scholarly journals Determining Risk Factors That Affect Progression in Patients with Nonproliferative Diabetic Retinopathy

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Dalbert J. Chen ◽  
Jacky C. Kuo ◽  
Alex J. Wright ◽  
Alice Z. Chuang ◽  
Wenyaw Chan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Diabetic Patients ◽  
Progression Rate ◽  
Factors Affecting ◽  
Duration Of Diabetes ◽  
Nonproliferative Diabetic Retinopathy ◽  
Sojourn Times ◽  
Endothelial Growth Factor

Purpose. To determine risk factors that affect nonproliferative diabetic retinopathy (NPDR) progression and establish a predictive model to estimate the probability of and time to progression in NPDR. Patients and Methods. Charts of diabetic patients who received an initial eye exam between 2010 and 2017 at our county hospital were included. Patients with proliferative diabetic retinopathy (PDR), fewer than 2 years of follow-up, or fewer than 3 clinic visits were excluded. Demographics and baseline systemic and ocular characteristics were recorded. Follow-up mean annual HbA1c and blood pressure, best-corrected visual acuity, and the number of antivascular endothelial growth factor treatments were recorded. Stage and date of progression were recorded. A 5-state nonhomogeneous continuous-time Markov chain with a backward elimination model was used to identify risk factors and estimate their effects on progression. Results. Two hundred thirty patients were included. Initially, 65 eyes (28.3%) had no retinopathy; 73 (31.7%) mild NPDR; 60 (26.1%) moderate NPDR; and 32 (13.9%) severe NPDR. Patients were followed for a mean of 5.8 years (±2.0 years; range 2.1–9.4 years). 164 (71.3%) eyes progressed during the follow-up. Time-independent risk factors affecting progression rate were age (hazard ratio (HR) = 0.99, P = 0.047 ), duration of diabetes (HR = 1.02, P = 0.018 ), and Hispanic ethnicity (HR = 1.31, P = 0.068 ). Mean sojourn times at mean age, duration of diabetes, and annual HbA1c for a non-Hispanic patient were estimated to be 3.03 (±0.97), 4.63 (±1.21), 6.18 (±1.45), and 4.85 (±1.25) years for no retinopathy, mild NPDR, moderate NPDR, and severe NPDR, respectively. Each 1% increase in HbA1c annually diminished sojourn times by 15%, 10%, 7%, and 10% for no retinopathy, mild NPDR, moderate NPDR, and severe NPDR, respectively. Conclusion. HbA1c level is a significant modifiable risk factor in controlling the progression of DR. The proposed model could be used to predict the time and rate of progression based on an individual’s risk factors. A prospective multicenter study should be conducted to further validate our model.

scholarly journals Vascular endothelial growth factor (VEGF)-related polymorphisms rs10738760 and rs6921438 are not risk factors for proliferative diabetic retinopathy (PDR) in patients with type 2 diabetes mellitus (T2DM)

2019 ◽  
Vol 19 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Jana Sajovic ◽  
Ines Cilenšek ◽  
Sara Mankoč ◽  
Špela Tajnšek ◽  
Tanja Kunej ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Vascular Endothelial Growth Factor ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Diabetic Patients ◽  
Vascular Endothelial ◽  
Endothelial Growth Factor

Vascular endothelial growth factor (VEGF) is an important regulator of angiogenesis and has been investigated as a candidate gene in a number of conditions, including diabetes and its microvascular complications (e.g., retinopathy and nephropathy). Several VEGF-related polymorphisms have been shown to contribute to nearly half of the variability in circulating VEGF levels in healthy individuals. Our aim was to assess the association between VEGF-related rs10738760 and rs6921438 polymorphisms and proliferative diabetic retinopathy (PDR) in Slovenian patients with type 2 diabetes mellitus (T2DM). We also investigated the effect of these polymorphisms on VEGF receptor 2 (VEGFR-2) expression in fibrovascular membranes (FVMs) from patients with PDR. This case-control study enrolled 505 unrelated patients with T2DM: 143 diabetic patients with PDR as a study group, and 362 patients with T2DM of >10 years duration and with no clinical signs of PDR as a control group. Patient clinical and laboratory data were obtained from their medical records. rs10738760 and rs6921438 polymorphisms were genotyped using TaqMan SNP Genotyping assay. VEGFR-2 expression was assessed by immunohistochemistry in 20 FVMs from patients with PDR, and numerical areal density of VEGFR-2-positive cells was calculated. The occurrence of PDR was 1.7 times higher in diabetic patients carrying GA genotype of rs6921438 compared to patients with GG genotype, with a borderline statistical significance (OR = 1.7, 95% CI = 1.00 – 2.86, p = 0.05). In addition, A allele of rs6921438 was associated with increased VEGFR-2 expression in FVMs from PDR patients. However, we observed no association between AA genotype of rs6921438 nor between rs10738760 variants and PDR, indicating that the two polymorphisms are not genetic risk factors for PDR.

scholarly journals Evaluation of HbA1c Level and Other Risk Factors in Diabetic Retinopathy: A Study of Type 2 Diabetic Patients Attending in a Tertiary Level Hospital

KYAMC Journal ◽  
2017 ◽  
Vol 6 (2) ◽  
pp. 614-619 ◽  
Author(s):  
Sayama Hoque ◽  
MA Muttalib ◽  
Md Imtiajul Islam ◽  
Parvin Akter Khanam ◽  
Subhagata Choudhury
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Diabetic Retinopathy ◽  
Blood Glucose ◽  
Advanced Age ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Duration Of Diabetes ◽  
Type 2 Diabetic

Background: Retinopathy is the leading cause of blindness in persons with diabetes. Strict monitoring and maintenance of normal blood glucose specially HbA1c and prevention of different risk factors can prevent and delay the diabetic retinopathy. The purpose of the study was to explore the factors influencing or related to the development of the diabetic retinopathy with spcial concern to the HbA1c levels.Materials and Methods: We studied 400 type 2 diabetic patients in this cross-sectional study which was conducted in the out-patient department of BIRDEM hospital, Bangladesh. The randomly selected patients were evaluated for the presence of retinopathy through the review of their registered diabetic guide book. We included sociodemographic information, blood pressure, anthropometry (height, weight, BMI) and lipid profile of the patients. Glycaemic status was assessed by HbA1c (HbA1c was categorized into 3 groups) and plasma glucose levels. We used Student's t-test, Chi-square test and logistic regression analysis to determine and quantify the association of diabetic retinopathy with various risk factors specially HbA1c.Results: 400 type 2 diabetic patients (male 166 and female 234) were studied. The prevalence of retinopathy was 12.3%; male 12.7%, female 12.0%. Increasing HbA1c categories above 7.0% were significantly associated with increased prevalence of retinopathy (4.2 vs 12.3 vs 18.1%;c2 = 12.529, p < .01). Logistic regression models of univariate analysis showed that the risk of retinopathy at HbA1c categories >7.0% was (OR = 3.22; 95% CI: 1.12-9.25) and the risk was strongly increased at the HbA1c categories 8% (OR = 5.07; 95% CI: 1.90-13.50). Advanced age (OR = 2.92; 95% CI: 1.44-5.91), longer duration of diabetes (OR = 3.08; 95% CI: 1.49-6.37), presence of hypertension (OR = 2.42; 95% CI: 1.14-5.16), FBG (OR = 1.139; 95% CI: 1.036-1.251), blood glucose 2 hours ABF (OR = 1.124; 95% CI: 1.046-1.207) and SBP (OR = 1.033; 95% CI: 1.011-1.056) had significant association with retinopathy.Conclusions: HbA1c categories >7.0% is an important risk factor for the development of retinopathy. Poor glycaemic control, advanced age, longer duration of diabetes, hypertension are other significant risk factors of diabetic retinopathy.KYAMC Journal Vol. 6, No.-2, Jan 2016, Page 614-619

scholarly journals Prevalence and associated risk factors for diabetic retinopathy at first ophthalmological contact

2021 ◽  
Vol 12 (8) ◽  
pp. 118-124
Author(s):  
Bhavkaran Singh ◽  
Prempal Kaur ◽  
Jaspreet Singh ◽  
Parveen Grang
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Observational Study ◽  
Health Concern ◽  
Accurate Estimation ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Screening Programs ◽  
Duration Of Diabetes ◽  
Associated Risk Factors

Background: Type 2 diabetes mellitus (DM) is now considered as a growing global public health concern due to cost associated with diabetic micro and macrovascular complications. Diabetic retinopathy (DR) is one of the leading causes of vision loss. Accurate estimation of prevalence of DR among diabetic patients and associated risk factors are of crucial importance to plan and execute preventive strategies in the community. Aims and Objectives: The present cross sectional hospital based observational study was undertaken to determine the prevalence of DR in diabetic patients at their first ophthalmological contact and toevaluate associated risk factors. Materials and Methods: In this cross sectional hospital based observational study, all diabetic patients visiting ophthalmology clinic for the first time after being diagnosed as diabetic were enrolled. After recording demographic data and biochemical findings, each patient was investigated for DR and correlated with associated risk factors. Results: Of 1699 patients, majority (68.9%) of them had come to ophthalmology clinic with complaint of decreased vision. Only 16.12 % (274) patients had been referred for retinal exam by treating physician. DR was prevalent in 242(16.98%) non-referred and 31(11.31%) referred patients. Mean age and mean duration of diabetes was significantly higher in non-referred patients. Vision threatening DR was also significantly higher in nonreferred patients. Prevalence of DR was significantly correlated with age at presentation, duration of diabetes, rural background, uncontrolled diabetes, systolic blood pressure and high BMI. Conclusion: Low referral by treating physician and lack of awareness among patient accounts for late presentation of diabetic patients to ophthalmologist. Beyond just developing strategies to promote screening programs for early detection and management of DR, education of the patients,comprehensive planning and coordination between ophthalmologist and physician can go a long way to decrease the economic and social burden of preventable blindness due to diabetic retinopathy.

scholarly journals Prevalence, risk factors and awareness of diabetic retinopathy among admitted diabetic patients at a tertiary level hospital in Kathmandu

2014 ◽  
Vol 6 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Raba Thapa ◽  
Deepak Man Joshi ◽  
Aparna Rizyal ◽  
Nhukesh Maharjan ◽  
Rajesh Dhoj Joshi
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Case Series ◽  
Systemic Hypertension ◽  
P Value ◽  
Diabetic Patients ◽  
Duration Of Diabetes ◽  
Case Series Study ◽  
Systemic Problems ◽  
Clinically Significant

Introduction: Diabetic retinopathy (DR) is one of the commonest causes of visual impairment and blindness in Nepal. Objectives: The study aims to explore the prevalence, risk factors and awareness of DR among admitted diabetic patients. Materials and methods: A non-interventional case series study was conducted among the inpatient diabetic cases referred for ophthalmic consultation. The patients’ detailed demographics, awareness on DR, concurrent systemic problems, and glycemic control status were recorded. DR was graded using the Early Treatment Diabetic Retinopathy Study Criteria. Main outcome measures: The prevalence, risk factors and awareness of diabetic retinopathy among the study participants was analyzed. Results: A total of 277 diabetic patients were enrolled in the study. The mean age was 62.25 ± 13.26 years. Only one-third (34.6 %) of the cases were admitted for sugar control and newly diagnosed cases comprised of 19.49 %. Nearly half of the cases (46.6 %) were not aware of diabetic retinopathy and dilated fundus evaluation was done for the first time in 44.4 %. DR was found in 38.26 % of the cases and was diagnosed in 13 % of the new cases. Almost four-fifths (78 %) of the diabetics had had the disease for a duration of 16 to 20 years. Clinically significant macular edema was found in 5.78 % and proliferative DR in 2.52 %. DR was significantly associated with the duration of diabetes (P value = 0.001) and concurrent hypertension (P value = 0.004). Conclusion: The prevalence of DR was 38 % among the admitted diabetic cases and the DR was significantly associated with the duration of diabetes and systemic hypertension. Almost half of the cases had been unaware of DR before referral. This emphasizes the importance of the collaboration of the physician and the ophthalmologist for an early DR detection.   DOI: http://dx.doi.org/10.3126/nepjoph.v6i1.10760   Nepal J Ophthalmol 2014; 6 (2): 24-30

scholarly journals Association between Aqueous Cytokines and Diabetic Retinopathy Stage

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Hailiang Wu ◽  
De-Kuang Hwang ◽  
Xudong Song ◽  
Yong Tao
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Diabetic Retinopathy ◽  
Tumor Necrosis ◽  
Control Group ◽  
Diabetic Patients ◽  
Vascular Endothelial ◽  
Nonproliferative Diabetic Retinopathy ◽  
Endothelial Growth Factor ◽  
Necrosis Factor ◽  
Cataract Patients

Purpose.To measure the concentrations of various cytokines in the aqueous humor from patients with different stages of diabetic retinopathy.Methods.All selected cataract patients were categorized into 4 groups: the control group (patients without diabetes), nonretinopathy (NDR) group (diabetic patients without retinopathy), nonproliferative diabetic retinopathy (NPDR) group, and proliferative diabetic retinopathy (PDR) group. The aqueous concentrations of interleukin- (IL-) 1β, IL-2, IL-4, IL-5, IL-6, IL-10, interferon-γ, tumor necrosis factor-α, and vascular endothelial growth factor (VEGF) from patients were measured using the cytometric bead array technique.Results.In this study, 10, 22, 15, and 14 patients were included in the control, NDR, NPDR, and PDR groups, respectively. No difference was observed in the aqueous concentrations of all cytokines between the control group and the NDR group. By contrast, comparison of these groups revealed that the aqueous concentrations of most inflammatory cytokines were significantly higher in the PDR and NPDR groups. In addition, the concentrations of IL-2, IL-5, and VEGF were higher in the PDR group than those in the NPDR group.Conclusions.Aqueous concentrations of various cytokines increased with the severity of patients’ diabetic retinopathy. This finding implies that these cytokines might play a role in the progression of diabetic retinopathy.

scholarly journals Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury

2021 ◽  
Vol 12 ◽  
Author(s):  
Manqiu Mo ◽  
Ling Pan ◽  
Zichun Huang ◽  
Yuzhen Liang ◽  
Yunhua Liao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Survival Rate ◽  
Prediction Model ◽  
Validation Cohort ◽  
Kidney Injury ◽  
Calibration Plot ◽  
Diabetic Patients ◽  
Factors Affecting

ObjectiveWe aimed to analyze the risk factors affecting all-cause mortality in diabetic patients with acute kidney injury (AKI) and to develop and validate a nomogram for predicting the 90-day survival rate of patients.MethodsClinical data of diabetic patients with AKI who were diagnosed at The First Affiliated Hospital of Guangxi Medical University from April 30, 2011, to April 30, 2021, were collected. A total of 1,042 patients were randomly divided into a development cohort and a validation cohort at a ratio of 7:3. The primary study endpoint was all-cause death within 90 days of AKI diagnosis. Clinical parameters and demographic characteristics were analyzed using Cox regression to develop a prediction model for survival in diabetic patients with AKI, and a nomogram was then constructed. The concordance index (C-index), receiver operating characteristic curve, and calibration plot were used to evaluate the prediction model.ResultsThe development cohort enrolled 730 patients with a median follow-up time of 87 (40–98) days, and 86 patients (11.8%) died during follow-up. The 90-day survival rate was 88.2% (644/730), and the recovery rate for renal function in survivors was 32.9% (212/644). Multivariate analysis showed that advanced age (HR = 1.064, 95% CI = 1.043–1.085), lower pulse pressure (HR = 0.964, 95% CI = 0.951–0.977), stage 3 AKI (HR = 4.803, 95% CI = 1.678–13.750), lower 25-hydroxyvitamin D3 (HR = 0.944, 95% CI = 0.930–0.960), and multiple organ dysfunction syndrome (HR = 2.056, 95% CI = 1.287–3.286) were independent risk factors affecting the all-cause death of diabetic patients with AKI (all p &lt; 0.01). The C-indices of the prediction cohort and the validation cohort were 0.880 (95% CI = 0.839–0.921) and 0.798 (95% CI = 0.720–0.876), respectively. The calibration plot of the model showed excellent consistency between the prediction probability and the actual probability.ConclusionWe developed a new prediction model that has been internally verified to have good discrimination, calibration, and clinical value for predicting the 90-day survival rate of diabetic patients with AKI.

scholarly journals Pattern and Risk Factors of Diabetic Retinopathy among Type 2 Diabetic Patients: Experience in a Tertiary Care Hospital

2016 ◽  
Vol 17 (1) ◽  
pp. 17-20
Author(s):  
Md Mostarshid Billah ◽  
Muhammad Abdur Rahim ◽  
Md Anisur Rahman ◽  
Palash Mitra ◽  
Tufayel Ahmed Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Glycemic Control ◽  
Proliferative Diabetic Retinopathy ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Duration Of Diabetes ◽  
Type 2 Diabetic

Background: Diabetic retinopathy is the commonest cause of blindness in the working age group of both developed and developing countries. It is the indicator of all micro-vascular complications of diabetes mellitus. This study was aimed to find out the frequency and pattern of diabetic retinopathy among hospitalized adult type 2 diabetic patients.Methodology: This cross-sectional study was carried out in the Department of Medicine and Endocrinology of BIRDEM General Hospital, Dhaka over a period of six months. Retinopathy was determined by fundoscopic examination in dilated pupil. Data were collected in preformed questionnaire including demographic characteristics, fundoscopic findings, and laboratory investigation reports with prior informed consent of the patients.Results: Total patients were 94, male were 52 and female were 42. Mean age of the patients was 52.2 ± 11.12 years. Hypertension was the most common (42.8%) co-morbid condition followed by dyslipidemia (33%), nephropathy (34%), neuropathy (21.3%), ischemic heart disease (9.6%) and stroke (5.3%). Study showed 37.23% Patient had good glycemic control (HbA1C <7%) and 62.77% had poor glycemic control. The frequency of retinopathy of any form was present in 36.2% patients. Among them, non-proliferative diabetic retinopathy (NPDR) was present in 78.79%, proliferative diabetic retinopathy (PDR) 6.06%, maculopathy 6.06%, both maculopathy and PDR in 9.09% diabetic patients. Among NPDR, 46.15 % was mild, 26.92% was moderate and 26.92% was severe NPDR. This study also revealed retinopathy was more with increase in duration of diabetes (66.6% vs. 17.3% p=0.01), in poorly controlled diabetic than good control (52.54% vs. 8.5%, p=0.01), those with hypertension (55% vs. 22%, p=0.02), and those having diabetic nephropathy (78.12% vs. 14.51%, p=0.01).Conclusion: This study showed frequency of diabetic retinopathy was 36.2% and among retinopathy NPDR was predominate. Poor glycemic control, increase duration of diabetes, presence of other microvascular complication i.e. nephropathy found to be significant risk factors for developing retinopathy.J MEDICINE January 2016; 17 (1) : 17-20

scholarly journals Correction: Prevalence and Progression Rate of Diabetic Retinopathy in Type 2 Diabetes Patients in Correlation with the Duration of Diabetes

2018 ◽  
Vol 126 (09) ◽  
pp. e2-e2
Author(s):  
Margarete Voigt ◽  
Sebastian Schmidt ◽  
Thomas Lehmann ◽  
Benjamin Köhler ◽  
Christof Kloos ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Progression Rate ◽  
Duration Of Diabetes ◽  
Diabetes Patients

scholarly journals The U-Shaped Association between Bilirubin and Diabetic Retinopathy Risk: A Five-Year Cohort Based on 5323 Male Diabetic Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Miao Liu ◽  
Jianhua Wang ◽  
Yao He
Keyword(s):  
Diabetic Retinopathy ◽  
Cohort Study ◽  
Risk Model ◽  
Continuous Variable ◽  
Hazard Ratio ◽  
Diabetic Patients ◽  
Lower Baseline ◽  
The Impact ◽  
Chinese Male

Aims. This study aimed at assessing the impact of baseline bilirubin (TBiL) on the incidence of diabetic retinopathy (DR) based on a five-year cohort study which consisted of 5323 Chinese male diabetic patients.Methods. A cohort study based on 5323 male diabetic patients was conducted in Beijing, from 2009 to 2013. Both baseline TBiL and follow-up changes were measured. Cox proportional risk model was used to calculate the hazard ratio (HR) of TBiL for DR risk.Results. During the follow-up period, there were 269 new DR cases. The incidence of five-year follow-up was 5.1% (95% CI: 4.5%~5.6%). The TBiL level of those who had diabetic retinopathy was lower than that of those without (12.51+ 1.20 mol/L and 13.11+ 1.32μmol/L,P=0.033). And more interestingly, along with the quintiles of baseline TBiL, there showed a U-shaped curve with DR incidence. And the RRs were 0.928 (95% CI: 0.646–1.331), 0.544 (95% CI: 0.365–0.811), 0.913 (95% CI: 0.629–1.324), and 1.035 (95% CI: 0.725–1.479) for the second, third, fourth, and fifth quintiles of baseline TBiL levels, respectively, compared with the first quintile. For follow-up TBiL changes, after being adjusted for related covariables and baseline TBiL levels (as continuous variable) in the model, the RRs for DR were 1.411 (95% CI: 1.081–1.842) for those who had decreased TBiL level and 0.858 (95% CI: 0.770–0.947) for those who had increased TBiL level during follow-up. And this association was more prominent among those with lower baseline TBiL level.Conclusions. Serum TBiL had a U-shaped relationship with DR incidence, which was independent of control status of diabetes and other related covariates.

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