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Open Access Research article

Retinopathy among young adults with Diabetes Mellitus from a tertiary care setting in Sri Lanka

Prasad Katulanda12*, Yasindu C Waniganayake3, Priyanga Ranasinghe4, WM Udai Akalanka Wijetunga3, Mahesh Jayaweera3, Nishantha P Wijesinghe3, Rezvi Sheriff1 and David R Matthews2

Author Affiliations

1 Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, Sri Lanka

2 Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom

3 Ministry of Health Care and Nutrition, Colombo, Sri Lanka

4 Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

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BMC Endocrine Disorders 2014, 14:20  doi:10.1186/1472-6823-14-20

Published: 4 March 2014

Abstract

Background

Diabetic retinopathy (DR) is one of the leading causes for complete loss of vision among working-aged adults around the world. The present study aims to evaluate the rate of DR and its risk factors among the adults with young-onset diabetes from a tertiary care setting in Sri Lanka.

Methods

A consecutive sample of 1,007 individuals referred from multiple centers, were invited for the study. Ophthalmological evaluation was done, with dilated indirect ophthalmoscopy by an Ophthalmologist. Retinopathy was classified according to the International Clinical DR Disease Severity Scale. An interviewer-administered questionnaire was used to collect socio-demographic and anthropometric details. Seated blood pressure, Fasting Blood Glucose (FBG), HbA1c and urine microalbumin were also measured. Data were analysed using SPSSv14. A binary logistic regression analysis was performed in all patients, with ‘presence of DR’ as the dichotomous dependent variable and other independent covariates.

Results

Sample size was 684 (response rate–67.9%), mean age was 37.1 ± 5.9 years and 36.0% were males. Mean duration of diabetes was 5.2 ± 4.0 years. Previous retinal screening had been done in 51.0% by a non-specialist doctor and in 41.5% by a consultant ophthalmologist. Rate of any degree of DR in the study population was 18.1% (Males 16.4%, Females 20.0%; P = NS). In patients with DR, majority had mild Non-Proliferative DR (NPDR) (57.2%), while 32.2% had moderate NPDR, 0.8% had severe NPDR and 9.7% had maculopathy. Mean age, duration of diabetes, systolic (SBP) and diastolic blood pressure (DBP), FBG, HbA1c and urine microalbumin levels were significantly higher amongst the patients with DR. The results of the binary logistic regression indicate that the duration of diabetes (OR:1.24), HbA1c (OR:1.19), age (OR:1.11), urine Microalbumin (OR:1.11) and DBP (OR:1.04) all were significantly associated with DR.

Conclusions

In this large multi center study, nearly one in five adults with young-onset diabetes was found to have retinopathy. Age, duration of diabetes, HbA1C and urine Microalbumin levels were significantly associated with the presence of retinopathy, while HbA1c was also a significant factor determining severity. Nearly 50% of the study population has never undergone retinal screening by an ophthalmologist, highlighting the need for well organized screening programs.

Keywords:
Diabetic retinopathy; Diabetes mellitus; Rate; Young-onset diabetes; Sri Lanka