1425 subjects with diabetes, 911 (63.9%) returned for 4-year follow-up. After excluding 21 with ungradable retinal images, data from 890 subjects were analyzed. Participants underwent examinations based on a standard protocol, which included grading of retinal photographs.
The incidences of DR, diabetic macular edema (DME), and sight-threatening diabetic retinopathy (STDR) were 9.2%, 2.6%, and 5.0%, respectively. In subjects with DR at baseline, the incidence of DME and STDR had increased (11.5% and 22.7%, respectively). 1-step and 2-step progressions of DR were seen in 30.2% and 12.6% of participants, respectively, and 1-step and 2-step regressions were seen in 12.0% and 1.8%, respectively. Incident DR, DME, and STDR were associated with higher systolic blood pressure (odds ratio, OR, 1.21, 2.11 and 1.72, respectively, for every 10 mmHg increase). Incident DR and DME were associated with increasing duration of diabetes (OR 2.29 and 4.77, respectively, for every 10-year increase) and presence of anemia (OR 1.96 and 10.14, respectively). Incident DR was also associated with higher hemoglobin A1c (OR 1.16 for every 1% increase). Variables associated with 1-step progression were every 10 mg/dL increase in serum total cholesterol (OR 15.65) as a risk factor, and 10 mg/dL increase in serum triglyceride (OR 0.52) as a protective factor.
The incidences of STDR and DME were higher in people with pre-existing DR than in those without DR at baseline.
评估印度人群中糖尿病视网膜病变（DR）的4年发病率、进展情况及危险因素。
在一项对1425名糖尿病患者的横断面研究中，911名（63.9%）患者返回进行4年随访。排除21名视网膜图像无法分级的患者后，对890名患者的数据进行分析。参与者按照标准方案接受检查，其中包括对视网膜照片进行分级。
DR、糖尿病性黄斑水肿（DME）和威胁视力的糖尿病视网膜病变（STDR）的发病率分别为9.2%、2.6%和5.0%。在基线时患有DR的患者中，DME和STDR的发病率有所上升（分别为11.5%和22.7%）。分别有30.2%和12.6%的参与者出现了DR的1级和2级进展，分别有12.0%和1.8%的参与者出现了1级和2级逆转。新发DR、DME和STDR与较高的收缩压相关（收缩压每升高10 mmHg，比值比分别为1.21、2.11和1.72）。新发DR和DME与糖尿病病程延长（病程每延长10年，比值比分别为2.29和4.77）及贫血的存在（比值比分别为1.96和10.14）相关。新发DR还与较高的糖化血红蛋白水平相关（糖化血红蛋白每升高1%，比值比为1.16）。与1级进展相关的变量包括血清总胆固醇每升高10 mg/dL作为危险因素（比值比为15.65），以及血清甘油三酯每升高10 mg/dL作为保护因素（比值比为0.52）。
基线时已有DR的患者中，STDR和DME的发病率高于无DR的患者。
