Diabetes mellitus and visual impairment - National Health and Nutrition Examination Survey, 1999-2004

Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3727, , USA.
Archives of ophthalmology (Impact Factor: 4.4). 10/2008; 126(10):1421-7. DOI: 10.1001/archopht.126.10.1421
Source: PubMed


To examine the prevalence and correlates of visual impairment (VI) among US adults with and without diabetes mellitus.
Using National Health and Nutrition Examination Surveys conducted during 1999-2004, we estimated the prevalence of presenting (correctable or uncorrectable), correctable, and uncorrectable VI among Americans 20 years or older with and without diabetes. Data were weighted to make estimates representative of the US civilian noninstitutionalized population. We used multivariate logistic regression to calculate odds ratios and corresponding 95% confidence intervals.
Approximately 11.0% of US adults with diabetes had some form of VI (3.8% uncorrectable and 7.2% correctable). Among those without diabetes, 5.9% had some form of VI (1.4% uncorrectable and 4.5% correctable). People with diabetes were more likely to have uncorrectable VI than those without diabetes, even after controlling for selected other factors (P < .05). Our findings also suggest a strong association between VI (correctable and uncorrectable) and older age, member of racial/ethnic minorities, lower income, and lack of health insurance, all independent of diabetes status (P < .05).
Vision loss is more common in people with diabetes than in people without diabetes. Diverse public health strategies are needed to reduce the burden of both correctable and uncorrectable VI.

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Available from: Jinan Saaddine, May 01, 2014
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    • "The number of elderly patients with type 2 diabetes is continuously increasing and many of them suffer from poor vision due to senile changes or diabetic eye complications [1-4]. Since type 2 diabetes is characterized by a progressive decline in insulin secretory function, many patients eventually require insulin therapy [5-7], which is a common problem in elderly patients with type 2 diabetes. "
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    ABSTRACT: Patients with type 2 diabetes who require insulin therapy are commonly elderly and have poor visual acuity. In this study, we examined the clinical usefulness of the indicator magnifying window (IMW) for elderly patients with type 2 diabetes. We recruited 50 patients with type 2 diabetes over the age of 60 who had used insulin pens for glucose control. They were asked to set the insulin pen at randomly selected doses with or without an IMW. We assessed dosing accuracy, convenience, self-confidence, need for eyeglasses, preference, and willingness to recommend the IMW to other patients. Although the IMW did not improve the dosing accuracy or convenience, it significantly decreased the need for eyeglasses. Overall, the clinical usefulness of the IMW is quite limited in elderly patients with type 2 diabetes.
    Full-text · Article · Apr 2013 · Diabetes & metabolism journal
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    • "Secondly, self-reported visual impairment does not permit to differentiate between uncorrectable and correctable visual impairment. Uncorrectable but not correctable visual impairment as assessed by measurements of visual acuity and automated refraction was significantly more prevalent among adults with than without diabetes in the National Health Interview and Examination Survey (NHANES) 1999–2004 after adjustment for confounders [37]. Finally, the risk of severe visual impairment due to microvascular complications increases with the duration of diabetes [40] and long-standing diabetes may be underrepresented in our survey. "
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    ABSTRACT: Background Despite the major public health impact of diabetes, recent population-based data regarding its prevalence and comorbidity are sparse. Methods The prevalence and comorbidity of diabetes mellitus were analyzed in a nationally representative sample (N = 9133) of the non-institutionalized German adult population aged 50 years and older. Information on physician-diagnosed diabetes and 20 other chronic health conditions was collected as part of the national telephone health interview survey ‘German Health Update (GEDA)’ 2009. Overall, 51.2% of contacted persons participated. Among persons with diabetes, diabetes severity was defined according to the type and number of diabetes-concordant conditions: no diabetes-concordant condition (grade 1); hypertension and/or hyperlipidemia only (grade 2); one comorbidity likely to represent diabetes-related micro- or macrovascular end-organ damage (grade 3); several such comorbidities (grade 4). Determinants of diabetes severity were analyzed by multivariable ordinal regression. Results The 12-month prevalence of diabetes was 13.6% with no significant difference between men and women. Persons with diabetes had a significantly higher prevalence and average number of diabetes-concordant as well as diabetes-discordant comorbidities than persons without diabetes. Among persons with diabetes, 10.2%, 46.8%, 35.6% and 7.4% were classified as having severity grade 1–4, respectively. Determinants of diabetes severity included age (cumulative odds ratio 1.05, 95% confidence interval 1.03-1.07, per year) and number of discordant comorbidities (1.40, 1.25-1.55). With respect to specific discordant comorbidities, diabetes severity was correlated to depression (2.15, 1.29-3.56), respiratory disease (2.75, 1.72-4.41), musculoskeletal disease (1.53, 1.06-2.21), and severe hearing impairment (3.00, 1.21-7.41). Conclusions Diabetes is highly prevalent in the non-institutionalized German adult population 50 years and older. Diabetes comorbidities including diabetes-concordant and diabetes-discordant conditions need to be considered in epidemiological studies, in order to monitor disease burden and quality of diabetes care. Definitional standards of diabetes severity need to be refined and consented.
    Full-text · Article · Feb 2013 · BMC Public Health
    • "This increase will likely result in increased visual morbidity. The important causes of blindness in subjects with diabetes includes cataract, age-related macular degeneration, glaucoma and uncorrected refractive errors.4 The National Health and Nutrition Survey conducted in the USA reported that VI was more common in diabetics than in non-diabetics.4 "
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    ABSTRACT: Purpose: To report the prevalence of visual impairment (VI) and the associated risk factors in type II diabetic subjects. Materials and Methods: The study included type II diabetes mellitus subjects who were enrolled from a cross-sectional study. Participants underwent biochemical testing and comprehensive ocular examination including stereo fundus photography. The VI was defined based on the World Health Organization criteria. Results: The prevalence of VI was 4% in the cohort. The risk factors associated with the presence of VI included a female gender, age greater than 60 years, low socio-economic status, hypertension, microalbuminuria, macroalbuminuria, neuropathy, use of insulin and alcohol. Various ocular risk factors are nuclear sclerosis, subjects who have undergone cataract surgery, myopia and sight-threatening diabetic retinopathy (STDR). After adjusting for the factors using stepwise logistic regression analysis, hypertension, use of alcohol, post-cataract surgery and myopia were not risk factors. Stepwise logistic regression analysis indicated that VI was higher among subjects older than 60 years (odds ratio (OR): 4.95 [2.67-9.15]) and those who belonged to a low socio-economic status (OR: 2.91 [1.24-6.85]). The systemic risk factors for VI included microalbuminuria (OR: 2.91 [1.59-5.33]), macroalbuminuria (OR: 4.65 [1.57-13.77]) and presence of neuropathy (OR: 1.97 [1.09-3.59]) among subjects. Subjects with nuclear sclerosis (OR: 36.82 [11.12-112.36]) and presence of STDR (OR: 4.17 [1.54-11.29]) were at a higher risk of VI. Cataract was the most common cause of VI in the cohort. Conclusion: Visual impairment, among type II diabetic subjects (4%), is a major public health problem that needs to be addressed. Cataract is the most common reversible cause of vision impairment in this population.
    No preview · Article · Mar 2012 · Middle East African journal of ophthalmology
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