BR Ambedkar Medical College & Hospital, Bangalore.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
India being a developing country and undergoing socioeconomic growth on fast pace is at a higher risk of catering diabetic population owing to the unhealthy lifestyle with a significant fraction belonging to the urban population. According to IDF, estimated population with diabetes in India as in 2019 is 77.0056 million which accounts for around 10.4% of the population. Keeping in mind the population of our country, this population proportion can give us an idea about the disease burden and is rightly regarded as the 'Diabetic Capital' of the world. Majority of morbidity and mortality associated with diabetes can be attributed to its complications. These can be categorised into vascular as well as non-vascular complications. Vascular complications are further divided into microvascular and macrovascular complications. Microalbuminuria is the earliest clinically detectable stage of diabetic kidney disease at which appropriate interventions can retard, or reverse, the progress of the disease. Diabetic nephropathy (Kimmelstiel-Wilson syndrome) is the leading cause of end-stage renal disease (ESRD) worldwide, and it is estimated that 20% of type 2 diabetic patients reach ESRD during their lifetime. Here, this study explores the incidence of different stages of diabetic retinopathy in relation to different stages of nephropathy among type 2 Diabetes mellites patients.
A prospective study done with 50 patients with long standing history of Type 2 Diabetes Mellitus (more than 5 years) attending Medicine OPD at our hospital with informed consent fitting the inclusion and exclusion criteria were taken up for the study. Albuminuria estimation as well as fundoscopy was done with informed consent. All patients underwent a thorough clinical examination and a proper history was taking into account their BMI, their details of medications like OHAs / Insulin as well as presence of other co morbid conditions.
With the above data in hand, the incidence of diabetic retinopathy in different stages of diabetic nephropathy, CKD stages were calculated and analysed. 2 (66.7%) of Grade II Nephropathy, 3(60%) of Grade IIIa, 11(55%) of Grade IIIb, 2 (12.5%) of grade IV and none among Grade V had a normal fundus. 1(33.3%) of Grade II, 1(20%) of Grade IIIa, 5(25%) of Grade IIIb, 4(25%) of Grade IV and nil had Mild NP 1(20%) of Grade IIIa, 3(15%) of Grade IIIb, 4(25%) of Grade IV and 1(16.7%) of Grade V had Moderate NP 1(5%) of Grade IIIb, 3(18.8%) of Grade IV and 2(33.3%) of Grade V had severe NP 3(18.8%) of Grade IV and 3(50%) of Grade V had P Statistical analysis by Fisher Exact testing showed that the above data is significant with a P value of 0.016.
This study showed severity of diabetic retinopathy by assessing its different stages in relation to different stages of diabetic nephropathy. Data shows that severe forms of diabetic retinopathy is more linked to long standing history of diabetes causing kidney damage among those with good glycaemic control. Hence it is advisable to include fundoscopy & albuminuria as the screening tool in the evaluation of long-standing diabetes, so that we can predict the development of diabetic retinopathy and treat them in early stages.
评估 2 型糖尿病患者不同阶段的糖尿病肾病与不同阶段的糖尿病视网膜病变之间的关系。
本前瞻性研究纳入了 50 名在我院内科门诊就诊的长期（>5 年）2 型糖尿病患者，所有患者均签署了知情同意书，并符合纳入和排除标准。在获得患者知情同意后，我们对他们进行了蛋白尿估计和眼底检查。所有患者均接受了全面的临床检查，并详细了解了他们的体重指数、口服降糖药/胰岛素的使用情况以及其他合并症的情况。
在纳入的 50 名患者中，33 名（66.7%）患者处于 2 期肾病，3 名（60%）患者处于 3a 期，11 名（55%）患者处于 3b 期，2 名（12.5%）患者处于 4 期，而 5 期患者的眼底均正常。2 期患者中有 1 名（33.3%）出现轻度非增生性视网膜病变（NP），3a 期患者中有 1 名（20%）出现轻度 NP，3b 期患者中有 5 名（25%）出现轻度 NP，4 期患者中有 4 名（25%）出现轻度 NP，5 期患者中有 1 名（16.7%）出现轻度 NP。3a 期患者中有 1 名（20%）出现中度 NP，3b 期患者中有 3 名（18.8%）出现中度 NP，4 期患者中有 4 名（25%）出现中度 NP，5 期患者中有 2 名（33.3%）出现中度 NP。3b 期患者中有 1 名（5%）出现重度 NP，4 期患者中有 3 名（18.8%）出现重度 NP，5 期患者中有 3 名（50%）出现重度 NP。Fisher 确切检验的统计分析显示，上述数据具有统计学意义（P 值为 0.016）。
本研究通过评估不同阶段的糖尿病肾病与不同阶段的糖尿病视网膜病变之间的关系，发现糖尿病视网膜病变的严重程度与长期糖尿病导致的肾脏损害有关。数据显示，在血糖控制良好的情况下，严重的糖尿病视网膜病变与长期糖尿病史导致的肾脏损害更为相关。因此，建议在长期糖尿病的评估中，将眼底检查和蛋白尿作为筛查工具，以便预测糖尿病视网膜病变的发生，并在早期进行治疗。
