Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Department of Health Statistics, Faculty of Preventive Medicine, Fourth Military Medical University, Xi'an, China.
Front Public Health. 2022 Sep 15;10:966714. doi: 10.3389/fpubh.2022.966714. eCollection 2022.
Diabetes mellitus (DM) and diabetic retinopathy (DR) increase the global burden. Since their pathogenesis is complex, it is necessary to use the biopsychosocial model to discover the most effective strategies. The study is aimed to investigate the psycho-behavioral factors of DR and confirm the discrepancies from previous studies.
The study comprised seven cycles of cross-sectional data of the National Health and Nutrition Examination Survey (NHANES) from 2005-2006 to 2017-2018. Samples of DM were selected from this complex multi-stage probability sample and divided into the non-DR and DR groups, where 4,426 samples represented 18,990,825 individuals after weighting. This study comprehensively explored the biological, social, and psychological risk factors of DR, among which the biological factors included blood pressure, blood routine, HbA1c%, blood glucose, the duration of DM, family history, comorbidities, and treatment methods. Social aspects include gender, education, income, insurance, smoking, drinking, sleep habits, and recreational activities. The Patient Health Questionnaire-9 (PHQ-9) was used to assess the psychological state. Taylor series regression was used to examine the connection between factors and DR.
Men accounted for 55.5% of the DR group ( = 0.0174). Lymphocyte count, insulin treatment, heart failure, stroke, liver condition, and renal failure showed significant differences in DR ( < 0.05). The incidence of depression in DR was 40.5%. Mild to moderate depression [odds ratio was associated with DR [(OR) = 1.37, 95% confidence interval (CI): 1.06-1.79], but there was no statistical difference in severe depression (OR = 1.34, 95% CI: 0.83-2.17). Although ≤ 6 h of sleep was associated with DR (OR = 1.38, 95% CI: 1.01-1.88), we found no statistical differences in alcohol consumption, recreational activities, or sedentary time between the two groups in our current study ( > 0.05).
The biological risk factors of DR are significant. It showed that stroke is associated with DR, and retinal exams have the potential value as a screening tool for the brain. Besides, psycho-behavioral risk factors of DR should also be paid attention. Our study highlights that mild and moderate depression and ≤6 h of sleep are distinguishably associated with DM complicated with DR. It indicates that psycho-behavioral risk factors confer a vital influence on diabetic health care and DR.
糖尿病（DM）和糖尿病视网膜病变（DR）增加了全球负担。由于其发病机制复杂，有必要使用生物心理社会模型来发现最有效的策略。本研究旨在调查 DR 的心理行为因素，并确认与以往研究的差异。
本研究包括 2005-2006 年至 2017-2018 年期间国家健康和营养检查调查（NHANES）的七轮横断面数据周期。DM 样本从这个复杂的多阶段概率样本中选择，分为非 DR 和 DR 组，其中 4426 个样本在加权后代表 18990825 人。本研究全面探讨了 DR 的生物、社会和心理风险因素，其中生物因素包括血压、血常规、HbA1c%、血糖、DM 病程、家族史、合并症和治疗方法。社会方面包括性别、教育、收入、保险、吸烟、饮酒、睡眠习惯和娱乐活动。使用患者健康问卷-9（PHQ-9）评估心理状态。泰勒级数回归用于检查因素与 DR 之间的关系。
男性占 DR 组的 55.5%（=0.0174）。淋巴细胞计数、胰岛素治疗、心力衰竭、中风、肝脏状况和肾功能衰竭在 DR 中存在显著差异（<0.05）。DR 患者的抑郁发生率为 40.5%。轻度至中度抑郁[与 DR 相关的优势比为 1.37，95%置信区间（CI）：1.06-1.79]，但重度抑郁无统计学差异（OR=1.34，95%CI：0.83-2.17）。尽管睡眠时间≤6 小时与 DR 相关（OR=1.38，95%CI：1.01-1.88），但我们发现两组之间在饮酒、娱乐活动或久坐时间方面无统计学差异（>0.05）。
DR 的生物风险因素很重要。研究表明，中风与 DR 相关，视网膜检查具有作为大脑筛查工具的潜力。此外，还应注意 DR 的心理行为风险因素。我们的研究强调，轻度和中度抑郁以及睡眠时间≤6 小时与 DM 并发 DR 有明显的相关性。这表明心理行为风险因素对糖尿病保健和 DR 有重要影响。
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