Risk factors for diabetic retinopathy, diabetic macular edema, and sight-threatening diabetic retinopathy

IF 3.7 3区医学 Q1 OPHTHALMOLOGY Asia-Pacific Journal of Ophthalmology Pub Date : 2024-05-01 DOI:10.1016/j.apjo.2024.100067

Guihua Zhang , Weiqi Chen , Haoyu Chen , Jianwei Lin , Ling-Ping Cen , Peiwen Xie , Yi Zheng , Tsz Kin Ng , Mårten Erik Brelén , Mingzhi Zhang , Chi Pui Pang

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Abstract

Objective

To identify the risk factors for the development of diabetic retinopathy (DR), diabetic macular edema (DME), and sight-threatening DR (STDR) based on a city-wide diabetes screening program.

Research design and methods

Diabetic patients were prospectively recruited between June 2016 and December 2022. All patients underwent dilated fundus photography centered on the disc and macula or macular spectral domain optical coherence tomography (SD-OCT) scan. Complete medical history was documented. Systematic examination, blood analysis, and urinalysis were performed. Multivariate logistic regression analysis adjusting for age and sex was conducted.

Results

Out of 7274 diabetic patients, 6840 had gradable images, among which 3054 (42.0%) were graded as DR, 1153 (15.9%) as DME, and 1500 (20.6%) as STDR. The factors associated with DR, DME, and STDR included younger age (odds ratio [OR]: 0.96, 0.97, and 0.96 respectively), lower BMI (OR: 0.97, 0.95, and 0.95 respectively), longer duration of diabetes (OR: 1.07, 1.03, and 1.05 respectively) and positive of urinary albumin (OR: 2.22, 2.56, and 2.88 respectively). Other associated factors included elevated blood urea nitrogen (OR: 1.22, 1.28, and 1.27 respectively), higher LDL-cholesterol, lower blood hemoglobin (OR: 0.98, 0.98, and 0.98), insulin intake, presence of diabetic foot pathologies and diabetic peripheral neuropathy. We also identified novel risk factors, including high serum potassium (OR: 1.37, 1.46, and 1.55 respectively), high-serum sodium (OR: 1.02, 1.02, and 1.04 respectively). Better family income was a protective factor for DR, DME, and STDR. Alcohol consumption once a week was also identified as a protective factor for DR.

Conclusions

Similar risk factors for DR, DME, and STDR were found in this study. Our data also indicates high serum sodium, high serum potassium, low blood hemoglobin, and level of family income as novel associated factors for DR, DME, and STDR, which can help with DR monitoring and management.

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糖尿病视网膜病变、糖尿病黄斑水肿和危及视力的糖尿病视网膜病变的风险因素。

目的根据全市范围内的糖尿病筛查计划，确定发生糖尿病视网膜病变（DR）、糖尿病黄斑水肿（DME）和视力威胁性DR（STDR）的风险因素：在 2016 年 6 月至 2022 年 12 月期间前瞻性地招募了糖尿病患者。所有患者均接受了以视盘和黄斑为中心的扩张眼底照相术或黄斑光谱域光学相干断层扫描（SD-OCT）扫描。系统检查、血液分析和尿液分析均已完成。对年龄和性别进行了多变量逻辑回归分析：在 7274 名糖尿病患者中，有 6840 人获得了可分级图像，其中 3054 人（42.0%）被分级为 DR，1153 人（15.9%）被分级为 DME，1500 人（20.6%）被分级为 STDR。与 DR、DME 和 STDR 相关的因素包括年龄较小（几率比 [OR]：分别为 0.96、0.97 和 0.96）、体重指数较低（OR：分别为 0.97、0.95 和 0.95）、糖尿病病程较长（OR：分别为 1.07、1.03 和 1.05）以及尿白蛋白呈阳性（OR：分别为 2.22、2.56 和 2.88）。其他相关因素包括血尿素氮升高（OR 值分别为 1.22、1.28 和 1.27）、低密度脂蛋白胆固醇升高、血红蛋白降低（OR 值分别为 0.98、0.98 和 0.98）、胰岛素摄入量、糖尿病足病变和糖尿病周围神经病变。我们还发现了一些新的风险因素，包括高血清钾（OR 分别为 1.37、1.46 和 1.55）、高血清钠（OR 分别为 1.02、1.02 和 1.04）。较好的家庭收入是DR、DME和STDR的保护因素。每周饮酒一次也被认为是 DR 的保护因素：本研究揭示了高血清钠、高血清钾、低血红蛋白和家庭收入水平是 DR 的新型相关因素，这有助于 DR 的监测和管理。

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来源期刊

Asia-Pacific Journal of Ophthalmology OPHTHALMOLOGY-

CiteScore

8.10

自引率

18.20%

发文量

197

审稿时长

6 weeks

期刊介绍： The Asia-Pacific Journal of Ophthalmology, a bimonthly, peer-reviewed online scientific publication, is an official publication of the Asia-Pacific Academy of Ophthalmology (APAO), a supranational organization which is committed to research, training, learning, publication and knowledge and skill transfers in ophthalmology and visual sciences. The Asia-Pacific Journal of Ophthalmology welcomes review articles on currently hot topics, original, previously unpublished manuscripts describing clinical investigations, clinical observations and clinically relevant laboratory investigations, as well as .perspectives containing personal viewpoints on topics with broad interests. Editorials are published by invitation only. Case reports are generally not considered. The Asia-Pacific Journal of Ophthalmology covers 16 subspecialties and is freely circulated among individual members of the APAO’s member societies, which amounts to a potential readership of over 50,000.