Ranjit Mohan Anjana

Centre for IT Education, Bhubaneswar, Orissa, India

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Publications (71)138.42 Total impact

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    ABSTRACT: To assess the relationship between regularity of follow-up and risk of complications in patients with type 2 diabetes (T2DM) followed up for 9 years at a tertiary diabetes center in India. We compared glycemic burden [cumulative time spent above a HbA1c of 53 mmol/mol (7 %)] and incidence of diabetes complications (retinopathy, neuropathy, nephropathy, peripheral arterial disease, coronary heart disease) between 1,783 T2DM patients with "regular follow-up" (minimum of three visits and two HbA1c tests every year from 2003 to 2012), and 1,798 patients with "irregular follow-up" (two visits or less and one HbA1c or less per year during the same time period), retrospectively identified from medical records. Cox proportional hazards models were used to estimate risk associated with diabetes complications. Compared to those with regular follow-up, the irregular follow-up group had significantly higher mean fasting and postprandial plasma glucose, HbA1c, glycemic burden, total and LDL cholesterol, and triglycerides at every time point during the 9 years of follow-up. Those with irregular follow-up had double the total and mean monthly glycemic burden and 1.98 times higher risk of retinopathy (95 % CI 1.62, 2.42) and 2.11 times higher risk of nephropathy (95 % CI 1.73, 2.58) compared to those with regular follow-up, even after adjusting for time-varying confounding variables. Complications tended to develop significantly earlier and were more severe in those with irregular follow-up. Among patients with type 2 diabetes, regular follow-up was associated with significantly lower glycemic burden and lower incidence of retinopathy and nephropathy over a 9-year period.
    Acta Diabetologica 12/2014; · 3.68 Impact Factor
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    ABSTRACT: Abstract Aim: This study looked at the association of adipokines, inflammatory and oxidative stress markers in subjects with the following phenotypes: metabolically healthy, nonobese (MHNO), metabolically healthy, obese (MHO), metabolically obese, nonobese (MONO), and metabolically obese, obese (MOO). Materials and Methods: Subjects with MHNO (n=462), MHO (n=192), MONO (n=315), and MOO (n=335) were randomly selected from the Chennai Urban Rural Epidemiology Study. Adiponectin, visfatin, resistin, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), oxidized low-density lipoprotein (LDL), and monocyte chemoattractant protein-1 (MCP-1) were measured by enzyme-linked immunosorbent assay. Results: Levels of adiponectin were lowest in the MOO group, followed by the MONO, MHO, and the MHNO groups (P=0.042), whereas the levels of visfatin (P=0.042) and resistin (P=0.043) were highest in the MOO group, followed by the MONO, MHO, and the MHNO groups. Levels of hs-CRP (P=0.029), TNF-α (P=0.036), IL-6 (P=0.042), oxidized LDL (P=0.036), and MCP-1 (P=0.039) increased from the MHNO to MHO to MONO to MOO phenotypes. Linear regression analysis of the parameters with body mass index (BMI) and metabolic syndrome components showed that adiponectin is negatively associated with abdominal obesity (β=-0.060; P=0.039) and BMI (β=-0.076; P=0.009) and that TNF-α is negatively associated with high-density lipoprotein levels (β=0.114, P=0.049) even after adjusting for age and gender. hs-CRP (β=0.112, P=0.020) and oxidized LDL (β=0.114, P=0.050) showed a positive association with systolic blood pressure even after adjusting for age and gender. Conclusions: The metabolically obese phenotype is characterized by altered adipokine and inflammatory profiles, which could make this phenotype at high risk for type 2 diabetes mellitus and cardiovascular diseases.
    Diabetes Technology &amp Therapeutics 12/2014; · 2.29 Impact Factor
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    ABSTRACT: Background: Rapid economic development and rural-to-urban migration in low- and middle-income countries has coincided with a growth in non-communicable diseases, such as hypertension. Exposure to the urban milieu may increase the risk of hypertension through changes in diet, physical activity, and tobacco consumption. Migrants, who are exposed to both rural and urban environments, may have a different prevalence of risk factors relative to urban-born residents. Aims: This study investigates the associations between migrant status and hypertension risk factors and prevalence in Chennai, India. Methods: We surveyed 546 adults from the Center for Cardiometabolic Risk Reduction in South-Asia Surveillance study in Chennai, India. We linked individuals' migration histories with clinical and sociodemographic data. Blinder-Oaxaca regression decomposition was used to evaluate the contribution of individual risk factors to the migrant/non-migrant difference in hypertension prevalence. Results: Migrants had an 8.5% greater prevalence of hypertension than non-migrants (p=0.085). Migrants older than 50 had greater age-specific hypertension prevalences relative to non-migrants. 65.4% of the migrant/non-migrant difference in hypertension could be explained by differences in the distribution of the risk factors in our model (p=0.037); the remaining 34.6% is attributable to an unexplained "migrant effect." Implications: The higher prevalence of hypertension in migrants is not purely due to differences in known risk factors. Compared to urban-born, migrants may face different, unknown, risks for hypertension. As the share of migrants in urban India grows, further research is required to investigate causes underlying the differences in hypertension prevalence between urban-born and migrant populations.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Abstract Objectives: This study assessed the relationship between diabetic retinopathy (DR) and coronary artery diseases (CAD) in Asian Indians, who are known to be at high risk of CAD and diabetes but have lower prevalence of DR. Subjects and Methods: Type 2 diabetes subjects (n=1,736) were selected from the urban component of the population-based Chennai Urban Rural Epidemiology Study Eye Study. Four-field stereo retinal color photography was done, and DR when present was classified according to the Early Treatment Diabetic Retinopathy Study grading system. Among the 1,723 subjects with gradable fundus photographs, 12-lead electrocardiogram (ECG) was performed in 1,602 individuals, and analysis was restricted to this group. CAD was diagnosed based on documented medical history of CAD or Minnesota coding of ECGs. Results: The prevalence of CAD was significantly higher among subjects with DR compared with those without (11.3% vs. 6.7%; P=0.007). A significant association was observed between DR and CAD in subjects with glycated hemoglobin (HbA1c) levels >7% (P=0.002). After controlling for age and gender, only hard exudates were associated with CAD (P=0.032). Logistic regression analysis revealed that even after adjusting for age, gender, HbA1c, mean arterial blood pressure, smoking, serum cholesterol, triglyceride, and low-density lipoprotein cholesterol levels, DR was significantly associated with CAD among the study subjects (odds ratio [OR]=1.58; 95% confidence interval [CI], 1.00-2.49; P=0.049) and those subjects with duration of diabetes >10 years (OR=4.06; 95% CI, 1.55-10.60; P=0.004). Conclusions: This cross-sectional study shows a significant association between DR and CAD in South Indian subjects with type 2 diabetes.
    Diabetes Technology &amp Therapeutics 11/2014; · 2.29 Impact Factor
  • Journal of Diabetes and its Complications 11/2014; · 1.93 Impact Factor
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    ABSTRACT: The prevalence of obesity in adolescents and children has risen to alarming levels globally, and this has serious public health consequences. Sedentary lifestyle and consumption of calorie-dense foods of low nutritional value are speculated to be two of the most important etiological factors responsible for escalating rate of childhood overweight in developing nations. To tackle the childhood obesity epidemic we require comprehensive multidisciplinary evidence-based interventions. Some suggested strategies for childhood obesity prevention and management include increasing physical activity, reducing sedentary time including television viewing, personalized nutrition plans for very obese kids, co-curriculum health education which should be implemented in schools and counseling for children and their parents. In developing countries like India we will need practical and cost-effective community-based strategies with appropriate policy changes in order to curb the escalating epidemic of childhood obesity.
    Indian journal of endocrinology and metabolism. 11/2014; 18(Suppl 1):S17-25.
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    ABSTRACT: To assess the association of serum adiponectin and microvascular complications of diabetes in an urban south Indian type 2 diabetic population. Diabetic subjects [n=487] were included from Chennai Urban Rural Epidemiology Study (CURES). Four-field stereo retinal color photography was done and diabetic retinopathy (DR) was classified as non-proliferative DR (NPDR) or proliferative DR (PDR) according to the Early Treatment Diabetic Retinopathy Study grading system. Sight threatening DR (STDR) was defined as the presence of NPDR with diabetic macular edema, and/or PDR. Neuropathy was diagnosed if vibratory perception threshold of the great toe using biothesiometry exceeded ≥20V. Nephropathy was diagnosed if urinary albumin excretion (UAE) was ≥30μg/mg creatinine. Serum total adiponectin levels were measured by radioimmunoassay. Subjects with any microvascular complications had significantly higher levels of adiponectin levels compared to those without the complications (geometric mean: 6.1 vs. 5.3μg/mL, p=0.004). The adiponectin level was significantly higher in subjects with DR (6.8 vs. 5.5μg/mL, p=0.004) and neuropathy (5.6 vs. 6.5μg/mL, p=0.024) compared to those without. Adiponectin levels were not significantly different in subjects with and without nephropathy. Serum adiponectin levels increased with the severity of DR [No DR - 5.5μg/mL; NPDR without DME - 6.5μg/mL; STDR - 8.3μg/mL, p=0.001]. Regression analysis revealed adiponectin to be associated with microvascular disease (presence of neuropathy and/or retinopathy and/or nephropathy) (OR: 1.44, 95% CI: 1.01-2.06, p=0.049) even after adjusting for age, gender, BMI, HbA1c, diabetes of duration, serum cholesterol and triglycerides, hypertension and medication status. In Asian Indians with type 2 diabetes, serum adiponectin levels are associated with microvascular complications and also with the severity of retinopathy. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
    Clinical Biochemistry 10/2014; · 2.23 Impact Factor
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    ABSTRACT: The Diabetes in Pregnancy Study Group of India (DIPSI) guidelines recommend the non-fasting 75-g oral glucose tolerance test (OGTT) as a single-step screening and diagnostic test for gestational diabetes mellitus (GDM). The aim of this study was to compare the DIPSI criteria with the World Health Organization (WHO) 1999 and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for GDM.
    Acta Diabetologica 10/2014; · 3.68 Impact Factor
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    ABSTRACT: Aims This paper attempts to describe the patterns of exercise and the perceived benefits and barriers to exercise in an urban south Indian population. Methods Study participants were recruited from the baseline survey of the D-CLIP (Diabetes Community Lifestyle Improvement Program). Frequency, duration, type and location of exercise were assessed using a questionnaire, while a Likert type scale was used to assess perceived benefits of and barriers to exercise. Quality of life was measured using the EQ-5D. Results Out of 1281 participants (63.7% males), 24.1% reported doing ≥150 minutes of exercise/week (“exercisers”) compared to 75.9% “non-exercisers”. Exercisers were significantly older (47 vs.43 years), better educated (68.8% vs.60%), had a higher monthly income (41% vs.29.2%), consumed more fruits (38.2% vs. 25.6%) and vegetables (84.1% vs.77.7%) and had better perceived state of health (81.1% vs. 76.8%), compared to non-exercisers. Exercisers had significantly lower HOMA-IR, higher Matsuda index and lower prevalence of low HDL cholesterol compared to non-exercisers. However, there were no significant differences in cardio-metabolic risk factors like diabetes, hypertension and obesity between the two groups. Walking was the most common type of exercise. Both exercisers and non-exercisers perceived the benefits of exercising, but barriers weighed more heavily on exercise behavior. Conclusions Urgent steps are needed to improve overall exercise levels in India by addressing barriers and improving the quality of exercise performed so as to enhance overall metabolic health.
    Diabetes Research and Clinical Practice 10/2014; · 2.54 Impact Factor
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    ABSTRACT: Metformin, a standard therapy in type 2 diabetes, reduces vitamin B12 levels. Studies linking low vitamin B12 levels and cardiovascular disease are equivocal and suggest improving B12 levels may help in primary prevention. The role of vitamin B12 deficiency on cardiovascular risk factors, especially in type 2 diabetes has not been explored. The aim of this study is to investigate whether vitamin B12 deficiency in type 2 diabetes patients is associated with cardiovascular risk factors in two different ethnic groups in UK and India.
    Cardiovascular Diabetology 09/2014; 13(1):129. · 3.71 Impact Factor
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    ABSTRACT: There is little data correlating dietary fibre (DF) intake and cardiovascular risk in Asian Indians with diabetes.
    Indian journal of endocrinology and metabolism. 09/2014; 18(5):624-30.
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    ABSTRACT: Objective To assess the prevalence, incidence, etiology and factors related to progression of peripheral arterial disease [PAD] in Asian Indian type 2 diabetic patients. Methods Patients with type 2 diabetes (T2DM), with multiple doppler studies done between 2001-2011 at a tertiary diabetes center in south India, were included. Baseline clinical and biochemical characteristics and Ankle Brachial Index [ABI] measurements were abstracted from the electronic medical records. Results 2512 T2DM patients were followed for an average of 7 years. 7.6% of the study population had PAD in 2001 [women-11.8%, men- 5.1%] with an adjusted odds ratio (OR) of 3.09 [Confidence Interval (CI):1.9- 4.9] for women. Prevalent PAD was associated with increased mortality [Hazards ratio (HR) 3.3, CI:1.4-7.7]. 280 new patients of PAD were identified- crude incidence, 17/1000 patient years with higher rates in females [HR 1.94, CI:1.4-2.7]. Age and duration of diabetes were the other predictors of incident PAD. Progression of PAD was seen in 16.5% of patients, with age (p = 0.002) and HbA1c (p = 0.022) being the predictors. Conclusions Women had a higher prevalence of PAD. Older age, female gender and duration of diabetes were related to an increased incidence of PAD. An elevated HbA1c being associated with progression of PAD stresses the need for strict control of diabetes.
    Journal of Diabetes and its Complications 09/2014; · 1.93 Impact Factor
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    ABSTRACT: Abstract Aims: This study estimated the levels of glycemic control among subjects with self-reported diabetes in urban and rural areas of four regions in India. Research Design and Methods: Phase I of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) Study was conducted in a representative population of three states of India (Tamil Nadu, Maharashtra, and Jharkhand) and one Union Territory (Chandigarh) and covering a population of 213 million people. Using a stratified multistage sampling design, individuals ≥20 years of age were recruited. Glycemic control among subjects with self-reported diabetes was assessed by measurement of glycated hemoglobin (HbA1c), estimated by the Variant™ II Turbo method (Bio-Rad, Hercules, CA). Results: Among the 14,277 participants in Phase I of INDIAB, there were 480 subjects with self-reported diabetes (254 urban and 226 rural). The mean HbA1c levels were highest in Chandigarh (9.1±2.3%), followed by Tamil Nadu (8.2±2.0%), Jharkhand (8.2±2.4%), and Maharashtra (8.0±2.1%). Good glycemic control (HbA1c <7%) was observed only in 31.1% of urban and 30.8% of rural subjects. Only 22.4% of urban and 15.4% of rural subjects had reported having checked their HbA1c in the past year. Multiple logistic regression analysis revealed younger age, duration of diabetes, insulin use, and high triglyceride levels to be significantly associated with poor glycemic control. Conclusions: The level of glycemic control among subjects with self-reported diabetes in India is poor. Urgent action is needed to remedy the situation.
    Diabetes Technology &amp Therapeutics 08/2014; · 2.29 Impact Factor
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    ABSTRACT: Aim: To estimate the prevalence and clinical profile of Non Alcoholic Fatty Liver Disease (NAFLD) among young type 1 diabetes mellitus (T1DM) patients at a tertiary care diabetes centre in India.Methods: Electronic medical records of T1DM patients (age at first diagnosis of T1DM ≤25years) registered from January 1992 to May 2013, who had undergone ultrasonography and who denied history of any alcohol intake (n=736) were reviewed. NAFLD was diagnosed if there was any degree of fatty liver. Retinopathy was assessed initially by direct and indirect ophthalmoscopy and later by retinal photography, Nephropathy was diagnosed if urine protein excretion was >500 mg/day and neuropathy, if vibration perception threshold on biothesiometry was≥20 V.Results: A total of 204/736 (27.7%) T1DM patients had NAFLD. When compared to T1DM subjects without NAFLD, body mass index (18.9±4.2vs 20.2±4.7 kg/m2;p<0.001), waist circumference (67.9±13.2vs 71.9±13.3 cms;p<0.05), systolic blood pressure (110±15vs 116±18 mmHg;p<0.001) and diastolic blood pressure (72±9vs 74±10 mmHg;p<0.05) were higher, while fasting blood glucose (201±101vs 183±101mg/dl;p<0.05) and alkaline phosphatase (419 (12.5) vs 315 (15.8);p<0.001) were lower among T1DM with NAFLD. Multiple logistic regression analysis showed a significant association between NAFLD and retinopathy [OR:2.01;CI:1.13-3.43;p=0.017, after adjusting for gender, duration of diabetes, overweight/obesity, hypertension, fasting plasma glucose and nephropathy and with nephropathy [OR:1.89;CI:1.02-3.50;p=0.042), after adjusting for gender and fasting plasma glucose.Conclusions: This study suggests that NAFLD is also seen among T1DM patients and that it has an independent and significant association with retinopathy and nephropathy.
    Endocrine Practice 08/2014; 1(-1):1-24. · 2.59 Impact Factor
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    ABSTRACT: The aim of the study is to determine the prevalence of hypertension (HTN) and its risk factors in urban and rural India. In Phase I of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, individuals aged ⩾20 years were surveyed using a stratified multistage sampling design, in three states (Tamil Nadu, Maharashtra and Jharkhand) and one union territory (Chandigarh) of India. Blood pressure was measured in all study subjects (n=14 059). HTN was defined as systolic blood pressure ⩾140 mm Hg, and/or DBP ⩾90 mm Hg and/or use of antihypertensive drugs. Overall age-standardized prevalence of HTN was 26.3% (self-reported: 5.5%; newly detected: 20.8%). Urban residents of Tamil Nadu, Jharkhand, Chandigarh and Maharashtra (31.5, 28.9, 30.7 and 28.1%) had significantly higher prevalence of HTN compared with rural residents (26.2, 21.7, 19.8 and 24.0%, respectively). Multivariate regression analysis showed that age, male gender, urban residence, generalized obesity, diabetes, physical inactivity and alcohol consumption were significantly associated with HTN. Salt intake ⩾6.5 g per day, showed significantly higher risk for HTN (odds ratio: 1.4, 95% confidence interval: 1.0-1.9, P=0.042) even after adjusting for confounding variables. In conclusion, prevalence of undiagnosed HTN is high in India and this calls for regular screening.Journal of Human Hypertension advance online publication, 31 July 2014; doi:10.1038/jhh.2014.57.
    Journal of Human Hypertension 07/2014; · 2.69 Impact Factor
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    ABSTRACT: To determine the prevalence of overweight and obesity among children and adolescents in Chennai, India, using national and international age- and sex- specific body mass index (BMI) cut-off points.
    Indian pediatrics 07/2014; 51(7):544-9. · 1.01 Impact Factor
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    ABSTRACT: To study the pattern and prevalence of dyslipidemia in a large representative sample of four selected regions in India. Phase I of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study was conducted in a representative population of three states of India [Tamil Nadu, Maharashtra and Jharkhand] and one Union Territory [Chandigarh], and covered a population of 213 million people using stratified multistage sampling design to recruit individuals ≥20 years of age. All the study subjects (n = 16,607) underwent anthropometric measurements and oral glucose tolerance tests were done using capillary blood (except in self-reported diabetes). In addition, in every 5th subject (n = 2042), a fasting venous sample was collected and assayed for lipids. Dyslipidemia was diagnosed using National Cholesterol Education Programme (NCEP) guidelines. Of the subjects studied, 13.9% had hypercholesterolemia, 29.5% had hypertriglyceridemia, 72.3% had low HDL-C, 11.8% had high LDL-C levels and 79% had abnormalities in one of the lipid parameters. Regional disparity exists with the highest rates of hypercholesterolemia observed in Tamilnadu (18.3%), highest rates of hypertriglyceridemia in Chandigarh (38.6%), highest rates of low HDL-C in Jharkhand (76.8%) and highest rates of high LDL-C in Tamilnadu (15.8%). Except for low HDL-C and in the state of Maharashtra, in all other states, urban residents had the highest prevalence of lipid abnormalities compared to rural residents. Low HDL-C was the most common lipid abnormality (72.3%) in all the four regions studied; in 44.9% of subjects, it was present as an isolated abnormality. Common significant risk factors for dyslipidemia included obesity, diabetes, and dysglycemia. The prevalence of dyslipidemia is very high in India, which calls for urgent lifestyle intervention strategies to prevent and manage this important cardiovascular risk factor.
    PLoS ONE 05/2014; 9(5):e96808. · 3.53 Impact Factor
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    ABSTRACT: To describe the clinical profile, maternal and fetal outcomes, and the conversion rates to diabetes in women with gestational diabetes mellitus (GDM) seen at a tertiary care diabetes center in urban south India.
    Indian journal of endocrinology and metabolism. 05/2014; 18(3):400-6.
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    ABSTRACT: Representative data on knowledge and awareness about diabetes is scarce in India and is extremely important to plan public health policies aimed at preventing and controlling diabetes.
    Indian journal of endocrinology and metabolism. 05/2014; 18(3):379-85.
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    ABSTRACT: Aim To assess the prevalence and risk factors for diabetic retinopathy(DR) in people with young onset type 1 (T1DM-Y) and type 2 diabetes (T2DM-Y). Methods T1DM-Y(n = 150) and T2DM-Y(n = 150) participants, age between 10 and 25 years at diagnosis, had a complete clinical evaluation, biochemical assessment, and four field digital retinal colour photography. The Early Treatment Diabetic Retinopathy Study grading system was used to grade DR. Proliferative diabetic retinopathy (PDR) and diabetic macular edema(DME) were considered as sight threatening DR. Results The prevalence of any DR was 53.3%[95%CI 45.3–61.3] in T1DM-Y (duration of diabetes:12.4 ± 7.4years) and 52.7%[44.7–60.7] in T2DM-Y (11.8 ± 8.3 years). The age and gender adjusted prevalence of DR, DME and PDR prevalence were 62.5%, 10% and 7.3% in T1DM-Y,whereas 65.8%,12.7% and 9.3% in T2DM-Y respectively. In multivariable logistic regression, diabetes duration[Odds ratio(OR) 1.99per5yrs;CI1.42-2.79], waist circumference [1.28per5cm;1.05-1.56] and microalbuminuria [2.39per50μg;1.07-5.31] were associated with DR in T1DM-Y, and diabetes duration [2.18per5yrs;1.59-2.97], diastolic blood pressure [1.51per5mmHg;1.151.98], Glycated hemoglobin[1.37per%;1.07-1.75] and lower stimulated C-peptide[1.61per0.5pmol/ml;1.19-2.16;] were associated with DR in T2DM-Y. Conclusion Over half of the people with young-onset diabetes, regardless of type, have retinopathy within 10–12 years of diabetes duration, emphasizing the need for regular eye screening and aggressive control of glucose and blood pressure to prevent DR.
    Journal of diabetes and its complications 05/2014; · 2.11 Impact Factor