ASSOCIATION BETWEEN SEVERITY OF DIABETIC RETINOPATHY WITH BIOMARKERS: A CROSS-SECTIONAL STUDY FROM A TERTIARY EYE HOSPITAL OF NEPAL
Main Article Content
Keywords
Diabetes mellitus, Diabetic retinopathy, Glycosylated Hemoglobin, Biomarkers, Nepal.
Abstract
Background
Diabetic Retinopathy is a chronic microvascular complication of diabetes mellitus. Several risk factors are associated with the development of diabetic retinopathy. This study aimed to investigate the associations of the severity of diabetic retinopathy with different biomarkers among patients with Diabetic Retinopathy.
Methods
A cross-sectional study involved 88 patients aged 40 years and older. Patients with a confirmed diagnosis of diabetic retinopathy resulting from Type 2 Diabetes mellitus were enrolled in the Vitreo-Retinal clinic of Biratnagar Eye Hospital of Nepal from April 2022 to April 2023. The diabetic retinopathy status of each patient was assessed through a comprehensive ophthalmologic examination, and grading of diabetic retinopathy was done. The duration of Diabetes mellitus, Glycosylated Hemoglobin levels, fasting blood sugar, postprandial, and several biomarkers (serum cholesterol, triglyceride, low-density lipoprotein, creatinine) of each participant were recorded and associations between the severity of DR and the duration of DM, HbA1c levels, and these biomarkers were explored.
Results
The mean age (mean ± SD) of 88 participants was 56.01 ± 9.09, with males being 69.3% of participants. According to the DR severity grading, 52.3% had Proliferative DR followed by 26.1% with severe non-proliferative DR, 14.8% with moderate non-proliferative DR, and 6.8% with mild non-proliferative DR. The vast majority (85.2%) of the patients had HbA1C levels higher than 7.0 mmol/l. There were significant associations between the severity of DR and HbA1C levels (p = 0.022) and between proliferative DR and uncontrolled fasting blood sugar levels (p=0.001). The duration of DM also exhibited a significant risk factor for the severity of DR (p = 0.001). No other biomarkers were found to have a significant association with severity of DR (all, p ≥ 0.05).
Conclusions
HbA1c levels, duration of DM, and uncontrolled fasting blood sugar levels were strongly associated with the presence and severity of DR. Findings suggest that diabetic patients with higher HbA1C, indicating uncontrolled blood sugar for a prolonged period, are at risk of developing severe DR. This study recommends regular and comprehensive eye examination in patients with Type 2 DM to avoid the late presentation of severe DR and to prevent visual impairment.
References
2. Chang Villacreses MM, Karnchanasorn R, Ou HY, Samoa R, Chuang LM, Chiu KC. The Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy. J Clin Med. 2021;10(21).
3. Cetin EN, Bulgu Y, Ozdemir S, Topsakal S, Akin F, Aybek H, et al. Association of serum lipid levels with diabetic retinopathy. Int J Ophthalmol. 2013;6(3):346-9.
4. Jeng CJ, Hsieh YT, Yang CM, Yang CH, Lin CL, Wang IJ. Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression. PLoS One. 2016;11(8):e0161897.
5. Wu L, Fernandez-Loaiza P, Sauma J, Hernandez-Bogantes E, Masis M. Classification of diabetic retinopathy and diabetic macular edema. World J Diabetes. 2013;4(6):290-4.
6. Care ADAJD. 6. Glycemic targets: standards of medical care in diabetes—2018. 2018;41(Supplement_1):S55-S64.
7. Aschner P. New IDF clinical practice recommendations for managing type 2 diabetes in primary care. Diabetes Res Clin Pract. 2017;132:169-70.
8. ATP III guidelines at-a-glance quick desk reference . [Available from: http://www.nhlbi.nih.gov/guidelines/cholesterol/atglance.pdf.
9. Pagana KD, Pagana TJ, Pagana TN. Mosby's diagnostic and laboratory test reference-E-book: Elsevier Health Sciences; 2014.
10. Almutairi NM, Alahmadi S, Alharbi M, Gotah S, Alharbi M. The Association Between HbA1c and Other Biomarkers With the Prevalence and Severity of Diabetic Retinopathy. Cureus. 2021;13(1):e12520.
11. Khan RMT, Saleem H, Bhatti SA, Sadiq MU, Sadiq MIJPJoM, Sciences H. Association of Severity of Diabetic Retinopathy with Levels of HbA1c. 2022;16(07):790-.
12. Pradhan E, Suwal B, Paudyal G. South Asia edition Community Eye Health Journal.
13. Thapa R, Paudyal G, Maharjan N, Bernstein PS. Awareness of diabetic retinopathy among diabetic patients in Nepal. Acta Ophthalmol. 2012;90(3):e242.
14. Thapa R, Bajimaya S, Sharma S, Rai BB, Paudyal G. Systemic association of newly diagnosed proliferative diabetic retinopathy among type 2 diabetes patients presented at a tertiary eye hospital of Nepal. Nepal J Ophthalmol. 2015;7(1):26-32.
15. Rema M, Premkumar S, Anitha B, Deepa R, Pradeepa R, Mohan V. Prevalence of diabetic retinopathy in urban India: the Chennai Urban Rural Epidemiology Study (CURES) eye study, I. Invest Ophthalmol Vis Sci. 2005;46(7):2328-33.
16. Thapa R, Twyana SN, Paudyal G, Khanal S, van Nispen R, Tan S, et al. Prevalence and risk factors of diabetic retinopathy among an elderly population with diabetes in Nepal: the Bhaktapur Retina Study. Clin Ophthalmol. 2018;12:561-8.
17. Bastola P, Khatiwada S, Khadka M, Dahal P, Bastola S. Diabetic retinopathy among diabetic patients at a tertiary care hospital: a descriptive cross-sectional study. Journal of the Nepal Medical Association. 2022;60(247):234.
18. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin Epidemiologic Study of diabetic retinopathy. XIV. Ten-year incidence and progression of diabetic retinopathy. Arch Ophthalmol. 1994;112(9):1217-28.
19. Krishnaiah S, Das T, Nirmalan PK, Shamanna BR, Nutheti R, Rao GN, et al. Risk factors for diabetic retinopathy: Findings from The Andhra Pradesh Eye Disease Study. Clin Ophthalmol. 2007;1(4):475-82.
20. Shrestha A, Suwal R, Shrestha R, Khadka DJNJoO. Burden and Risk Factors of Diabetic Retinopathy Among Diabetic Patients Attending a Multispecialty Tertiary Eye Hospital in Nepal. 2022;14(1):82-92.
21. Shakya K, Shrestha J, Joshi SJNJoOaBP-rAJotNOSN. Association between diabetic retinopathy and serum lipoproteins level. 2009;1(2):107-13.
22. Klein R, Klein BE, Moss SE, Davis MD, DeMets DLJAoim. Is blood pressure a predictor of the incidence or progression of diabetic retinopathy? 1989;149(11):2427-32.
23. Zhang X, Kumari N, Low S, Ang K, Yeo D, Yeoh LY, et al. The association of serum creatinine and estimated glomerular filtration rate variability with diabetic retinopathy in Asians with type 2 diabetes: A nested case-control study. Diab Vasc Dis Res. 2018;15(6):548-58.
24. Wang Q, Cheng H, Jiang S, Zhang L, Liu X, Chen P, et al. The relationship between diabetic retinopathy and diabetic nephropathy in type 2 diabetes. 2024;15:1292412.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Lily Rajbanshi
Assistant Professor, Ophthalmologist / Vitreo Retina Consultant and Phaco Surgeon, Biratnagar Eye Hospital, Biratnagar, Nepal.
Dr. Nistha Shrestha
Ophthalmologist / Vitreo - Retina Fellow, Biratnagar Eye Hospital, Biratnagar, Nepal.
Dr. Sristi Thakur
Ophthalmologist / Vitreo Retina Fellow, Biratnagar Eye Hospital, Biratnagar, Nepal.