Krishnan Radhika, Jain Astha, Nare Siddhita, Sankaranarayanan Rajkumar, Bartlett Jacquelaine, Iyengar Sudha K, Williams Scott M, Sundaram Natarajan
Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India.
Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States of America.
PLOS Glob Public Health. 2023 Apr 12;3(4):e0000351. doi: 10.1371/journal.pgph.0000351. eCollection 2023.
Diabetes onset precedes diabetic retinopathy (DR) by 5-10 years, but many people with diabetes remain free of this microvascular complication. Our aim was to identify risk factors for DR progression in a unique and diverse population, the slums of Mumbai. We performed a nested case-control study of 1163 diabetics over 40 years of age from slums in 18 wards of Mumbai. Data was collected on 33 variables and assessed for association with DR using both univariate and multivariate analyses. Stratified analyses were also performed on males and females, separately. Among hypertensive individuals we also assessed whether duration of hypertension associated with DR. Of 31 non-correlated variables analysed as risk factors for DR, 15 showed evidence of significant association. The most prominent included sex, where being a female associated with decreased odds of DR, while longer duration of diabetes and poor glycaemic control associated with increased odds. The duration of diabetes effect was partially, but significantly, mediated by age of diabetes diagnoses (8.6% of variance explained, p = 0.012). Obesity as measured by several measures, including body mass index (BMI) and measures of central obesity had a negative association with DR; increased measures of obesity consistently reduced odds of DR. As in most earlier studies, DR was associated with the duration of diabetes and glycaemic control. However, other factors, especially obesity related measures were associated with DR, in ways that contrast with most prior studies. These results indicated that the overall pattern of association in the Mumbai slums was novel. Thus, in previously uncharacterized populations, such as the slums that we examined, it is important to evaluate all risk factors de novo to appropriately assess patterns of association as the patterns of association with DR can be complex and population specific.
糖尿病发病比糖尿病视网膜病变（DR）早5至10年，但许多糖尿病患者并未出现这种微血管并发症。我们的目的是在孟买贫民窟这一独特且多样化的人群中确定DR进展的风险因素。我们对来自孟买18个病房贫民窟的1163名40岁以上的糖尿病患者进行了一项巢式病例对照研究。收集了33个变量的数据，并使用单变量和多变量分析评估其与DR的关联。还分别对男性和女性进行了分层分析。在高血压患者中，我们还评估了高血压病程是否与DR相关。在作为DR风险因素分析的31个不相关变量中，有15个显示出显著关联的证据。最突出的因素包括性别，女性患DR的几率降低，而糖尿病病程较长和血糖控制不佳则与几率增加相关。糖尿病病程的影响部分但显著地由糖尿病诊断年龄介导（解释了8.6%的方差，p = 0.012）。通过多种测量方法（包括体重指数（BMI）和中心性肥胖测量方法）衡量的肥胖与DR呈负相关；肥胖测量值增加会持续降低患DR的几率。与大多数早期研究一样，DR与糖尿病病程和血糖控制相关。然而，其他因素，尤其是与肥胖相关的测量指标，与DR的关联方式与大多数先前研究形成对比。这些结果表明，孟买贫民窟的总体关联模式是新颖的。因此，在以前未进行特征描述的人群中，例如我们所研究的贫民窟，重新评估所有风险因素以适当评估关联模式非常重要，因为与DR的关联模式可能很复杂且因人群而异。
