|Year : 2013 | Volume
| Issue : 4 | Page : 366-369
Frequency of diabetic retinopathy in patients with diabetes mellitus and its correlation with duration of diabetes mellitus
Piyush Bansal, Rajendra P Gupta, Megha Kotecha
Department of Ophthalmology, Padmashree Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Web Publication||17-Sep-2013|
Rajendra P Gupta
Padmashree Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Dr D Y Patil Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Purpose : To evaluate the correlation between diabetic retinopathy (DR) and duration of diabetes mellitus (DM). Materials and Methods : A cross-sectional study was carried out in 500 patients who were reported diabetics or newly diagnosed diabetics referred for screening for DR. Patients with posterior segment disease in whom posterior segment was not visualized were excluded from the study. A detailed evaluation of patients diabetic and hypertensive status was done along with their detailed ophthalmological examination. All patients were investigated for blood sugar levels, urine sugar levels, and HbA 1 C. Grading of DR was done by the ETDRS grading system. Results : Total prevalence of DR is 32%. Among these, non-proliferative diabetic retinopathy (NPDR) is seen in 71.88% and proliferative diabetic retinopathy (PDR) in 28.12% patients. This study shows an increasing prevalence of DR with increasing duration of DM. The prevalence of DR was seen to be 9.44% when duration of diabetes detected was less than 5 years and was 76.47% in patients with diabetes of more than 20 to 25 years. Conclusion : There is an increasing prevalence of DR with increase in duration of DM. All patients having diabetes of more than 25 years were found to have retinopathy.
Keywords: Diabetic macular edema, Diabetic retinopathy, Non-proliferative diabetic retinopathy, Proliferative diabetic retinopathy.
|How to cite this article:|
Bansal P, Gupta RP, Kotecha M. Frequency of diabetic retinopathy in patients with diabetes mellitus and its correlation with duration of diabetes mellitus. Med J DY Patil Univ 2013;6:366-9
|How to cite this URL:|
Bansal P, Gupta RP, Kotecha M. Frequency of diabetic retinopathy in patients with diabetes mellitus and its correlation with duration of diabetes mellitus. Med J DY Patil Univ [serial online] 2013 [cited 2021 Oct 27];6:366-9. Available from: https://www.mjdrdypu.org/text.asp?2013/6/4/366/118267
| Introduction|| |
Diabetes mellitus can no longer be considered a disease of affluent nation alone, it has become a global problem, a major epidemic of the 21 st century, and one which shows no sign of abating. 
India, the world's second most populous country, now has more number of people with type 2 diabetes than any other nation. Calling India the diabetes capital of the world, the International Journal of Diabetes in Developing Countries says that there is an alarming rise in. 
Diabetes is traditionally known as the "silent disease," exhibiting no symptoms until it progresses to severe target organ damage.  Case detection, therefore, requires active and opportunistic screening efforts. However, even when diagnosed, inadequate glycemic control results in seriously disabling or life-threatening complications.
The prevalence of diabetes mellitus is growing rapidly worldwide and is reaching epidemic proportions. , IDF says "New figures indicate that the number of people living with diabetes is expected to rise from 366 million in 2011 to 552 million by 2030, if no action is taken. This equates to approximately 3 new cases every 10 seconds or almost 10 million per year."  In 2011, IDF estimated that India alone has 61.3 million people living with diabetes.
DM is a major systemic cause of blindness in the major part of the world. It is now considered to be a heterogenous group of syndrome in which not only carbohydrate metabolism but metabolism of lipid and proteins are also deranged. The associated metabolic deregulation causes secondary pathophysiological changes in multiple organ systems that impose a tremendous burden on the health care system.
More number of diabetics is encountered in the elderly age group. It is expected that the demographic shift toward a larger ageing population in India will have an effect on the pattern of chronic diseases and their complications.
Type 1 diabetics typically have a faster progression of DR and more commonly lose vision due to PDR. Type 2 diabetics, who outnumber type 1 patients (9:1), lose vision more commonly due to diabetic macular edema (DME). ,,
Diabetic retinopathy (DR) however is an end organ response to a systemic disease, representing only one of many microvascular and macrovascular diabetic complications. The newer evolving techniques and technology have improved the diagnostic accuracy of screening methods and access of the diabetic patients to specialist care. In spite of this progress, DR remains a significant cause of acquired visual loss in working-age adults worldwide. Patients with DR are 25 times more likely to be blind than are non-diabetic patients of similar age and gender. 
Application of current standards of care demonstrates that most severe vision loss from diabetes is preventable.
Aims and objectives
- To calculate the frequency of DR in patients with diabetes mellitus.
- To evaluate the correlation between DR and duration of diabetes mellitus.
| Materials and Methods|| |
This study was conducted at a tertiary care hospital of a medical college in Pune from June 2007 to September 2010. Ethical committee approval was obtained. Consent was taken in all cases and a separate specific consent was taken for FFA. A cross-sectional institutional study was carried out on 500 patients who were reported diabetics or newly diagnosed diabetics referred for screening for DR. Patients with posterior segment disease in whom posterior segment was not visualized were excluded from the study.
Complete history was taken including age of onset of DM, duration of DM, any treatment for DM, any ocular treatment, and any other systemic illness/co-morbid disease.
A detailed ophthalmological examination was done which included the following:
Visual acuity measurement using Snellen's distant vision chart and Jaeger's near vision chart
Examination of lids, Lacrimal system
Examination of conjunctiva
Detailed examination of the anterior segment, cornea, AC, iris (for neo-vascularization) and lens by a slit lamp bio-microscope
Measurement of IOP.
Gonioscopy was done in cases with a shallow anterior chamber or occludable anterior chamber angle. While doing Gonioscopy, neo-vascularization of the angle of anterior chamber was also looked for.
Fundus examination by a direct ophthalmoscope, indirect ophthalmoscope and slit lamp biomicroscopy with a 90D lens after dilating the pupil using tropicamide with phenylephrine.
Fundus examination was done to see for media, vitreous hemorrhage, pre-retinal hemorrhage, background retina for micro-aneurysms, hemorrhage, hard and soft exudates, venous beading, IRMAs, NVD, NVE, fibrovascular fronds in the vitreous, tractional retinal detachment, combined retinal detachment, and clinically significant macular edema (CSME). Severity of maculopathy and severity of retinopathy was noted.
Any evidence of hypertensive retinopathy, branch retinal vein occlusion, central retinal vein occlusion, age-related macular degeneration, macular scar was noted.
Fundus fluoroscein angiography was done after taking a written informed consent. All patients were investigated for blood sugar levels, urine sugar levels and HbA 1 C, blood urea, creatinine, cholesterol, and serum triglyceride
Grading of DR was done by the ETDRS grading system.
After complete evaluation, the patient was counselled and appropriate treatment was advised.
| Results|| |
All the 500 patients studied had duration of diabetes mellitus ranging from 1 to 29 years. Their age ranged from 34 to 78 years. The mean age of the patients without DR was 54 years while the mean age of the patients having DR was found to be 66 years.
This study has revealed the following:
Duration of diabetes was directly associated with Diabetic Retinopathy [Figure 1] and [Table 1]. Out of the 500 diabetics, 32% (160/500) had diabetic retinopathy, out of which 28.12% (45/160) was proliferative diabetes retinopathy [Figure 2] and 71.88% (115/160) was non proliferative diabetes retinopathy [Figure 3]. Corelation between HbA1C levels and diabetes retinopathy is shown in [Table 2], while the effect of diabetes retinopathy on vision is shown in [Table 3].
|Figure 1: Co-relating diabetic retinopathy with the duration of diabetes mellitus.|
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|Table 1: Association of diabetic retinopathy with duration of diabetes mellitus |
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| Discussion|| |
500 cases of DM were studied to measure the prevalence of DR and it was correlated with the duration of DM
Prevalence of DR
Two clinic-based studies showed prevalence rates of DR in DM type II patients in South India 34.1% and 37%, respectively. ,
Agarwal et al showed the prevalence rate of 28.9%. 
A study done by Narendran et al showed an overall prevalence rate of DR to be 26.2%. Out of which NPDR was seen in 94.1% cases. 
Our present study has revealed the total prevalence of DR to be 32% which corroborates with the previous studies.
In our study, NPDR is seen in 71.88% and PDR is seen in 28.12%. It does not corroborate with the previous study done by Narendran et al. In our study we have more patients presenting with PDR. This may be due to the reason that patients with longer duration of diabetes are more in our study.
The Z values for duration of diabetes 0-5 years is -12.2995 and for 5-10 years is 0.217391 which are found to be insignificant. Z values have been found to be 4.136691 for duration of 10-15 years, 3.911343 for 15-20 years, 6.010929 for 20-25 years which are found to be significant. Hence, in all the patients having DM of 10 years or longer duration should be screened for DR.
Z values in patients having diabetes more than 25 years is found to be infinity hence there is high likelihood of all patients of more than 25 years of diabetes to have DR.
Agarwal et al study has shown the maximum prevalence of DR in patients of >15 years of diabetes to be 52.2%. 
This study shows an increasing prevalence of DR with increasing duration of diabetes. In our study also we have a 62% prevalence of DR with duration of DM of 16-20 years, but higher prevalence in 20-25years duration of DM and retinopathy was found to be maximum in patients with diabetes of more than 25 years.
More number of cases were reported with poor glycemic control but that is not statistically significant. There were three cases of PDR and eight cases of NPDR where the glycemic control was good but still patients had DR. It may be due to the fact that glycemic control only depicts the past 90 days control, may be because earlier control might not be good or diabetes may be of longer duration. Similarly, in 3 cases having HbA 1 C > 11.50, there was no DR. In these cases duration of diabetes was short.
Visual status was poor in PDR as compared to that in non-DR. In some cases not having DR, vision was also diminished due to early senile lens changes.
The limitation of the study was that it was an institutional-based study and not population based.
| Conclusion|| |
The presence of diabetic retinopathy is found to be minimal (9.44%) in less than 5 years of diabetes age. It is more in patients having diabetes of duration 20-25 years (76.47%) and in all patients with duration of diabetes more than 25 years. PDR was found to be present more in patients having DM of longer duration.
All the patients having diabetes mellitus of 10 years or longer duration should be screened for diabetic retinopathy.
Poor glycemic control revealed increased incidence of diabetic retinopathy but it is not found to be statistically significant.
The mean age of the patients having diabetic retinopathy was found to be 66 years; hence, all the diabetic patients in this age group should be screened for diabetes retinopathy with high suspicion.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]
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