Prevalence and Risk Factors for Diabetic Retinopathy The Singapore Malay Eye Study
ABSTRACT To describe the prevalence and risk factors of diabetic retinopathy in Asian Malays.
Population-based cross-sectional study.
Persons with diabetes of Malay ethnicity aged 40 to 80 years in Singapore.
Diabetes mellitus was defined as random glucose of 11.1 mmol/l or more, use of diabetic medication, or a physician diagnosis of diabetes. Retinal photographs taken from both eyes were graded for diabetic retinopathy using the modified Airlie House classification system.
Any diabetic retinopathy, retinopathy grades, macular edema, or vision-threatening retinopathy.
Of the 3261 persons who participated in this study, 757 (23.1%) had diabetes and gradable retinal photographs. In persons with diabetes, the overall prevalence of any retinopathy was 35.0% (95% confidence interval [CI], 28.2-43.4), the overall prevalence of macular edema was 5.7% (95% CI, 3.2-9.9), and the overall prevalence of vision-threatening retinopathy was 9.0% (95% CI, 5.8-13.8). Compared with men, women had significantly higher proportions with more severe diabetic retinopathy, moderate (12% vs. 4%) and severe (3% vs. 0.2%) nonproliferative retinopathy, proliferative retinopathy (7% vs. 2%), and vision-threatening retinopathy (13% vs. 3%). In multiple logistic regression, independent risk factors for any retinopathy were longer diabetes duration (odds ratio [OR], 1.07; 95% CI, 1.04-1.09, per year increase), higher hemoglobin A1(c) (OR, 1.21; 95% CI, 1.10-1.33, per % increase), hypertension (OR, 1.85; 95% CI, 1.04-3.30), and higher pulse pressure (OR, 1.34, 95% CI, 1.19-1.51, per 10-mmHg increase); older age (OR, 0.73; 95% CI, 0.57-0.93, per decade increase) and higher total cholesterol levels (OR, 0.75; 95% CI, 0.63-0.89, per 1-mmol/l increase) were protective of any retinopathy. Vision-threatening retinopathy additionally was associated with previous stroke (OR, 3.74; 95% CI, 1.24-11.26), cardiovascular disease (OR, 2.23; 95% CI, 1.08-4.62), and chronic kidney disease (OR, 4.45; 95% CI, 2.18-9.07). Female gender was not an independent risk factor for diabetic retinopathy after adjusting for metabolic and socioeconomic risk factors.
One in 10 Malay adults with diabetes in Singapore has vision-threatening diabetic retinopathy. Risk factors for retinopathy in this population are largely similar to white populations elsewhere, suggesting that control of these risk factors may reduce both the prevalence and impact of retinopathy.
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ABSTRACT: Background: Gender differences in glycaemic control and diabetes' complications have been well studied overseas but not locally. Gender is one of the non-modifiable factors for the diabetes patient but it is an important factor for effective personalized diabetes care. This paper examined the gender differences in glycaemic control and diabetes' complications. Methods: This was a registry-based observational study from May–December 2008. An online standard case record form was available for site data providers to register their diabetes patients aged 18 years old and above annually. Demographic data, diabetes duration, treatment modalities, as well as various risk factors and diabetes complications were reported. Multivariate analysis was per-formed. Results: A total of 20,646 diabetes patients were included. The majority (99.2%) had been diagnosed with type 2 diabetes mellitus (T2D); 42.8% of the sample were men; 57.1% were Malay. The mean age was 58.0 years (standard deviation (SD) = 11.49) with 77.6% of the sample being aged 50 years old and above. Despite similar diabetes control (HbA1c < 6.5%), females suffered more microvascular complications (estimated glomerular filtration rate (eGFR) <60 mls/min: X 2 = 753.54, P = <0.001) while men suffered more from macrovascular complications (ischaemic heart disease (X 2 = 57.61, P = <0.001) and stroke (X 2 = 13.87, P = <0.001)). Multivariate logistic regression analyses showed that T2D men were more likely to suffer from stroke (odds ratio (OR) = 1.21, 95% confidence interval (CI) = 0.89–1.64), ischaemic heart disease (OR = 1.55, CI = 1.35–1.78) and nephropathy (OR = 1.59, CI = 1.44–1.75). Conclusion: We observed that men suffered more diabetes-related complications despite similar glycaemic control and better risk factor control.Journal of Men s Health 08/2012; · 0.68 Impact Factor
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ABSTRACT: At present, it is difficult to determine Foveal Avascular Zone (FAZ) enlargement based on colour fundus images. Fundus image analysis presents several challenges such as high image variability, improper illumination and artifacts. A new approach for grading Diabetic Retinopathy (DR) by analysing FAZ enlargement in colour fundus image has been developed. Investigations show that FAZ area ranges can be used to indicate progression of the disease. The mean accuracy and standard deviation of ranges obtained are 92.2% and 3.22, respectively. This new approach is reliable, accurate and fast compared to the current method based on DR pathologies.International Journal of Biomedical Engineering and Technology 01/2011; 6(3):232-50. DOI:10.1504/IJBET.2011.041463
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ABSTRACT: An enlargement of foveal avascular zone (FAZ) is usually found in eyes with diabetic retinopathy (DR) resulting from a loss of capillaries in the perifoveal capillary network. Currently it is difficult to discern the FAZ area and to measure FAZ enlargement in an objective manner based on raw color fundus images. Instead, ophthalmologists observe and record the occurrences of DR pathologies for the grading of DR severity. Fundus image analysis presents several challenges such as high image variability, improper illumination and artifacts due to presence of pathologies for different patients and differing imaging conditions for the same patient. A new approach for grading the severity of DR by analyzing the FAZ enlargement in color fundus image has been developed. It is based on the binary map of retinal vasculature where the vessel ends and pathologies surrounding FAZ are derived for accurate determination of the FAZ area. The paper discusses image analysis of FAZ area for grading of DR. Results obtained show that FAZ area ranges are highly correlated to the severity of DR. The mean accuracy and standard deviation of ranges obtained are 92.2% and 3.22, respectively. This new approach is found reliable, accurate and fast compared to the current method based on DR pathologies. It has the potential to be used for mass screening of DR enabling early detection and intervention to prevent the progression of the disease and blindness.