尼泊尔50岁及以上成年人中糖尿病和糖尿病视网膜病变的患病率：一项基于人群的横断面调查。
Prevalence of diabetes and diabetic retinopathy among adults aged 50 years and above in Nepal: a population-based cross-sectional survey.
作者信息
Shah Ranjan, Mishra Sailesh Kumar, Sapkota Yuddha Dhoj, Das Sanyam Sandip, Gurung Reeta, Shrestha Mohan Krishna, Sapkota Alina, Pant Chet Raj, Shahi Brish Bahadur
机构信息
Program and Research, Nepal Netra Jyoti Sangh, Kathmandu, Bagmati, Nepal
Executive Director, Nepal Netra Jyoti Sangh, Kathmandu, Central Development Region, Nepal.
出版信息
BMJ Open Ophthalmol. 2025 Jun 20;10(1):e002191. doi: 10.1136/bmjophth-2025-002191.
BACKGROUND
Diabetic retinopathy (DR), a microvascular complication of diabetes mellitus (DM), is a leading cause of vision loss worldwide. There is limited national data to inform about the prevalence of DM and DR and its associated factors, which led to the basis of conducting this survey, which would guide us for the same as part of the Rapid Assessment of Avoidable Blindness (RAAB) survey conducted across Nepal.
METHODS
A population-based cross-sectional RAAB survey was conducted using multistage cluster random sampling. RAAB+DR methodology was conducted between June 2019 and February 2021 among individuals aged≥50 years across selected provinces. Diabetes was diagnosed based on treatment history and random blood glucose test with level>200 mg/dL, while DR was graded by trained ophthalmologists. All relevant data were imported into the RAAB software to determine the prevalence of DM, DR and associated factors.
RESULTS
Among the 13 510 participants examined, the prevalence of DM was found to be 6.1% which was higher in Bagmati province at 9.4% (95% CI: 8.2% to 10.7%). Prevalence of DM was higher among females, but DR was more common in males in rural areas and females in urban areas. Untreated diabetes was most common in Madhesh (35.1%). DR prevalence was highest in Bagmati (15.9%; 95% CI: 12.7% to 19.1%), and 2.5% (95% CI: 1.2% to 3.8%) of those patients had sight-threatening DR. In Bagmati, 24.1% of diabetics had never undergone an eye examination.
CONCLUSION
The limited coverage of DR screening underscores the need for enhanced community-based DR screening and referral programmes. Our study lacked the use of plasma blood glucose level measurement to diagnose DM, proper slit lamp examination for diabetic retinopathy grading and diagnosis, and inclusion of a younger population providing a better representation. Strengthening these initiatives can prevent vision-threatening complications in underserved populations.
背景
糖尿病视网膜病变（DR）是糖尿病（DM）的一种微血管并发症，是全球视力丧失的主要原因。关于糖尿病和糖尿病视网膜病变的患病率及其相关因素的全国性数据有限，这构成了开展本次调查的基础，该调查将作为在尼泊尔全国范围内开展的可避免失明快速评估（RAAB）调查的一部分，为我们提供指导。
方法
采用多阶段整群随机抽样方法进行基于人群的横断面RAAB调查。2019年6月至2021年2月期间，在选定省份对年龄≥50岁的个体采用RAAB+DR方法进行调查。根据治疗史和随机血糖水平>200mg/dL诊断糖尿病，而糖尿病视网膜病变由训练有素的眼科医生进行分级。所有相关数据都导入RAAB软件，以确定糖尿病、糖尿病视网膜病变的患病率及其相关因素。
结果
在13510名接受检查的参与者中，糖尿病患病率为6.1%，其中加德满都省的患病率较高，为9.4%（95%CI：8.2%至10.7%）。女性糖尿病患病率较高，但农村地区男性和城市地区女性的糖尿病视网膜病变更为常见。未经治疗的糖尿病在马德西最为常见（35.1%）。糖尿病视网膜病变患病率在加德满都最高（15.9%；95%CI：12.7%至19.1%），其中2.5%（95%CI：1.2%至3.8%）的患者患有威胁视力的糖尿病视网膜病变。在加德满都，24.1%的糖尿病患者从未接受过眼部检查。
结论
糖尿病视网膜病变筛查覆盖率有限，凸显了加强基于社区的糖尿病视网膜病变筛查和转诊计划的必要性。我们的研究缺乏使用血浆血糖水平测量来诊断糖尿病、缺乏用于糖尿病视网膜病变分级和诊断的适当裂隙灯检查，也未纳入更年轻的人群以提供更好的代表性。加强这些举措可以预防服务不足人群中威胁视力的并发症。
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