Prevalence and Risk Factors of Diabetic Retinopathy in Subjects with Suboptimal Glycemic, Blood Pressure and Lipid Control. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, Report 33)

Raman, Rajiv; Gupta, Aditi; Kulothungan, Vaitheeswaran; Sharma, Tarun

doi:10.3109/02713683.2012.669005

Cited by 24 publications

(22 citation statements)

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“…In the MDRS 24-month cohort study, lower hemoglobin was associated with the presence of STDR at baseline (previously reported 14 ) but not with the progression of DR. Cross-sectional (but not cohort) studies have demonstrated an association between the presence of DR and anemia in India32, 33, 34 and China 35 . Potential confounders of the association between hemoglobin and retinopathy are socioeconomic and nutritional status and decreased erythropoietin production due to diabetic nephropathy.…”

Section: Discussionmentioning

confidence: 99%

First Prospective Cohort Study of Diabetic Retinopathy from Sub-Saharan Africa

et al. 2016

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PurposeTo describe the prevalence, incidence, and progression of retinopathy and to report associations with demographic, clinical, and biochemical variables in people with diabetes in Southern Malawi.DesignProspective cohort study.ParticipantsSubjects were systematically sampled from 2 primary care diabetes clinics.MethodsWe performed the first prospective cohort study of diabetic retinopathy from Sub-Saharan Africa over 24 months. Visual acuity, glycemic control, blood pressure, human immunodeficiency virus (HIV) status, urine albumin-to-creatinine ratio, hemoglobin, and lipids were assessed. Retinopathy was graded at an accredited reading center using modified Wisconsin grading of 4-field mydriatic photographs.Main Outcome MeasuresIncidence of sight-threatening retinopathy and progression of retinopathy by 2 steps on the Liverpool Diabetic Eye Study Scale.ResultsA total of 357 subjects were recruited to the 24-month cohort study. At baseline, 13.4% of subjects were HIV positive and 15.1% were anemic. The 2-year incidence of sight-threatening diabetic retinopathy (STDR) for subjects with level 10 (no retinopathy), level 20 (background), and level 30 (preproliferative) retinopathy at baseline was 2.7% (95% confidence interval [CI], 0.1–5.3), 27.3% (95% CI, 16.4–38.2), and 25.0% (95% CI, 0–67.4), respectively. In a multivariate logistic analysis, 2-step progression of diabetic retinopathy was associated with glycosylated hemoglobin (odds ratio [OR], 1.27; 95% CI, 1.12–1.45), baseline grade of retinopathy (OR, 1.39; 95% CI, 1.02–1.91), and HIV infection (OR, 0.16; 95% CI, 0.03–0.78). At 2 years, 17 subjects (5.8%) lost ≥15 letters.ConclusionsIncidence of STDR was approximately 3 times that reported in recent European studies. The negative association of HIV infection with retinopathy progression is a new finding.

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Section: Discussionmentioning

confidence: 99%

First Prospective Cohort Study of Diabetic Retinopathy from Sub-Saharan Africa

et al. 2016

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“…[17] The inter-study discrepancy could be explained by differences in study design (e.g. population-based vs. clinical), and study population (Indian[17] and Israeli[24] participants).…”

Section: Discussionmentioning

confidence: 99%

“…[17] The inter-study discrepancy could be explained by differences in study design (e.g. population-based vs. clinical), and study population (Indian[17] and Israeli[24] participants). Similarly, definitions of the indicators of diabetes control varied, particularly for poor lipid control, which was defined as TC:HDL≥4.0 in our study, and LDL≥100mg/dl[17, 24] and TC≥5.5 mmol/l[25] in the others.…”

Section: Discussionmentioning

confidence: 99%

“…Three individual indicators of good diabetes control were used that were defined according to standard established definitions from international guidelines and literature[17–19] namely (1) glycemic control (Hb A1c <7%); (2) BP control (SBP/DBP<130/80mmHg); (3) lipid control (TC:HDL<4.0). From these, three individual indicators of poor control were defined: glucose control (Hb A1c ≥7%); BP control (SBP/DBP≥130/80mmHg); and lipid control (TC:HDL≥4.0).…”

Section: Methodsmentioning

confidence: 99%

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Combined poor diabetes control indicators are associated with higher risks of diabetic retinopathy and macular edema than poor glycemic control alone

et al. 2017

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PurposeTo examine the association of individual and combined indicators of diabetes control with diabetic retinopathy and diabetic macular edema.Materials and methodsIn this clinical, cross-sectional study, 613 adults with type 2 diabetes (372 any diabetic retinopathy; 183 any diabetic macular edema) were examined. Diabetic retinopathy was assessed from fundus photographs; diabetic macular edema from Ocular Coherence Tomography scans; and HbA1c and serum lipid values from fasting blood samples. Poor glucose control was defined as HbA1c≥7%; poor blood pressure control as SBP≥130/DBP≥80; and poor lipid control as total cholesterol:HDL ratio≥4.0. The association of poor glucose control, poor blood pressure control and poor lipid control alone and in combination (poor glucose & blood pressure control; poor glucose & lipid control; poor blood pressure & lipid control; and poor glucose, blood pressure & lipid control) with diabetic retinopathy/diabetic macular edema was examined using multiple logistic regression models.ResultsPatients’ mean±standard deviation age was 64.9±11.6 years (57% male). In adjusted models, compared to those with good control of all indicators (n = 99, 18.3%), the odds ratio (95% Confidence Interval) of having any diabetic retinopathy was 2.44 (1.34–4.46), 3.75 (1.75–8.07), 4.64 (2.13–10.12) and 2.28 (1.01–5.16) for poor glucose control only; poor glucose & blood pressure control; poor glucose & lipid control; and poor glucose, blood pressure & lipid control, respectively. Correspondingly for diabetic macular edema, they were 3.19 (1.55–6.59); 3.60 (1.58–8.22); 2.76 (1.18–6.44); and 3.01 (1.18–7.67), respectively. Odds were not significantly increased for other indicators.DiscussionCompared to individual indicators of poor diabetes control, risk of diabetic retinopathy and diabetic macular edema increased three to fourfold with a combination of these indicators. Targeting combined diabetes control indicators is important to reduce risk of diabetic retinopathy/diabetic macular edema.

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“…[4344] Cognitive functions have been affected by DM especially in older patients with long standing DM. Hence, to prevent and minimize these unwanted disease effects, TGC is recommended.…”

Section: Glycemic Controlmentioning

confidence: 99%

Tight glycemic control and cardiovascular effects in type 2 diabetic patients

Moodahadu

Dhall²,

Zargar³

et al. 2014

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Diabetes Mellitus (DM) with poor glycemic control is one of the leading causes for cardiovascular mortality in diabetic patients. Tight glycemic control with glycosylated haemoglobin of <7 gms% is recommended as a routine and < 6.5 gms% is recommended for young and newly diagnosed diabetics. Treatment goal aims at achieving near normal blood glucose level, and directed at management of other co morbid conditions such as obesity, hypertension and dyslipidemia. Oral hypoglycemic agents are the preferred drugs, alone or in combination. Preference for glitazones is declining due to the increasing evidences of associated adverse events. Gliptins appear as promising agents with lesser tendency to cause hypoglycemia, but their long term safety and efficacy is yet to be established. We emphasize the role of preventive measures in prediabetics and in established DM, treatment should be individualized and customized to minimize hypoglycemic effects and to retain quality of life.

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Prevalence and Risk Factors of Diabetic Retinopathy in Subjects with Suboptimal Glycemic, Blood Pressure and Lipid Control. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, Report 33)

Abstract: We found high prevalence of suboptimal metabolic control among subjects with type 2 diabetes. Suboptimal glycemic and SBP control, and their combination was the most detrimental for the development of DR.

Cited by 24 publications

References 49 publications

First Prospective Cohort Study of Diabetic Retinopathy from Sub-Saharan Africa

First Prospective Cohort Study of Diabetic Retinopathy from Sub-Saharan Africa

Combined poor diabetes control indicators are associated with higher risks of diabetic retinopathy and macular edema than poor glycemic control alone

Tight glycemic control and cardiovascular effects in type 2 diabetic patients

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