Prevalence,risk Factors And Effects On General Quality Of Life In Patients With Type 2 Diabetes Melliitus With Diabetic Retinopathy In An Urban Community

ObjectiveThe purpose of the study was to describe the prevalence of diabetic retinopathy in patients with type 2 diabetes mellitus(T2DM)in an urban community in Gusu Suzhou,explore risk factors affecting the prevalence of diabetic retinopathy,and comprehensively assess the impact of DR(Diabetic retinopathy)on generic HRQOL(Health related quality of life)as measured by the EQ-5D-5L(EuroQol-5 Dimensions-5 level)in Chinese patients with T2DM.The study results would be valuable for the clinical management and health promotion ofT2DM patients with DR in China.MethodsThe Gusu Diabetic Retinopathy Screening Study was a community-based survey on community-dwelling patients with T2DM in Suzhou,Jiangsu Province and was conducted in2015.The inclusion criteria were type 2 diabetes patients older than 18 years old.Based on the health records,we identified a total of1247 patients with known T2DM,among whom 913(73.2%)participated in the study.For each participant,two retinal fundus photographs(one centered at the optic disc and the other on the macula)were taken for both eyes using a digital retinal camera(Canon Inc.,Japan)upon pupil dilation.Retinopathy lesions were graded according to the Airlie House classification system of the Early Treatment Diabetic Retinopathy Study.Face-to-face interviews were conducted on all patients using pre-designed questionnaires that included basic information,lifestyle habits,disease history,etc.The EQ-5D-5Lwas used for evaluating the quality of life.Physical examination includes blood pressure,HbA1C(hemoglobin a1c),etc.All data were input into EpiData3.2 to establish a database for double entry and validation.Statistical analyses were performed using SPSS(version 19.0)and SAS(version9.3)at a significance level of 0.05.ResultsAmong the 913 participants in this study,880 had gradable retinal fundus photograph in at least one eye and were included in the data analyses.The mean age of participants included in the analyses was 67.7 ± 8.3 years and there were more women than men(56%vs.44%).The mean duration of diabetes was 10.5 ±7.1 years and the mean blood level of HbA1c was 7.2 ± 1.3%mmol/L.The overall prevalence of any DR was 18.0%(95%confidence interval,95%Cl:15.5-20.6%)in this population.The prevalence was 6.4%(95%CI:4.7-8.0%)for unilateral and 11.6%(95%CI:9.5-13.7%)for bilateral DR,respectively.VTDR(vision-threatening diabetic retinopathy)affected 4.4%(95%CI:3.1-5.8%)of the study participants.The risk factors for DR and VTDR were evaluated in multivariate logistic regression models.In multivariate analyses,the presence of DR among T2DM patients was associated with decreased age(odd ratio,OR=0.97;P=0.01;per year increase),longer durations of diabetes(OR=1.03;per year increase;P=0.03),higher blood levels of HbAlc(OR=1.15;per unit increase;P=0.03).Interaction effects were not detected(all P for interaction>0.05).The presence of VTDR was significantly associated with increasing age after adjusting.Although low systolic blood pressure or HbA1C was not significantly associated with reduced DR risk in univariate analysis,a combination of reduced HbA1C and blood pressure levels showed a 43%reduction in the likelihood of DR(multivariate analysis OR=0.57,95%CI=0.33-0.99,P=0.045).The average EQ-5D-5L score for non-diabetic retinopathy was 0.983±0.067,for unilateral DR patients was 0.971±0.082,and for bilateral DR patients was 0.970±0.145.Patients with unilateral DR and bilateral DR score were significantly lower than patients without DR(P<0.05).After adjusting gender,age,education level,marital status,tea,smoking,drinking,HbA1C,diabetes course,hypertension,hyperlipidemia,diabetic foot,heart disease,diabetic nephropathy,bilateral DR scores were significantly lower(P=-0.019;95%CI:-0.037,-0.002;P=0.009)compared with no DR,and QOL scores was not significantly different in unilateral DR compared with no DR and bilateral DR.Patients with unilateral DR and bilateral DR had higher rates of problems in self-care,daily activities,and anxiety/depression than those without DR(P<0.05).After multi-factor adjustment,DR was significantly associated with problems in daily activities(OR=0.16,95%CI:0.03-0.77,P=0.02,unilateral DR vs.no DR;OR=0.1 1,95%CI:0.03-0.40,P=0.01,bilateral DR vs.no DR).However,there was no significant difference between DR patients and patients without DR.There was no significant difference in all EQ-5D dimensions between unilateral DR and bilateral DR patients(P>0.05).ConclusionsThe results of this study showed that the incidence of diabetic retinopathy in this city was 18%,of which the prevalence of unilateral DR was 6.4%,the prevalence of bilateral DR was 11.6%,and the prevalence of VTDR was 4.4%.This indicates that the incidence of diabetic retinopathy in this city is slightly lower than that in other areas.The presence of DR among T2DM patients was associated with decreased age,longer durations of diabetes,higher blood levels of HbAlc.The presence of VTDR was significantly associated with increasing age.In this screening study,we found that simultaneous reduction of systolic blood pressure and HbA1C to below the standard was associated with a possible reduction in the prevalence of DR.The DR found in this study had little effect on general quality of life.Compared with patients without DR,Chinese T2DM patients with bilateral DR had lower EQ-5D health utility scores,and bilateral DR were only related to daily activity.This conclusion can provide reference for the clinical management and health promotion of T2DM patients and DR patients in China.