Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Front Endocrinol (Lausanne). 2024 Jul 8;15:1363757. doi: 10.3389/fendo.2024.1363757. eCollection 2024.
Diabetes mellitus (DM) is a global public health problem characterized by an elevated blood glucose level. Monitoring blood sugar levels is vital for effective diabetes management and preventing complications. However, the association between longitudinal biomarkers and the incidence of diabetic complications is often overlooked. Therefore, this study aimed to assess the incidence of diabetic retinopathy, predictors, and association with longitudinal fasting blood sugar level changes among diabetes mellitus patients in Ethiopia.
A multicenter retrospective follow-up study was carried out in referral hospitals in Amhara region, Ethiopia. A random sample of 462 newly diagnosed DM patients was selected. The proportional hazard assumption was checked for the survival sub-model, and for the longitudinal sub-model, the normality assumption was checked. Then the joint modeling with time-dependent lagged parameterizations was fitted. Model assumptions and comparisons were checked. Finally, the hazard ratio with a 95% confidence interval (CI) with a corresponding P-value<0.05 was used to identify predictors.
In this study, Overall, 54 patients developed DR, and the incidence rate was 2.33 per 1000 person-months over the follow-up period, with a 95% CI of [1.78, 3.05]. Rural residence (AHR = 2.21, 95% CI: [1.21, 4.05]), hypertension co-morbidity (AHR = 3.01, 95% CI: [1.85, 6.53]), and longer duration of DM (>5 years) (AHR = 2.28, 95% CI: [1.91, 5.15]) were important predictors for the incidence of DR. In addition, the incidence of DR was substantially correlated with the time-dependent lagged value of FBS change (AHR = 4.20, 95% CI [1.62, 10.85]).
In this study, the incidence of diabetic retinopathy was somewhat high when compared to prior similar studies in Ethiopia. A joint model of longitudinal fasting blood sugar level changes was significantly associated with an increased risk of DR. Besides, being rural residence, hypertension co-morbidity, and a longer duration of DM were significant predictors for the incidence of DR. Therefore, public awareness, an integrated care approach, and prioritizing glycemic control are highly recommended.
糖尿病（DM）是一种以血糖升高为特征的全球性公共卫生问题。监测血糖水平对于有效的糖尿病管理和预防并发症至关重要。然而，纵向生物标志物与糖尿病并发症发生之间的关联常常被忽视。因此，本研究旨在评估埃塞俄比亚糖尿病患者中糖尿病视网膜病变的发生率、预测因素以及与空腹血糖水平纵向变化的相关性。
在埃塞俄比亚阿姆哈拉地区的转诊医院进行了一项多中心回顾性随访研究。随机选择了 462 名新诊断的 DM 患者进行研究。对生存子模型进行了比例风险假设检验，对纵向子模型进行了正态性假设检验。然后，采用时间相关滞后参数化的联合建模进行拟合。检查了模型假设和比较。最后，使用具有 95%置信区间（CI）和相应 P 值<0.05 的风险比来识别预测因素。
本研究中，共有 54 名患者发生了 DR，在随访期间的发生率为每 1000 人-月 2.33 例，95%CI 为 [1.78, 3.05]。农村居住（AHR = 2.21, 95%CI：[1.21, 4.05]）、高血压合并症（AHR = 3.01, 95%CI：[1.85, 6.53]）和糖尿病病程较长（>5 年）（AHR = 2.28, 95%CI：[1.91, 5.15]）是 DR 发生的重要预测因素。此外，DR 的发生与空腹血糖变化的时间相关滞后值显著相关（AHR = 4.20, 95%CI [1.62, 10.85]）。
与埃塞俄比亚先前类似的研究相比，本研究中糖尿病视网膜病变的发生率相对较高。空腹血糖水平纵向变化的联合模型与 DR 风险的增加显著相关。此外，农村居住、高血压合并症和糖尿病病程较长是 DR 发生的重要预测因素。因此，强烈建议提高公众意识、采用综合护理方法并优先控制血糖。
