Prevalence And Factors Associated With Diabetic Retinopathy, A Multi-Centric Study In Kuwait

Abstract

Background: Diabetic retinopathy (DR) remains one of the major causes of vision loss and blindness in young adults despite the availability of effective treatment. Objective: To determine the prevalence of DR among adult diabetic patients attending primary health care centers in Kuwait and to identify factors that could be associated with DR. Methods: The current study is a part of a larger multi-centric one. The first phase of the study is a cross sectional one to determine the prevalence of DR among diabetic patients attending the selected primary health care centers. The second one was a nested case-control study, whereas all patients with DR (case group n = 216) were compared with all other diabetic patients without DR (control group n = 488) to determine the associated factors with cases. A pre-designed questionnaire included socio-demographic, clinical data, in addition to health care characteristics and personal practice. Basic univariate analyses were followed by multiple logistic regression analysis. Results: The prevalence of DR among adult diabetic patients attending primary health care centers was 43.6%. Of the personal factors examined, age was the only significant determinant of DR (OR = 2.2, 95% CI: 1.1 – 5.2) and (OR = 4.6, 95% CI: 2.0 – 11.0) for age groups 50 – 59 and > 60 as compared with those < 40 years respectively. Among clinical factors, patients with type 2 – insulin treated diabetes were more prone to have DR (OR = 8.0, 95% CI: 3.5 – 19.4). Duration of diabetes was a significant predictor of DR (OR = 2.6, 95% CI: 1.61 – 4.2) and (OR = 2.8, 95% CI: 1.5 – 5.5) for a duration of 10 – 19 and > 20 years as compared with < 10 years respectively. Also, poor glycemic state and uncontrolled hypertension were associated factors (OR = 2.0, 95% CI: 1.2 – 2.8) and (OR = 3.1, 95% CI: 2.0 – 4.9) respectively. Cardiovascular complications, neuropathy, nephropathy and diabetic foot were significantly associated with DR. Within patients' practice, regular follow-up was proved to be a protective factor (OR = 0.5, 95% CI: 0.3 – 0.8) Conclusion: Regular follow-up is the strongest modifiable risk factor for DR. Old patients with longer duration of diabetes particularly those having other types of long term diabetic complications and on insulin therapy are more prone and should be regularly screened for DR.

Keywords: Diabetic retinopathy - prevalence - associated factors