Author: Maria Syriga (Greece)
Co-authors: Zina Ioannou, Christos Pitsas, Ioanna Dagalaki, Michael Karampelas
Diabetic retinopathy comprises one of the most devastating microvascular complications associated with diabetes mellitus. Among the large number of risk factors influencing the pathophysiology of the disease, ethnicity has been shown to play a significant role in terms of the prevalence and progression of diabetes. Mediterranean populations are known to have a healthier profile as far as cardiovascular mortality rate is concerned. Thus, the effect of ethnic background should also be taken under consideration in the context of microvascular entities, including diabetic retinopathy. The aim of this study was to report the prevalence of diabetic retinopathy and maculopathy in a cohort of Greek diabetic patients and identify patient characteristics as possible risk factors associated with this entity.
This is a population-based, non-interventional, cross-sectional study conducted in diabetic Greek patients who attended the medical retina clinics of Hippokration General hospital of Athens during a period of one year.
Clinical and imaging data, including OCT scans were obtained. Retinal photographs were graded based on the newest modification of the International Clinical Disease Severity Scale classification system for diabetic retinopathy. Statistical analysis was performed using Statistical Package for the Social Sciences, version 2019 (SPSS Inc, Chicago, IL). Categorical data was described as absolute numbers and percentages while numerical variables as mean and ± standard deviation. Normality was tested with Q-Q plots. Confidence intervals (CI) at 95% and statistically significant p values ≤0.05 were set.
A total of 300 diabetic patients were included. Of these patients, 21 (7%) were diagnosed with diabetes mellitus type I and 279 (93%) with diabetes mellitus type II. The average duration of diabetes was 15 ± 9.4 years (95% CI, 13.9-16.1%) and the mean level of HbA1c was 7.2 ± 1.3 (95% CI, 7.1-7.4). Prevalence of diabetic retinopathy was 38.7% (116 patients), only 15 patients (5%) had proliferative diabetic retinopathy and cystoid macular oedema was detected in 19 patients (6.3%). Good glycemic control was recorded in 157 patients (52.3%), while 16 patients (5.3%) and 21 (7%) were previously subjected to panretinal photocoagulation and intravitreal anti-VEGF treatment, respectively. Patients diagnosed with any stage of diabetic retinopathy had statistically significant longer history of diabetes (p=0.000), poor glycemic control (p=0.009) and were more likely to be on medication for hypertriglyceridemia (p=0.000) compared to those with no diabetic retinopathy. Binary logistic regression analysis identified duration of diabetes (p=0.000), HbA1c levels (p=0.033) and hypertriglyceridemia (p=0.001) as risk factors for the development of diabetic retinopathy, while age, gender and other co-morbidities, including hypertension and hypercholesterolemia did not present any statistically significant association with the presence or stage of diabetic retinopathy.
The current study is the first attempt to present the extend and severity of diabetic retinopathy in Greek diabetic patients and also identify risk factors associated with this entity. The prevalence of diabetic retinopathy in this cohort was 38.7% and the majority (93%) had diabetes mellitus type II. Longer duration of diabetes, poor glycemic control and hypertriglyceridemia were identified as risk factors for the development and progression of diabetic retinopathy. Given the absence of a national screening program in Greece, our findings highlight the need for such a program in order to facilitate early diagnosis of diabetic retinopathy with special consideration to susceptible patient groups.
The authors received no financial support for the research, authorship and/or publication of this work.