Females with Type 2 Diabetes Mellitus Are Prone to Diabetic Retinopathy: A Twelve-Province Cross-Sectional Study in China

Abstract

Aims. To investigate the distribution of diabetic retinopathy (DR) by sex in patients with type 2 diabetes mellitus (T2DM) in a twelve-province cross-sectional study in China. Methods. Patients with T2DM, whose ages were ≥18 years, were recruited from 76 cities/counties in 12 provinces in mainland China between January 2015 and December 2018. All participants received a standardized interview, eye examinations, and digital fundus photography. The presence and severity of DR were diagnosed and classified by retina specialists according to the DR domestic typing method. Results. A total of 12,766 participants (5963 males and 6803 females) were eligible for this study. The total prevalence of DR was 30.1%. Females exhibited a significantly higher prevalence of DR than males (31.1% vs. 29.0%, P=0.011). A multivariate logistic regression analysis confirmed that female sex was an independent predictor for a higher prevalence of DR after adjusting for age, the duration of diabetes, economic status, and the presence of hypertension (OR: 1.096, 95% CI: 1.013-1.186, P=0.023). Even after stratification by the diabetic duration, age, and economic status, female sex was still independently associated with the presence of DR in patients whose T2DM history was more than 10 years, whose ages were over 60 years, or who were in a relatively intermediate economic area. Conclusion. Females had a higher prevalence of DR than males in T2DM patients with a diabetic history of more than 10 years, ages over 60 years, or a relatively intermediate economic status.

Global burden and gender disparity of vision loss associated with diabetes retinopathy

“…Many studies showed that women were at greater risk of DR than men (Karwatowski et al, 2002). It was also estimated that females have a higher prevalence of DR than males in Japan and China (Kajiwara et al 2014; Li et al 2020). Moreover, pregnancy could accelerate the progression of retinopathy in women (Rahman et al 2007).…”

Factors protecting against diabetic retinopathy in a geriatric Indian cohort

“…[ 5 6 ] However, studies performed among older adults have suggested the two have a more complex relationship. [ 9 10 11 21 ] We found older age to be associated with a lower prevalence of DR in our study population. For the prevalence of a chronic disease to decrease at older age strata, it is probable that subjects with DR at younger ages are dying earlier.…”

“…Similarly, Li et al . [ 10 ] performed a population-based study in Mainland China; their data suggested that females over the age of 60 have slightly increased odds of DR than their male counterparts.…”

“…[ 6 ] Studies have suggested that the significance of each of these risks differs in geriatric populations. [ 7 9 10 ] There has also been research on protective factors against DR with less consistent results and no focus specifically on geriatric populations. [ 11 12 13 ] This study aims to identify the protective factors for DR in a geriatric population in India.…”

Relationship between renal and liver function with diabetic retinopathy in patients with type 2 diabetes mellitus: a study based on cross-sectional data

“…Interestingly, the risk of DR in T2DM patients ≤ 60 years old was actually higher than that of patients > 60 years old. Research by Li et al 41 also showed that the risk for DR increased with age for people < 60 years old, while the prevalence of DR decreased with age for people > 60 years old, which may be due to the mortality rates of DM in populations > 60 years old being higher than those in younger patients; thus, the prevalence of DR was relatively low in the research subjects. In addition, people ≤ 60 years old paid more attention to their health and tended to have regular fundus examinations, and thus the higher detection rate of DR in the younger populations could be explained.…”