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Xu M, Li B, Li C, Chai P, Qiu Q, Zheng Z, Chen Q, Luo D, Xu X, Zhou C. Is longer axial length protective of vision-threatening diabetic retinopathy across different ages? A multicenter cohort of 736 patients. Int J Retina Vitreous 2024; 10:74. [PMID: 39390534 PMCID: PMC11465653 DOI: 10.1186/s40942-024-00593-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 10/02/2024] [Indexed: 10/12/2024] Open
Abstract
PURPOSE Vision-threatening diabetic retinopathy (VTDR) included severe non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR) and clinically significant diabetic macular edema (DME). To compare the axial length (AL) and assess its influence on VTDR across different ages. METHODS A retrospective cohort study. Medical chart review was performed in 736 consecutive patients with VTDR. The patients were divided into young (≤ 45 years) and elderly group (> 45 years) based on their age at the diagnosis of VTDR. After at least one year of standardized treatments, all eligible patients were followed up. The main outcome measures included the presence of tractional retinal detachment (TRD) involving foveal, final best-corrected visual acuity (BCVA), the development of neovascular glaucoma (NVG), and recurrent vitreous hemorrhage (VH) post-vitrectomy. ALs were compared between two age groups. The impact of AL on clinical outcomes was determined by logistic analyses after controlling for systemic parameters. RESULTS The study included 144 patients ≤ 45 years and 592 patients > 45 years. Young patients had significantly longer AL than elderly participants (23.9 mm vs 23.0 mm, p < 0.001). Over a median follow-up of 25.9 months, a larger proportion of young patients developed TRD (34.7% vs 16.2%, p < 0.001) and recurrent VH (18.6% vs 10.3%, p = 0.040) than elderly patients. In elderly group, longer AL is an independent protective factor in preventing TRD (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.4-0.7; P < 0.001). However, this beneficial effect was not observed in young patients. CONCLUSIONS Young patients with VTDR exhibited significantly longer AL but more aggressive clinical signs with compromised prognosis. In elderly group, a longer AL independently reduced the risk of TRD, while this protective effect did not exist for young patients.
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Affiliation(s)
- Mingpeng Xu
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Li
- Department of Ophthalmology, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Chenxin Li
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Peiwei Chai
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qinghua Qiu
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, China
| | - Zhi Zheng
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Qian Chen
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, China.
| | - Dawei Luo
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China.
| | - Xiaofang Xu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Chuandi Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.
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Silva JQ, Cebada AB, Escobar-Morreale H, Chávez LN. Complicaciones crónicas de la diabetes mellitus tipo 1. MEDICINE - PROGRAMA DE FORMACIÓN MÉDICA CONTINUADA ACREDITADO 2024; 14:1064-1071. [DOI: 10.1016/j.med.2024.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Alemayehu HB, Tilahun MM, Abebe MG, Tegegn MT. Sight-threatening diabetic retinopathy and its predictors among patients with diabetes visiting Adare General Hospital in Southern Ethiopia: a hospital-based cross-sectional study. BMJ Open 2024; 14:e077552. [PMID: 38387987 PMCID: PMC10882339 DOI: 10.1136/bmjopen-2023-077552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE The study aimed to determine the prevalence of sight-threatening diabetic retinopathy and its predictors among patients with diabetes attending Adare General Hospital in Southern Ethiopia. DESIGN A hospital-based cross-sectional study was conducted using a systematic random sampling method. SETTING The study was conducted at the diabetic clinic of Adare General Hospital in Sidama region, Southern Ethiopia. PARTICIPANTS The study included 391 patients with diabetes aged ≥18 years who had attended the diabetic clinic of Adare General Hospital in Southern Ethiopia. MAIN OUTCOME MEASURES Data were collected using questionnaires completed by an interviewer, a review of medical records and eye examinations. RESULT The study included 391 patients with diabetes with a median age of 49 years. The prevalence of sight-threatening diabetic retinopathy was 10.7% (95% CI: 7.7% to 14%). Rural dwellers (adjusted OR (AOR)=2.17, 95% CI: 1.05 to 4.46), duration of diabetes ≥6 years (AOR=2.43, 95% CI: 1.06 to 5.57), poor glycaemic control (AOR=2.80, 95% CI: 1.03 to 7.64), low physical activity (AOR=2.85, 95% CI: 1.01 to 8.05), hypertension (AOR=3.25, 95% CI: 1.48 to 7.15) and diabetic peripheral neuropathy (AOR=3.32, 95% CI: 1.18 to 9.33) were significantly associated with sight-threatening diabetic retinopathy. CONCLUSION This study showed a high prevalence of sight-threatening diabetic retinopathy. Sight-threatening diabetic retinopathy was significantly associated with modified factors such as glycaemic control, hypertension, physical activity and diabetic peripheral neuropathy. Therefore, all patients with diabetes were recommended to maintain normal blood glucose, avoid hypertension, exercise regularly and have regular eye examinations.
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Affiliation(s)
- Henok Biruk Alemayehu
- Department of Ophthalmology and Optometry, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Mikias Mered Tilahun
- Department of Optometry, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Marshet Gete Abebe
- Department of Ophthalmology and Optometry, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Melkamu Temeselew Tegegn
- Department of Optometry, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Alaryni A. Assessment and Factors Contributing to the Quality of Life in Diabetes Mellitus Patients: A Cross-Sectional Single-Center Study. Cureus 2024; 16:e54359. [PMID: 38500939 PMCID: PMC10945466 DOI: 10.7759/cureus.54359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Diabetes mellitus (DM) is one of the most common chronic illnesses worldwide, with its prevalence rising rapidly every year. This condition adversely affects vasculature, leading to several potentially devastating complications like cerebrovascular mishaps, myocardial infarction, retinal damage, and renal compromise. These sequelae could lead to serious disabilities and negatively impact quality of life (QoL). Objectives This study aims to assess the QoL of adult diabetic patients in Saudi Arabia and determine influencing socio-demographic factors. Methods This is a cross-sectional study targeting adult diabetic patients visiting the Imam Medical Center in Riyadh, Saudi Arabia, from October 2022 to June 2023. The study encompasses diabetic patients of both genders aged 18 or more but excludes those diagnosed recently, i.e., within less than one year. A validated Arabic questionnaire, available online, was used to assess the QoL of the diabetic patients enrolled in this study. The sample size was 244 adult diabetic patients recruited from the Imam Medical Center through their official social media sites. Results The cohort of 244 patients recruited in this study were mostly aged between 18 and 30 (44.7%), females (52.5%), and married (47.5%). Furthermore, 58.6% of the participants were found to hold a bachelor's degree, 48.8% were employed, and 36.1% earned less than 5000 Saudi riyals each month. Of the total patients, 36.5% were diagnosed with diabetes 1-5 years ago, while 30.5% were diagnosed 5-10 years ago. Type 1 diabetes afflicted 48.4% of participants, whereas 47.1% were affected by type 2 diabetes. It was also determined that type 2 diabetic patients have higher overall QoL scores than type 1 diabetic patients. QoL had a high mean score of 22.05±4.4. The psychological/spiritual domain has the greatest mean score of 24.06±5.4, while the social and economic domain has the lowest (20.58±4.6). The majority of participants (71.3%) did not have other chronic conditions, whereas hypertension (18%) is the prevalent comorbidity, followed by respiratory ailments (7.4%) and cardiovascular disease (3.3%). Furthermore, people with hypertension had a higher total QoL and four life domain scores than those with cardiovascular and respiratory disorders. Conclusion The relevance of the findings is that it could aid health practitioners in developing techniques to encourage patients to undertake self-care to improve physiological management of the condition and reduce complications.
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Affiliation(s)
- Abdullah Alaryni
- Internal Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Al Zabadi H, Taha I, Zagha R. Clinical and Molecular Characteristics of Diabetic Retinopathy and Its Severity Complications among Diabetic Patients: A Multicenter Cross-Sectional Study. J Clin Med 2022; 11:jcm11143945. [PMID: 35887709 PMCID: PMC9319242 DOI: 10.3390/jcm11143945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Diabetic retinopathy (DR) is a complication associated with uncontrolled DM. It is a leading preventable cause of visual impairment in the world and a cause of blindness in those under 75 years old in developing countries. We aimed to explore the prevalence and associated risk factors of DR among diabetic patients in the West Bank. Materials and Methods:A quantitative multicenter cross-sectional study was conducted in all West Bank cities. Nearly, 385 patients underwent a comprehensive eye examination in addition to blood and urine tests. A previously validated questionnaire for ocular examination classification was used together with a socio-demographic and past medical history information sheet. Results: The prevalence of all DR in the West Bank was 41.8%. The prevalence of non-proliferative diabetic retinopathy (NPDR) was 50.3% (38.5% for mild NPDR, 10.6% for moderate NPDR and 1.2% for severe NPDR). The prevalence of proliferative diabetic retinopathy (PDR) was 9.9% and 39.7% for diabetic macular edema (DME) (17.4% for mild, 15.5% for moderate and 6.8% for severe DME). The prevalence of vision-threatening PDR and DME was 49.7% for both. In a univariate analysis, DR was significantly associated with body mass index; BMI (p = 0.035), DM duration (p = 0.002), Low-density lipoprotein (LDL) (p = 0.034), glutamic-oxaloacetic transaminase (GOT) level (p = 0.016) andblood urea (BU) (p = 0.044). A multivariate analysis showed a strong significant association between DR andpatients who had DM for 10-19years (adjusted odds ratio; AOR (95%CI); 1.843 (1.05–3.22)), abnormal levels of LDL (AOR (95%CI); 0.50 (0.30–0.83)), abnormal levels of GOT (AOR (95%CI); 0.49 (0.27–0.89)), and overweight (AOR (95%CI); 0.39 (0.19–0.80)). Conclusions: We found that the prevalence of DR in Palestine was higher than the global prevalence. Referral coordination between ophthalmologists and internal physicians is necessary to better follow up with DR patients. An interventional educational program by clinicians and public health professionals is recommended.
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Affiliation(s)
- Hamzeh Al Zabadi
- Department of Public Health, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus P.O. Box 7, Palestine
- Public Health Program, Faculty of Graduate Studies, An-Najah National University, Nablus P.O. Box 7, Palestine;
- Correspondence: ; Tel.: +970-9-2342902; Fax: +972-9-2349739
| | - Ibrahim Taha
- Public Health Program, Faculty of Graduate Studies, An-Najah National University, Nablus P.O. Box 7, Palestine;
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
| | - Rami Zagha
- Microbiology, Immunology and Pathology Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus P.O. Box 7, Palestine;
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Wang XL, Cai FR, Gao YX, Zhang J, Zhang M. Changes and significance of retinal blood oxygen saturation and oxidative stress indexes in patients with diabetic retinopathy. World J Diabetes 2022; 13:408-416. [PMID: 35664547 PMCID: PMC9134027 DOI: 10.4239/wjd.v13.i5.408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/28/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is a diabetic complication that can severely affect the patients’ vision, eventually leading to blindness. DR is the most important manifestation of diabetic micro-vasculopathy and is mainly related to the course of diabetes and the degree of blood glucose control, while the age of diabetes onset, sex, and type of diabetes have little influence on it.
AIM To explore the changes in blood oxygen saturation and oxidative stress indices of retinal vessels in patients with DR.
METHODS In total, 94 patients (94 eyes) with DR (DR group) diagnosed at Jianyang people’s Hospital between March 2019 and June 2020, and 100 volunteers (100 eyes) (control group) without eye diseases, were included in this study. Arterial and venous blood oxygen saturation, retinal arteriovenous vessel diameter, and serum oxidative stress indicators in the two groups were compared. Based on the stage of the disease, the DR group was divided into the simple DR and proliferative DR groups for stratified analysis.
RESULTS The oxygen saturation of the retinal vessels in the DR group was significantly higher than that in the control group (P < 0.05). The retinal vessel diameters between the DR and control groups were not significantly different. The serum malondialdehyde (MDA) and 8-hydroxydehydroguanosine (8-OHdG) levels in the DR group were significantly higher than those in the control group (P < 0.05). The serum superoxide dismutase (SOD) and reduced glutathione (GSH) levels in the DR group were significantly lower than those in the control group (P < 0.05). The oxygen saturation of the retinal vessels in the patients with proliferative DR was significantly higher than that in the patients with simple DR (P < 0.05). The retinal vessel diameter in patients with proliferative DR was not significantly different from that of patients with simple DR (P > 0.05). Serum MDA and 8-OHdG levels in patients with proliferative DR were significantly higher than those in patients with simple DR (P < 0.05). Serum SOD and GSH levels in patients with proliferative DR were significantly lower than those in patients with simple DR (P < 0.05).
CONCLUSION Increased blood oxygen saturation of retinal arteries and veins and increased oxidative stress damage in patients with DR may be associated with decreased retinal capillary permeability and arterial oxygen dispersion, possibly reflecting the patient’s condition.
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Affiliation(s)
- Xiao-Li Wang
- Department of Ophthalmology, Jianyang People’s Hospital of Sichuan Province, Jianyang 641400, Sichuan Province, China
| | - Fang-Rong Cai
- Department of Ophthalmology, Jianyang People’s Hospital of Sichuan Province, Jianyang 641400, Sichuan Province, China
| | - Yun-Xia Gao
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610000, Sichuan Province, China
| | - Jian Zhang
- Department of Ophthalmology, Jianyang People’s Hospital of Sichuan Province, Jianyang 641400, Sichuan Province, China
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610000, Sichuan Province, China
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Alsbirk KE, Seland JH, Assmus J. Diabetic retinopathy and visual impairment in a Norwegian diabetic coast population with a high dietary intake of fish oils. An observational study. Acta Ophthalmol 2022; 100:e532-e538. [PMID: 34472215 DOI: 10.1111/aos.14977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 07/01/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To present retinal and visual findings in a Norwegian west coast diabetic population and to elucidate the effect of dietary intake of marine polyunsaturated fatty acids (PUFAs) on the development of diabetic retinopathy (DR). METHODS In an eye practice in an archipelago of 314 km², serving a population of about 40 000, we recorded the prevalence of visual impairment and DR in a referred diabetic population. 510 consecutive patients were included, 238 females and 272 males. 50 patients had type I and 460 had type II diabetes mellitus (DM). Self-reported medication, diet supplements, HbA1c and fish consumption were registered. RESULTS In the type I group, the median age was 44.5 and median DM duration 11.5 years [1-44]. 48% had photographic evidence of DR, 8 patients (16%) had proliferative retinopathy (PDR), and 6 patients (12%) had diabetic macular oedema (DME). All had best-corrected visual acuity (BCVA) of 0.5 (log MAR 0.3) or better in the best eye. In the type II group, the median DM duration was 8 years [1-53], and median age was 66. 98% had best eye BCVA at or better than 0.5 (log MAR 0.3) in the best eye. CONCLUSION None of the 510 patients had BCVA worse than 0.3 (log MAR 0.48) due to diabetic retinopathy. Compared to similar studies, we found a very low visual impairment rate. A possible protective effect of PUFA on the prevalence and progression of diabetic microangiopathy including retinopathy is discussed.
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Affiliation(s)
| | | | - Jörg Assmus
- Centre for Clinical Research Haukeland University Hospital Bergen Norway
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Goit RK, Taylor AW, Lo ACY. Anti-inflammatory α-Melanocyte-Stimulating Hormone Protects Retina After Ischemia/Reperfusion Injury in Type I Diabetes. Front Neurosci 2022; 16:799739. [PMID: 35281489 PMCID: PMC8914517 DOI: 10.3389/fnins.2022.799739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
Retinal ischemia/reperfusion (I/R) injury is a major cause of vision loss in many ocular diseases. Retinal I/R injury is common in diabetic retinopathy, which as a result of hyperglycemia damages the retina and can cause blindness if left untreated. Inflammation is a major contributing factor in the pathogenesis of I/R injury. α-Melanocyte-stimulating hormone (α-MSH) is an anti-inflammatory peptide hormone that has displayed protective effects against I/R-induced organ damages. Here, we aimed to investigate the protective role of α-MSH on I/R-induced diabetic retinal damage using hyperglycemic C57BL/6J Ins2Akita/+ mice. Experimental I/R injury was induced by blocking the right middle cerebral artery (MCA) for 2 h followed by 2 h or 22 h of reperfusion using the intraluminal method. Since ophthalmic artery originates proximal to the origin of the MCA, the filament also blocked blood supply to the retina. Upon treatment with α-MSH at 1 h after ischemia and 1 h after reperfusion, animals displayed significant improvement in amplitudes of b-wave and oscillatory potentials during electroretinography. α-MSH also prevented I/R-induced histological alterations and inhibited the development of retinal swelling. Loss of retinal ganglion cells as well as oxidative stress were significantly attenuated in the α-MSH-treated retinae. Level of interleukin 10 was significantly increased after α-MSH treatment. Moreover, gene expression of glutamate aspartate transporter 1, monocarboxylate transporter (MCT) 1 and MCT-2 were significantly higher after α-MSH administration. In conclusion, α-MSH mitigates the severity of I/R-induced retinal damage under hyperglycemic condition. These beneficial effects of α-MSH may have important therapeutic implications against retinal I/R injury under hyperglycemic condition.
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Affiliation(s)
- Rajesh Kumar Goit
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Andrew W. Taylor
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, United States
| | - Amy C. Y. Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- *Correspondence: Amy C. Y. Lo, , orcid.org/0000-0003-4239-6851
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Surowiec P, Matejko B, Kopka M, Filemonowicz-Skoczek A, Klupa T, Cyganek K, Romanowska-Dixon B, Malecki MT. Low prevalence of diabetic retinopathy in patients with long-term type 1 diabetes and current good glycemic control - one-center retrospective assessment. Endocrine 2022; 75:427-436. [PMID: 34542802 PMCID: PMC8816752 DOI: 10.1007/s12020-021-02871-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/05/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Despite progress in type 1 diabetes (T1DM) therapy, diabetic retinopathy (DR) is still a common complication. We analysed predictors and prevalence of DR in patients with T1DM lasting 10 years or more. All of the patients were considered to be currently in excellent glycemic control and treated using modern therapies. METHODS Study included 384 (80.7% women) T1DM patients participating in the Program of Comprehensive Outpatient Specialist Care at the University Hospital in Krakow between the years 2014 and 2020. A retrospective analysis of medical records was conducted. RESULTS The patients were on average 34 ± 9.2 years old, had a BMI 25.0 ± 3.9 and a T1DM duration of 20.5 ± 7.9 years. The mean level of HbA1c throughout the follow-up (mean duration 4.9 ± 1.4 years) was 6.9 ± 1%. The group included 238 (62.0%) patients treated with insulin pumps and 99 (25.8%) on multiple daily injections, 47 (12.2%) used both methods; almost all patients were on insulin analogues. DR was confirmed in 150 (39.1%) patients, from which 109 (28.4%) were diagnosed de novo. Severe DR was occurred in just 31 cases (8.1%). In the multivariate logistic regression, independent risk factors for the presence of DR were T1DM duration (OR 1.13; 95% CI, 1.09-1.19), HbA1c level (OR 1.41; 95% CI, 1.08-1.84), LDL level (OR 1.79; 95% CI, 1.16-2.87), and the combined presence of non-DR micro- and macrovascular chronic complications (OR 1.86; 95% CI, 1.16-3.03). CONCLUSIONS In this highly-selected group of T1DM patients, mostly female, the prevalence of both DR at any stage and severe DR was lower than earlier reported results from other cohorts. Independent risk factors for the DR cohort did not differ from previously reported studies.
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Affiliation(s)
- Paulina Surowiec
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Marianna Kopka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | | | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Katarzyna Cyganek
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Bożena Romanowska-Dixon
- University Hospital, Krakow, Poland
- Department of Ophthalmology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
- University Hospital, Krakow, Poland.
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Al-Abadla Z, Elgzyri T, Moussa M. The Effect of Diabetes on Health-Related Quality of Life in Emirati Patients. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2022. [DOI: 10.1159/000520599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Diabetes mellitus (DM) is known to negatively affect quality of life (QoL), yet very few studies have been done on QoL of patients with diabetes in the United Arab Emirates population. <b><i>Objectives:</i></b> The aim of this study was to assess the impact of DM on health-related QoL (HRQoL) of patients with diabetes of Emirati nationality. <b><i>Methods:</i></b> Two hundred and forty Emirati patients with diabetes, treated at the Dubai Diabetes Center, were randomly selected and interviewed using the Short Form-36 questionnaire to assess HRQoL domains. Appropriate statistical measures were performed to associate HRQoL domains with diabetes-related factors. <b><i>Results:</i></b> HRQoL satisfaction scores for physical and mental health domains were very high for the majority of participants. Male participants ranked significantly higher median scores in all HRQoL domains than females (77.36 vs. 65.28, <i>p</i> = 0.004). There was a significant (<i>p</i> < 0.001) negative correlation between diabetes duration and the total averaged score for all sub-domains, and significant (<i>p</i> < 0.001) negative correlations between glycated hemoglobin percentage (HBA1c%) and all sub-domains of HRQoL. Patients without complications had significantly better scores in all HRQoL sub-domains than patients suffering from any complications. Median total HRQoL score for those with neuropathy compared to those without neuropathy was 63.9 versus 82.6 (<i>p</i> < 0.001), for nephropathy was 43.6 versus 72.5 (<i>p</i> < 0.001), for retinopathy 50.7 versus 76.0 (<i>p</i> < 0.001), for ischemic heart disease 54.1 versus 77.3 (<i>p</i> < 0.001), and for cerebrovascular disease 36.7 versus 72.4 (<i>p</i> < 0.001). Multiple regression showed 3 significant predictors for the total averaged score from all HRQoL sub-domains; these were age (<i>p</i> = 0.007), HbA1c% (<i>p</i> < 0.001), and the number of complications related to DM (<i>p</i> = 0.001). <b><i>Conclusion:</i></b> HRQoL in Emirati patients with diabetes was significantly associated with the presence of diabetes-related complications, glycemic control, and age of the patient. The assessment of QoL in patients with diabetes can be a valuable measure for the healthcare providers to assess patient’s well-being.
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Habehh H, Gohel S. Machine Learning in Healthcare. Curr Genomics 2021; 22:291-300. [PMID: 35273459 PMCID: PMC8822225 DOI: 10.2174/1389202922666210705124359] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/12/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
Recent advancements in Artificial Intelligence (AI) and Machine Learning (ML) technology have brought on substantial strides in predicting and identifying health emergencies, disease populations, and disease state and immune response, amongst a few. Although, skepticism remains regarding the practical application and interpretation of results from ML-based approaches in healthcare settings, the inclusion of these approaches is increasing at a rapid pace. Here we provide a brief overview of machine learning-based approaches and learning algorithms including supervised, unsupervised, and reinforcement learning along with examples. Second, we discuss the application of ML in several healthcare fields, including radiology, genetics, electronic health records, and neuroimaging. We also briefly discuss the risks and challenges of ML application to healthcare such as system privacy and ethical concerns and provide suggestions for future applications.
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Affiliation(s)
- Hafsa Habehh
- Department of Health Informatics, Rutgers University School of Health Professions, 65 Bergen Street, Newark, NJ 07107, USA
| | - Suril Gohel
- Department of Health Informatics, Rutgers University School of Health Professions, 65 Bergen Street, Newark, NJ 07107, USA
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Thakur S, Verkicharla PK, Kammari P, Rani PK. Does myopia decrease the risk of diabetic retinopathy in both type-1 and type-2 diabetes mellitus? Indian J Ophthalmol 2021; 69:3178-3183. [PMID: 34708767 PMCID: PMC8725115 DOI: 10.4103/ijo.ijo_1403_21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To study the relationship between the severity of myopia and the severity of diabetic retinopathy (DR) in individuals with type 1 or type 2 diabetes mellitus (DM). Methods This retrospective study was conducted using data from electronic medical records from a multicentric eyecare network located in various geographic regions of India. Individuals with type 1 or type 2 DM were classified according to their refractive status. Severe nonproliferative DR (NPDR), PDR, or presence of clinically significant macular edema (CSME) with any type of DR was considered as vision-threatening diabetic retinopathy (VTDR). Results A total of 472 individuals with type-1 DM (mean age 41 ± 10 years) and 9341 individuals with type-2 DM (52 ± 9 years) were enrolled. Individuals with a hyperopic refractive error had a significant positive association with the diagnosis of VTDR (odds ratio (OR) 1.26; 95%CI 1.04-1.51, P = 0.01) and moderate nonproliferative DR (OR 1.27; 95%CI 1.02-1.59, P = 0.03) in type-2 DM; however, no significant association was found in type-1 DM. After adjusting for age, gender, anisometropia, and duration of diabetes, the presence of high myopia (< - 6 D) reduced the risk of VTDR in type 2 DM (OR 0.18; 95% CI 0.04-0.77, P = 0.02), but no association was found in type 1 DM. Mild and moderate myopia had no significant association with any forms of DR in both type-1 and type-2 DM. Conclusion Hyperopic refractive error was found to increase the risk of VTDR in persons with type 2 DM. High-myopic refractive error is protective for VTDR in type 2 DM, but not in type-1 DM.
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Affiliation(s)
- Swapnil Thakur
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pavan Kumar Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Priyanka Kammari
- Department of EyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Padmaja Kumari Rani
- Smt. Kanuri Santamma Centre for Vitreoretinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
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13
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Rafferty J, Owens DR, Luzio SD, Watts P, Akbari A, Thomas RL. Risk factors for having diabetic retinopathy at first screening in persons with type 1 diabetes diagnosed under 18 years of age. Eye (Lond) 2021; 35:2840-2847. [PMID: 33262478 PMCID: PMC8452782 DOI: 10.1038/s41433-020-01326-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 11/02/2020] [Accepted: 11/13/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To determine the risk factors for having diabetic retinopathy (DR) in children and young people (CYP) with type 1 diabetes (T1DM) at first screening. METHODS Records from the Diabetes Eye Screening Wales (DESW) service for people in Wales, UK, with T1DM diagnosed under age 18 years were combined with other electronic health record (EHR) data in the Secure Anonymised Information Linkage (SAIL) Databank. Data close to the screening date were collected, and risk factors derived from multivariate, multinomial logistic regression modelling. RESULTS Data from 4172 persons, with median (lower quartile, upper quartile) age 16.3 (13.0, 22.3) years and duration of diabetes 6.6 (2.3, 12.3) years were analysed. 62.6% (n = 2613) had no DR, 26.7% (n = 1112) background DR, and 10.7% (n = 447) had referable DR (RDR). No RDR was observed under 19 years of age. Factors associated with an increased risk of DR were diabetes duration, elevated HbA1c, and diastolic blood pressure. People diagnosed with T1DM at 12 years or older had an additional risk for each year they had diabetes compared to those diagnosed before age 12 controlling for the diabetes duration (odds ratios 1.23 and 1.34, respectively). CONCLUSIONS This study found that 37.4% of the study cohort had DR at first screening, the risk being greater the longer the duration of diabetes or higher the HbA1c and diastolic blood pressure. In addition, people diagnosed at 12 years of age or over were more likely to have DR with each additional year with diabetes.
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Affiliation(s)
- James Rafferty
- Diabetes Research Unit Cymru, Swansea University Medical School, Singleton Park, Swansea, UK.
| | - David R Owens
- Diabetes Research Unit Cymru, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Stephen D Luzio
- Diabetes Research Unit Cymru, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Patrick Watts
- Department of Ophthalmology, University Hospital of Wales, Cardiff, UK
| | - Ashley Akbari
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Rebecca L Thomas
- Diabetes Research Unit Cymru, Swansea University Medical School, Singleton Park, Swansea, UK
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Seid K, Tesfaye T, Belay A, Mohammed H. Determinants of diabetic retinopathy in Tikur Anbessa Hospital, Ethiopia: a case-control study. Clin Diabetes Endocrinol 2021; 7:12. [PMID: 34325741 PMCID: PMC8323205 DOI: 10.1186/s40842-021-00128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diabetic retinopathy is the most frequent complication of Diabetes Mellitus and remains the leading cause of preventable blindness. However, there are limited studies on the determinants of diabetic retinopathy in the study area as well in Ethiopia. Hence, this study aimed to assess the determinants of diabetic retinopathy among diabetic patients at Tikur Anbessa Hospital. Methods An institution-based unmatched case–control study design was conducted at Tikur Anbessa Hospital from May 11 to June 26, 2020. Diabetic patients who developed retinopathy within 2 years were cases in the study. Patients who were free of retinopathy were controls in this study. Data were collected using a pretested interviewer-administered questionnaire, Topcon retinal examination, and a record review. The collected data were entered into Epi Data version 3.1 software, and analyzed using SPSS version 25. Binary logistic regression analysis was used to assess the determinants of diabetic retinopathy. Results A total of 282 patients (142 cases and 140 controls) were included in the study. The mean age (± Standard deviation) for the cases and the controls were 50.6 (SD: ± 18.7) and 44.9 (SD: ± 17.65) respectively. Patients who had a glucometer at home (AOR = 0.048; 95% CI: 0.005–0.492), exercise adherence (AOR = 0.075; 95% CI: 0.007–0.84), diabetes duration < 5 years (AOR = 0.005; 95% CI: 0.00–0.10) and 5–10 years (AOR = 0.041; 95% CI: 0.003–0.57), health information on diabetic complications (AOR = 0.002; 95% CI: 0.00–0.042) and appointments every month (AOR = 0.004; 95% CI: 0.00–0.073) and every 3 months (AOR = 0.022; 95% CI: 0.002–0.23) were less likely to develop diabetic retinopathy. Participants who had poor glycemic control (AOR = 19.9; 95% CI: 2.34–168.69), systolic hypertension (AOR = 23.4; 95% CI: 2.56–215.36) and nephropathy (AOR = 17.85; 95% CI: 2.01–158.1), had a higher risk of developing diabetic retinopathy. Conclusions Patients who had a glucometer at home, exercise adherence, diabetes duration < 10 years, health information on diabetic complications, and frequent follow-up had a preventive role. However, poor glycemic control, systolic hypertension, and nephropathy increase the risk of diabetic retinopathy. A concerted effort should be made to improve the health status of patients with Diabetes Mellitus, with particular emphasis on lifestyle modification practices to prevent diabetic retinopathy.
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Affiliation(s)
- Kalid Seid
- Department of Nursing, College of Health Science, Mizan-Tepi University, P.O. Box: 260, Mizan, SNNPR, Ethiopia.
| | - Temamen Tesfaye
- School of Nursing, Faculty of Health Science, Institute of Health, Jimma University, P.O. Box: 378, Jimma, Ethiopia
| | - Admasu Belay
- School of Nursing, Faculty of Health Science, Institute of Health, Jimma University, P.O. Box: 378, Jimma, Ethiopia
| | - Hayat Mohammed
- Department of Medical Laboratory Science, College of Health Science, Mizan-Tepi University, P.O. Box: 260, Mizan, SNNPR, Ethiopia
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Zureik A, Julla JB, Erginay A, Vidal-Trecan T, Juddoo V, Gautier JF, Massin P, Tadayoni R, Riveline JP, Couturier A. Prevalence, severity stages, and risk factors of diabetic retinopathy in 1464 adult patients with type 1 diabetes. Graefes Arch Clin Exp Ophthalmol 2021; 259:3613-3623. [PMID: 34264396 DOI: 10.1007/s00417-021-05298-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To determine the prevalence of diabetic retinopathy (DR) and its risk factors in adult type 1 diabetes (T1D) patients METHODS: In this cross-sectional study, all T1D patients followed in the University Center for Diabetes and its Complications of Lariboisière Hospital (Paris, France) between January 2017 and February 2019 were included. Ophthalmologic and systemic data were collected from electronic records. The association between DR (and each grade) and associated factors were estimated by univariate and multivariate analyses using logistic regression models. RESULTS A total of 1464 patients (46.2% of women, mean age: 42.2 ± 15.8 years) were included. The mean hemoglobin A1c (HbA1c) was 7.8 ± 1.7% and the mean diabetes duration was 20.5 ± 13.5 years. DR prevalence was 50.1% (47.4-52.6) and the prevalence of mild, moderate, and severe non-proliferative DR and proliferative DR was 19.1%, 9.4%, 3.9%, and 17.6%, respectively. DR was significantly associated with male gender, an older age, former and current smoking status, a higher BMI, the presence of nephropathy and neuropathy, higher HBA1c, and longer diabetes duration. Patients with HbA1c > 10% had an adjusted odds ratio (OR) of 3.25 (1.77-6.01) of having DR compared to patients with HbA1c < 6.5%. Patients with a diabetes duration > 30 years had an adjusted OR of 24.87 (14.82-42.67) higher of having DR compared to patients with a diabetes duration < 10 years. CONCLUSION In this study, 50.1% of adult T1D patients had DR and 17.6% had proliferative DR. Diabetes duration and HbA1c were major risk factors.
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Affiliation(s)
- Abir Zureik
- University of Paris, Ophthalmology Department, AP-HP, Lariboisière Hospital, F-75010, Paris, France.
| | - Jean-Baptiste Julla
- Department of Diabetology and Endocrinology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France. Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France. Université de Paris, Paris, France
| | - Ali Erginay
- University of Paris, Ophthalmology Department, AP-HP, Lariboisière Hospital, F-75010, Paris, France
| | - Tiphaine Vidal-Trecan
- Department of Diabetology and Endocrinology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France. Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France. Université de Paris, Paris, France
| | - Vanessa Juddoo
- Department of Diabetology and Endocrinology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France. Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France. Université de Paris, Paris, France
| | - Jean-François Gautier
- Department of Diabetology and Endocrinology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France. Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France. Université de Paris, Paris, France
| | - Pascale Massin
- University of Paris, Ophthalmology Department, AP-HP, Lariboisière Hospital, F-75010, Paris, France
| | - Ramin Tadayoni
- University of Paris, Ophthalmology Department, AP-HP, Lariboisière Hospital, F-75010, Paris, France
| | - Jean-Pierre Riveline
- Department of Diabetology and Endocrinology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France. Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France. Université de Paris, Paris, France
| | - Aude Couturier
- University of Paris, Ophthalmology Department, AP-HP, Lariboisière Hospital, F-75010, Paris, France.
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Zimmerman C, Bruggeman B, LaPorte A, Kaushal S, Stalvey M, Beauchamp G, Dayton K, Hiers P, Filipp SL, Gurka MJ, Silverstein JH, Jacobsen LM. Real-World Screening for Retinopathy in Youth With Type 1 Diabetes Using a Nonmydriatic Fundus Camera. Diabetes Spectr 2021; 34:27-33. [PMID: 33627991 PMCID: PMC7887527 DOI: 10.2337/ds20-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the use of a portable retinal camera in diabetic retinopathy (DR) screening in multiple settings and the presence of associated risk factors among children, adolescents, and young adults with type 1 diabetes. DESIGN AND METHODS Five hundred youth with type 1 diabetes of at least 1 year's duration were recruited from clinics, diabetes camp, and a diabetes conference and underwent retinal imaging using a nonmydriatic fundus camera. Retinal characterization was performed remotely by a licensed ophthalmologist. Risk factors for DR development were evaluated by a patient-reported questionnaire and medical chart review. RESULTS Of the 500 recruited subjects aged 9-26 years (mean 14.9, SD 3.8), 10 cases of DR were identified (nine mild and one moderate nonproliferative DR) with 100% of images of gradable quality. The prevalence of DR was 2.04% (95% CI 0.78-3.29), at an average age of 20.2 years, with the youngest affected subject being 17.1 years of age. The rate of DR was higher, at 6.5%, with diabetes duration >10 years (95% CI 0.86-12.12, P = 0.0002). In subjects with DR, the average duration of diabetes was 12.1 years (SD 4.6, range 6.2-20.0), and in a subgroup of clinic-only subjects (n = 114), elevated blood pressure in the year before screening was associated with DR (P = 0.0068). CONCLUSION This study in a large cohort of subjects with type 1 diabetes demonstrates that older adolescents and young adults (>17 years) with longer disease duration (>6 years) are at risk for DR development, and screening using a portable retinal camera is feasible in clinics and other locations. Recent elevated blood pressure was a risk factor in an analyzed subgroup.
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Affiliation(s)
- Chelsea Zimmerman
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Brittany Bruggeman
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Amanda LaPorte
- University of Florida College of Medicine, Gainesville, FL
| | | | - Michael Stalvey
- Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, AL
| | - Giovanna Beauchamp
- Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, AL
| | - Kristin Dayton
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Paul Hiers
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Stephanie L. Filipp
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL
| | - Matthew J. Gurka
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL
| | | | - Laura M. Jacobsen
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
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Alemu Mersha G, Tsegaw Woredekal A, Tilahun Tesfaw M. Sight-threatening Diabetic Retinopathy and Associated Risk Factors Among Adult Diabetes Patients at Debre Tabor General Hospital, Northwest Ethiopia. Clin Ophthalmol 2020; 14:4561-4569. [PMID: 33408458 PMCID: PMC7779297 DOI: 10.2147/opth.s285606] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People with diabetes have an increased risk of developing sight-threatening conditions. Sight threatening diabetic retinopathy (STDR) is an advanced microvascular of complication of diabetes on the eye. It remains one of the leading causes of preventable blindness among working age adults around the world. There is a paucity of evidence on the prevalence of STDR and its associated factors in Ethiopia, particularly in the study area. Therefore, the aim of our study was to determine the prevalence of STDR and its associated factors among adult diabetes patients at Debre Tabor General Hospital (DTGH), Northwest Ethiopia. MATERIALS AND METHODS An institution-based cross-sectional study was conducted on 306 diabetes patients at Debre Tabor General Hospital with systematic random sampling technique. Semi-structured questionnaire, document review and physical examination were applied to collect the data. Binary and multivariable logistic regression model were used to identify associated factors for STDR. RESULTS The majority of the participants 163 (53.3%) were type 1 diabetes (T1DM) and the mean age of T1 and T2 DM participants was 34.5 (12.8) and 58.7 (10.7) years respectively. The prevalence of STDR was 15.3% (95%CI: 9.6%-20.9%) and 11.9% (6.6-17.5) in T1DM and T2DM, respectively. Low family monthly income (adjusted odds ratio (AOR)=4.4, 95%CI: 1.05-18.40) among T2DM, longer duration of diabetes (AOR=10.9, 95%CI: 2.94-40.4) among T1DM (AOR=3.54, 95CI: 1.06-11.8) among T2DM and poor glycemic control (AOR=3.93, 95%CI: 1.06-14.5) and hypertension (AOR=5.86, 95%CI: 1.20-28.6) among T1DM and BMI (AOR=4.79, 95%CI: 1.35-17.00) among T2DM were significantly associated with STDR. CONCLUSION AND RECOMMENDATION The prevalence of STDR was high. Low family monthly income, longer duration of diabetes, poor glycemic control, hypertension and obesity were positively associated with STDR. Early screening of STDR and improving diabetes self management in all diabetes patients were recommended.
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Affiliation(s)
- Getasew Alemu Mersha
- Department of Optometry, School of Medicine, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Asamere Tsegaw Woredekal
- Department of Ophthalmology, School of Medicine, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Matyas Tilahun Tesfaw
- Department of Ophthalmology, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
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Fuchs S, Ernst AU, Wang LH, Shariati K, Wang X, Liu Q, Ma M. Hydrogels in Emerging Technologies for Type 1 Diabetes. Chem Rev 2020; 121:11458-11526. [DOI: 10.1021/acs.chemrev.0c01062] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Stephanie Fuchs
- Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Alexander U. Ernst
- Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Long-Hai Wang
- Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Kaavian Shariati
- Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Xi Wang
- Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Qingsheng Liu
- Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Minglin Ma
- Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, United States
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Rajalakshmi R, Shanthirani CS, Anandakumar A, Anjana RM, Murthy GVS, Gilbert C, Mohan V. Assessment of diabetic retinopathy in type 1 diabetes in a diabetes care center in South India-Feasibility and awareness improvement study. Indian J Ophthalmol 2020; 68:S92-S95. [PMID: 31937740 PMCID: PMC7001175 DOI: 10.4103/ijo.ijo_1851_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The prevalence of youth-onset diabetes, both type 1 diabetes (T1D) and young-onset type 2 diabetes (YT2D) are gradually increasing in India. Early and repetitive screening for diabetic retinopathy (DR) is essential to provide timely management, and thereby prevent visual impairment due to the silent sight-threatening microvascular complication of diabetes. A study was undertaken at a diabetes care center in Chennai, south India, to assess the feasibility of screening for DR in T1D in a diabetes clinic and determine the burden of sight-threatening DR (STDR) in individuals with T1D. 315 people with T1D were screened for DR (mean age at onset of diabetes 12.3 ± 6.4 years) by digital retinal color photography, at the urban diabetes center, in a semi-urban and rural diabetes clinic. Counseling about diabetes and the importance of annual screening for retinopathy was provided by diabetes educators. Participants were reviewed after 6 months/1 year based on ophthalmologist's advice. DR was detected in 37.1% (n = 117), 42 (13%) of whom had STDR.Three-quarter participants were compliant with the annual follow-up retinal examination. The peer support group was established for participants with T1D and their families to foster interactions with service providers. The peer group meetings helped to increase the awareness of retinopathy among the parents and individuals with T1D. This narrative provides details of the study that shows that screening for DR among individuals with T1D in a diabetes clinic is a feasible model, irrespective of its location.
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Affiliation(s)
- Ramachandran Rajalakshmi
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - Amutha Anandakumar
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - G V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India, India DR Partners Implementation Consortium, Hyderabad, Telangana, India
| | - Clare Gilbert
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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20
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Yardley JE. The Athlete with Type 1 Diabetes: Transition from Case Reports to General Therapy Recommendations. Open Access J Sports Med 2019; 10:199-207. [PMID: 31827338 PMCID: PMC6902845 DOI: 10.2147/oajsm.s149257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/27/2019] [Indexed: 12/03/2022] Open
Abstract
Fear of hypoglycemia is a common barrier to exercise and physical activity for individuals with type 1 diabetes. While some of the earliest studies in this area involved only one or two participants, the link between exercise, exogenous insulin, and hypoglycemia was already clear, with the only suggested management strategies being to decrease insulin dosage and/or consume carbohydrates before and after exercise. Over the past 50 years, a great deal of knowledge has been developed around the impact of different types and intensities of exercise on blood glucose levels in this population. Recent decades have also seen the development of technologies such as continuous glucose monitors, faster-acting insulins and commercially available insulin pumps to allow for the real-time observation of interstitial glucose levels, and more precise adjustments to insulin dosage before, during and after activity. As such, there are now evidence-based exercise and physical activity guidelines for individuals with type 1 diabetes. While the risk of hypoglycemia has not been completely eliminated, therapy recommendations have evolved considerably. This review discusses the evolution of the knowledge and the technology related to type 1 diabetes and exercise that have allowed this evolution to take place.
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Affiliation(s)
- Jane E Yardley
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Edmonton, Canada.,Augustana Faculty, University of Alberta, Camrose, Canada.,Women's and Children's Research Institute, Edmonton, Canada
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21
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Laiginhas R, Madeira C, Lopes M, Neves JS, Barbosa M, Rosas V, Carvalho D, Falcão-Reis F, Falcão M. Risk factors for prevalent diabetic retinopathy and proliferative diabetic retinopathy in type 1 diabetes. Endocrine 2019; 66:201-209. [PMID: 31407162 DOI: 10.1007/s12020-019-02047-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Age at diagnosis of type 1 diabetes (DM1) has been implied as an important factor associated with the development of the microvascular complications. Our aim was to identify factors associated with prevalent diabetic retinopathy (DR) and proliferative diabetic retinopathy (PDR) in DM1 people with early and late-onset. METHODS We reviewed medical records from all DM1 people from the reference area of a tertiary center (about 340,000 persons). Univariate and multivariate logistic regression were used to assess the relationship between potential risk factors (sociodemographic, diabetes-related, co-morbidities, and laboratory parameters) and prevalent DR/PDR. We performed an analysis comparing patients diagnosed before (early-onset) and after (late-onset) 18 years of age. RESULTS We included 140 patients in early-onset DM1 group and 169 in late-onset DM1 group. Longer duration of diabetes and HbA1c remained associated with prevalent DR in both groups after adjusting for potential risk factors. Nephropathy was associated with prevalent DR in the late-onset group but not in the early-onset group. Peripheral neuropathy remained associated with prevalent PDR when modeled together in the multivariate model. High BMI demonstrated a significative association with PDR in early but not in the late-onset DM1 group. CONCLUSIONS Although previous reports suggest that age at DM1 diagnosis may have a role in DR prevalence, the risk factors for DR in early and late-onset DM1 were similar for both groups. Duration of disease and lifelong metabolic control were the major predictors for DR in both groups. Nephropathy was associated with DR in patients with late-onset disease. Neuropathy was associated with PDR occurrence in both groups. BMI was associated with PDR early-onset DM1 group.
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Affiliation(s)
- Rita Laiginhas
- Faculty of Medicine, Porto University, Porto, Portugal
- Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal
| | - Miguel Lopes
- Faculty of Medicine, Porto University, Porto, Portugal
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Margarida Barbosa
- Faculty of Medicine, Porto University, Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar de São João, Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Vitor Rosas
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Faculty of Medicine of Porto University, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal.
- Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal.
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22
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Thomas RL, Halim S, Gurudas S, Sivaprasad S, Owens DR. IDF Diabetes Atlas: A review of studies utilising retinal photography on the global prevalence of diabetes related retinopathy between 2015 and 2018. Diabetes Res Clin Pract 2019; 157:107840. [PMID: 31733978 DOI: 10.1016/j.diabres.2019.107840] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
AIMS The purpose of this study is to assess the prevalence of diabetic retinopathy (DR) world-wide from articles published since 2015 where the assessment of the presence and severity of DR was based on retinal images. METHODS A total of 4 databases were searched for the MESH terms diabetic retinopathy and prevalence. Of 112 publications 32 studies were included and individual data pooled for analysis. The presence of any DR or diabetic macular edema (DME) was recorded and severity as mild, moderate or severe non-proliferative DR (NPDR), proliferative DR (PDR) and DME and/or clinically significant macular edema (CSME). The level of severity of DR reported refer to persons with diabetes and not individual eyes. RESULTS The global prevalence of DR and DME, for the period 2015 to 2019 were 27.0% for any DR comprising of 25.2%, NPDR, 1.4% PDR and 4.6% DME. The lowest prevalence was in Europe at 20.6% and South East Asia at 12.5% and highest in Africa at 33.8%, Middle East and North Africa 33.8%, and the Western Pacific region at 36.2%. CONCLUSIONS This study illustrated difficulties in deriving a meaningful global prevalence rate for DR and DME due to the lack of uniformity in defining the study populations, methodological differences, retinal image capture and grading criteria. Therefore, international consensus is required using a minimal data set for future studies.
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Affiliation(s)
- R L Thomas
- Diabetes Research Unit Cymru, Swansea University, Wales, United Kingdom
| | - S Halim
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - S Gurudas
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - S Sivaprasad
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - D R Owens
- Diabetes Research Unit Cymru, Swansea University, Wales, United Kingdom.
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23
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Berger S, Andersen R, Dorenberg E, Meyer T, Weiss I, Smaastuen MC, Rosseland LA. Quality of life in patients with vascular malformations outside the central nervous system: Comparison with the general Norwegian population. J Plast Reconstr Aesthet Surg 2019; 72:1880-1886. [PMID: 31636028 DOI: 10.1016/j.bjps.2019.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/01/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to assess Health-Related Quality of Life (HRQoL) in a population of patients with vascular malformations outside the central nervous system (CNS) and to compare the results with data from a national reference population. METHODS In total, 111 consecutive patients above 14 years of age and referred for the first time to the national vascular malformation center from September 2011 to December 2012 were included. HRQoL was assessed using the Short-Form 36-item questionnaire (SF-36), which is a validated questionnaire with eight domains, covering both physical and mental aspects of HRQoL. The results were compared with national reference values. Possible association between HRQoL and selected demographic and clinical variables was analyzed using linear regression analysis. RESULTS The sample consisted of 47 men (42.3%) and 64 women (57.7%). The median age of patients was 27 years (range 14-63 years). Ninety-six patients (86.5%) were diagnosed with venous malformations and nine patients (8.1%) with arteriovenous malformations. Six patients had other types of malformations (9%). The patients had significantly lower SF-36 scores in all domains, except for General health, than the general population. There was a significant association between muscular involvement and lower SF-36 scores in the physical domains Bodily pain and Role limitation due to physical problems. CONCLUSIONS Our data suggest that patients with vascular malformations outside the CNS have impaired quality of life when compared with the general population. Muscular involvement seems to be associated with worse HRQoL in the physical aspects.
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Affiliation(s)
- Sigurd Berger
- Division of Radiology and Nuclear Medicine, Oslo University Hospital; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo.
| | - Rune Andersen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital
| | - Eric Dorenberg
- Division of Radiology and Nuclear Medicine, Oslo University Hospital
| | - Tone Meyer
- Department of Radiology, Vestfold Hospital Trust
| | | | - Milada Cvancarova Smaastuen
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Norway
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24
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Granado-Casas M, Castelblanco E, Ramírez-Morros A, Martín M, Alcubierre N, Martínez-Alonso M, Valldeperas X, Traveset A, Rubinat E, Lucas-Martin A, Hernández M, Alonso N, Mauricio D. Poorer Quality of Life and Treatment Satisfaction is Associated with Diabetic Retinopathy in Patients with Type 1 Diabetes without Other Advanced Late Complications. J Clin Med 2019; 8:jcm8030377. [PMID: 30889868 PMCID: PMC6462963 DOI: 10.3390/jcm8030377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/10/2019] [Accepted: 03/14/2019] [Indexed: 01/27/2023] Open
Abstract
Diabetic retinopathy (DR) may potentially cause vision loss and affect the patient’s quality of life (QoL) and treatment satisfaction (TS). Using specific tools, we aimed to assess the impact of DR and clinical factors on the QoL and TS in patients with type 1 diabetes. This was a cross-sectional, two-centre study. A sample of 102 patients with DR and 140 non-DR patients were compared. The Audit of Diabetes-Dependent Quality of Life (ADDQoL-19) and Diabetes Treatment Satisfaction Questionnaire (DTSQ-s) were administered. Data analysis included bivariate and multivariable analysis. Patients with DR showed a poorer perception of present QoL (p = 0.039), work life (p = 0.037), dependence (p = 0.010), and had a lower average weighted impact (AWI) score (p = 0.045). The multivariable analysis showed that DR was associated with a lower present QoL (p = 0.040), work life (p = 0.036) and dependence (p = 0.016). With regards to TS, DR was associated with a higher perceived frequency of hypoglycaemia (p = 0.019). In patients with type 1 diabetes, the presence of DR is associated with a poorer perception of their QoL. With regard to TS, these subjects also show a higher perceived frequency of hypoglycaemia.
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Affiliation(s)
- Minerva Granado-Casas
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
| | - Esmeralda Castelblanco
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain.
| | - Anna Ramírez-Morros
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Mariona Martín
- Department of Endocrinology & Nutrition, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Nuria Alcubierre
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
| | - Montserrat Martínez-Alonso
- Systems Biology and Statistical Methods for Biomedical Research, IRBLleida, University of Lleida, 25198 Lleida, Spain.
| | - Xavier Valldeperas
- Department of Ophthalmology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Alicia Traveset
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain.
| | - Esther Rubinat
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain.
| | - Ana Lucas-Martin
- Department of Endocrinology & Nutrition, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Marta Hernández
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
- Department of Endocrinology & Nutrition, University Hospital Arnau de Vilanova, 25198 Lleida, Spain.
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain.
| | - Didac Mauricio
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain.
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain.
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