糖尿病患者视网膜病变的筛查分析

目的 了解糖尿病(diabetes mellitus,DM)住院患者中糖尿病视网膜病变(diabetic retinopathy,DR)的发生情况,并探讨其相关危险因素.方法 回顾性临床调查研究.对2007年9月至2010年7月期间,在广西医科大学第一附属医院眼科住院的1610例DM患者采用眼底照相方法确立DR诊断,部分患者进行眼底血管荧光造影检查,计算DR发病率,并分析病程、年龄、发病年龄及血压对发病率的影响.结果 1610例(3201只眼)DM患者中DR发病率为30.2%,其中男性为27.3%,女性为35.0%.新确诊的340例DM患者中DR发病率为12.6%.3201只眼中,背景型DR 797只眼,占24.9%,增殖型124只眼,占3.9%.51～60岁年龄组以及在41～50岁间发病的DM患者,DR的发病率最高.45°眼底彩照与FFA检查结果比较,符率为78.1%.结论 以黄斑为中心单视野眼底照像作为早期DR的筛查方法是有效、实用且简便易行的.病程、年龄及发病年龄是DR发病的危险因素,随着病程延长其发病率显著增高.早期对DM 患者进行筛查、定期眼科检查,能及时发现病变、把握治疗时机,降低DR致盲率有着极其重要的意义.

Abstract：

Objective To determine the prevalence of diabetic retinopathy (DR) and to investigate the associated risk factors in patients with diabetes mellitus (DM).Methods Totally 1610 patients diagnosed DM by the WHO diagnostic criteria attending at the First Affiliated Hospital of Guangxi Medical University from 2007 to 2010.The data of disease history, visual acuity, eye disease and intraocular pressure were collected by inquiry and examination.Photography of ocular fundus was used to confirm the diagnosis of DR.According to the criteria of DR, diagnosis and statistics of DR were made and the relationship between the prevalence of DR and duration, age, the age of onset and blood pressure were analyzed.Results The prevalence of DR was 30.2% in 1610 diabetic patients,27.3% for male and 35.0% for female.The prevalence of DR of 340 newly onset diabetes was 12.6%.In 3201 eyes, the incidence of nonproliferative and proliferative DR (PDR) was 24.9% and 3.9%, respectively.The highest prevalence of DR was in the age group of 51 to 60 and the age of onset was 41 to 50 in patients with DM.Compared with FFA, the agreement rate of 45° fudus photography was 78.1%.Conclusions One-field mydriatic digital fudus photography centered at fovea is feasible and handy for screening of early diabetic retinopathy.Age, the age of onset and duration of disease are the risk factors of DR, longer the duration of DM, higher the incidence of DR.For early diagnosis and management of DR, the patient with DM should be examined regularly.It is very important to decrease the rate of blindness of DR.     

Prevalence and risk factors of diabetic retinopathy in children and young adults

BACKGROUND: Diabetic retinopathy (DR) is a severe complication of diabetic microangiopathy. The prevalence is low in children and increases with patient age and duration of diabetes. PATIENTS AND METHODS: Full ophthalmologic examination was completed by fluorescein angiography in 36 diabetic patients diagnosed in childhood, with duration of diabetes more than 5 years. RESULTS: After 5 years of diabetes, 44% of the patients had DR. Background retinopathy was found in 31%, preproliferative retinopathy in 5% and proliferative retinopathy in 8% of cases. DR was associated with diabetic maculopathy in 8 patients and cataract in 4 patients. DR was correlated with the age of patients at diagnosis of diabetes, time of ophthalmologic examination, sex, duration and balance of diabetes. CONCLUSION: The frequency of DR increases with the duration and the imbalance of diabetes. The importance of well balanced diabetes and regular ophthalmologic examination were necessary to decrease the frequency of DR.     

Diabetic retinopathy, visual impairment and ocular status among patients with diabetes mellitus in Yemen: A hospital-based study

Background:

We present a series of patients with diabetes mellitus (DM) who attended an eye hospital in Sana, Yemen during 2004.

Aim:

To determine the magnitude and risk factors of diabetic retinopathy (DR).

Design:

Cross-sectional study.

Materials and Methods:

Ophthalmologists assessed vision, ocular pressure, ocular media and posterior segment to note ocular manifestations among patients with DM. DR was graded by using bio-microscope and Volk lens. The prevalence and 95% confidence interval of ocular complications of DM were calculated. Risk factors of DR like age, sex, duration of diabetes and hypertension were evaluated.

Statistical Analysis:

Univariate and multivariate analysis.

Results:

Our series comprised 350 patients suffering from DM. The duration of diabetes was ≥15 years in 101 (29%) patients. Physician was treating 108 DM patients with insulin. The prevalence of DR was 55% (95% CI 49.6–60.1). The proportions of background diabetic retinopathy (BDR), preproliferative diabetic retinopathy (PPDR), proliferative diabetic retinopathy (PDR) and diabetic macular edema were 20%, 13%, 17% and 22% respectively. The prevalence of blindness among DM patients was 16%. The prevalence of cataract and glaucoma was 34.3% and 8.6%. Duration of DM was the predictor of DR. One-fifth of the patients had sight-threatening DR and needed laser treatment.

Conclusions:

DR was of public health magnitude among our patients. An organized approach is recommended to address DR in the study area.     

2型糖尿病视网膜病变与糖尿病其他并发症的相关性

目的：探讨2型糖尿病视网膜病变（ diabetic retinopathy, DR）与糖尿病的全身并发症的相关性。方法：分析2型糖尿病住院患者702例,将其分为NDR组、DR组两组,DR组又分为非增生性糖尿病视网膜病变（non－proliferative diabetic retinopathy,NPDR）组和增生性糖尿病视网膜病变（ proliferative diabetic retinopathy, PDR）组,分析DR与糖尿病大血管并发症、糖尿病肾病（ diabetic nephropathy, DN ）、糖尿病周围神经病变（ diabetic peripheral neuropathy,DPN）,糖尿病周围血管性疾病（ peripheral vascular disease of diabetes mellitus, PVD）、糖尿病足（ diabetic foot,DF）、糖尿病酮症酸中毒（ diabetic ketoacidosis,DKA）等糖尿病并发症的相关性。结果：DR的发生、发展与高血压、高血脂、颈部血管硬化、斑块,下肢动脉硬化、斑块, DN、DPN、DF及PVD等并发症有关。 PDR与高血压、DPN关系密切。结论：血管内皮损伤、微循环障碍是DR及糖尿病的全身大、小血管并发症的共同病理基础。糖尿病患者出现全身并发症时,DR的患病率增加,尤其是合并高血压、DPN时,PDR的患病率增加。所以糖尿病患者尤其是出现全身并发症者必需定期行眼底检查,以早期发现、早期治疗DR,降低致盲率。     

Prevalence and Associated Factors of Diabetic Retinopathy among Type 2 Diabetes Mellitus Patients in Brunei Darussalam: A Cross-sectional Study

PurposeTo determine the prevalence of diabetic retinopathy (DR) and the factors associated with retinopathy among type 2 diabetes mellitus (DM) patients in Brunei Darussalam.MethodsCross-sectional study of all type 2 DM patients who attended diabetic eye screening over a 3-month period at one of four government hospitals. We assessed association between DR with the following variables: age, sex, glycated hemoglobin (HbA1c), duration of DM, hypertension, hyperlipidemia, and microalbuminuria.ResultsThere were 341 patients (female, 58.9%; mean age, 55.3 ± 11.9 years) with a mean duration of DM of 9.4 ± 7.4 years and mean serum HbA1c of 8.4% ± 1.9%. The overall prevalence of any DR was 22.6% (95% confidence interval, 18.8–27.1) with prevalence rates of 4.1% (95% confidence interval, 2.1–6.4) for proliferative DR and 9.7% (95% confidence interval, 6.8–13.2) for vision-threatening DR. Multivariate analysis showed that DR was significantly associated with certain age groups (reduced in older age groups), longer duration of DM (11 years or more), poor control (HbA1c >9.0%) and presence of any microalbuminuria.ConclusionsDR affects one in five patients with DM in Brunei Darussalam, comparable to rates reported for other Asian populations. It is especially worrying that one in ten patients with DM had vision-threatening DR. DR was significantly associated with longer duration of DM, poor control and presence of microalbuminuria but reduced in older age groups. It is important to advocate good control right from the time of diagnosis of DM and institute timely and effective management of retinopathy. DR was significantly associated with longer duration of DM, poor control of diabetes, and presence of microalbuminuria but reduced in older age groups.     

Relationship of duration and onset of diabetes to prevalence of diabetic retinopathy

In a population study of all registered insulin-treated diabetic patients on the Swedish island of Gotland, the prevalence of diabetic retinopathy was determined with ophthalmoscopy, biomicroscopy, and color photography. Retinopathy was present in 173 of 368 patients (47%) and reached a prevalence of 100% after 30 years of diabetes. Proliferative retinopathy was found in 48 subjects (13%) and was more common in females (17%) than in males (9.4%) (P = .01). By simple logistic regression test, the prevalence of total and proliferative retinopathy was correlated with both duration and age at onset of diabetes (P less than .001). However, on multiple regression analysis only the relationship with duration was statistically significant (P less than .001); age at onset was not (P greater than .2). Age had an additional influence only on background retinopathy with hard exudates, which were more frequent in older subjects (P less than .01). Thus, age at onset of diabetes was not correlated with the prevalence of total or proliferative retinopathy.     

Prevalence and risk factors of diabetic retinopathy among noninsulin-dependent diabetic subjects.

In a population-based study in Taiwan, 11,478 subjects aged 40 years or older were screened for diabetes in one urban and five rural areas. Among the 715 subjects proven to have diabetes, 527 subjects underwent ophthalmoscopy. Diabetic retinopathy was present in 184 of the 527 subjects (35.0%), including background diabetic retinopathy in 157 subjects (30.0%), preproliferative diabetic retinopathy in 15 subjects (2.8%), and proliferative diabetic retinopathy in 12 subjects (2.2%). Diabetic retinopathy was correlated with the duration of diabetes and age at onset of diabetes, type of diabetes treatment, higher serum creatinine levels, and lower serum cholesterol levels. Several other factors, including gender, age, residential area, family income, educational level, control and family history of diabetes, body mass index, physical activity, exercise, cigarette smoking, stroke, ischemic heart disease, leg vessel disease, hypertension, and proteinuria, had no significant association with retinopathy. By multiple logistic regression analysis, duration of diabetes was the most important risk factor related to retinopathy. Diabetic subjects treated with insulin had a higher risk of developing retinopathy than those treated with dietary control (relative risk, 1.57; .05 < P < .10). The univariate analysis disclosed that proliferative diabetic retinopathy was related to older age at examination, older age at onset of diabetes, type of diabetes treatment, and presence of leg vessel disease. Insulin-treated diabetic subjects also had a higher risk of proliferative diabetic retinopathy than patients in whom diabetes was controlled by diet, with a relative risk of 2.51 (.05 < P < .10) in the multiple logistic regression analysis.     

The incidence of vision loss in a diabetic population

The 4-year incidence of blindness and vision loss was examined in a population-based study of diabetes mellitus. In subjects participating in baseline and 4-year follow-up examinations, the rate of blindness was 1.5, 3.2, and 2.7% in younger onset persons, older onset persons taking insulin, and older onset persons not taking insulin, respectively. The rate of blindness increased with increasing age, increasing diabetic retinopathy severity, and lower baseline visual acuity in all three groups. Blindness increased with increasing duration of diabetes in younger onset persons and older onset persons taking insulin. The incidence of vision loss, as measured by a doubling of the visual angle, was associated with older age, more severe retinopathy, and presence of macular edema in the three groups. It was also associated with duration of diabetes, presence of proteinuria, and higher glycosylated hemoglobin in younger onset and older onset persons taking insulin.     

Profile of retinal diseases in adult patients attending two major eye clinics in Kinshasa, the Democratic Republic of Congo

AIM: To investigate the anti-proliferation and apoptosis-inducing effects of Sodium Aescinate (SA) on retinoblastoma Y79 cells and its mechanism. METHODS: Y79 cells were cultured at different drug concentrations for different periods of time (24, 48, and 72h). The inhibitory effect of SA on proliferation of Y79 cells was detected by the cell counting kit-8 (CCK-8) assay, and the morphology of Y79 cells in each group was observed under an inverted microscope. An IC50 of 48h was selected for subsequent experiments. After pretreatment with SA for 24h and 48h, cellular DNA distribution and apoptosis were detected by flow cytometry. RT-qPCR and Western blot were used to assess changes in related genes (CDK1, CyclinB1, Bax, Bcl-2, caspase-9, caspase-8, and caspase-3). RESULTS: SA inhibited proliferation and induced apoptosis of Y79 cells in a time-dependent and concentration-dependent manner. Following its intervention in the cell cycle pathway, SA can inhibit the expression of CDK1 and CyclinB1 at the mRNA and protein levels, and block cells in the G2/M phase. In caspase-related apoptotic pathways, up-regulation of Bax and down-regulation of Bcl-2 caused caspase-9 to self-cleave and further activate caspase-3. What’s more, the caspase-8-mediated extrinsic apoptosis pathway was activated, and the activated caspase-8 was released into the cytoplasm to activate caspase-3, which-as a member of the downstream apoptotic effect group―initiates a caspase-cascade reaction that induces cell apoptosis. CONCLUSION: SA inhibits the proliferation of Y79 cells by arresting the cell cycle at the G2/M phase, and induces apoptosis via the caspase-related apoptosis pathway, indicating that SA may have promising potential as a chemotherapeutic drug.     

Effect of unilateral inferior oblique weakening on fundus torsion in bilateral eyes of children with congenital superior oblique palsy

AIM: To determine the frequency and types of retinal diseases in adult patients attending two public eye clinics of Kinshasa, Democratic Republic of Congo, and the extend of the related visual loss. METHODS: Review of medical records of patients with retinal diseases seen in the major eye clinics in Kinshasa, the University Hospital of Kinshasa (UHK) and Saint Joseph Hospital (SJH), from January 2012 to December 2014. Demographics and diagnoses were retrieved and analyzed. Outcome measures were frequency and prevalence of retinal diseases, blindness and low vision. RESULTS: A total of 40 965 patients aged 40y or older were examined during this period in both clinics. Of these, 1208 had retinal disease, giving a 3-year and an annual prevalence of 3% and 1%, respectively. Mean age was 61.7±10.7y, 55.8% of the patients were males. Arterial hypertension (68.1%) and diabetes (43.3%) were the most common systemic comorbidities. Hypertensive retinopathy (41.8%), diabetic retinopathy (37.9%), age-related macular degeneration (14.6%), and chorioretinitis and retinal vein occlusion (7.3% each) were the most common retinal diseases, with 3-year prevalence rates were 1.3%, 1.0%, 0.43%, and 0.21% respectively. Bilateral low vision and blindness were present in 26.8% and 8.4% of the patients at presentation. Major causes of low vision and blindness were diabetic retinopathy (14.8%), age-related macular degeneration (4.9%), retinal detachment (2.8%), and retinal vein occlusion (2.5%). The prevalence was significantly higher among males than females, and at the UHK than SJH. CONCLUSION: Retinal diseases are common among Congolese adult patients attending eye clinics in Kinshasa. They cause a significant proportion of low vision and blindness.     

Prevalence and associations of diabetic retinopathy in indigenous Australians within central Australia: the Central Australian Ocular Health Study

Purpose: To determine the prevalence and associations of diabetic retinopathy (DR) within the indigenous Australian population living in central Australia. Methods: 1884 individuals aged 20 years or older, living in one of 30 remote communities within the statistical local area of ‘central Australia’ were recruited for this study. This equated to 36% of those aged 20 years or older and 67% of those aged 40 years or older within this district. Participants were recruited as they presented to the eye clinic at each remote community. Following dilated slit‐lamp fundoscopy, the amount of DR in participants with diabetes mellitus (DM) was quantified using the Early Treatment of Diabetic Retinopathy Study criteria. The presence of any DR and vision‐threatening DR (clinically significant macular oedema and/or proliferative DR) in one or both eyes was presented. Results: Of those with diabetes, 22.2% (25.4% of those aged 40 years or older) had any DR and 7.0% (8.4% of those aged 40 years or older) had vision‐threatening DR. Both the presence of any DR and vision‐threatening DR were associated with advancing age and HbA1c level, but neither subcategory was associated with sex or self‐reported hypertension. Conclusion: Our study has shown similar prevalence rates for DR in indigenous Australians compared with non‐indigenous Australians. However, as DM is far more prevalent among indigenous Australians, the proportion of those affected by DR across the population should be considerably higher when compared with non‐indigenous Australians.     

The Beijing Desheng Diabetic Eye Study: rationale, design, methodology and baseline data

AIM: To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study (BDDES), and to determine the prevalence of diabetic retinopathy (DR) and possible risk factors in patients with type 2 diabetes mellitus (T2DM) in an urban community of Beijing, China. METHODS: Community-based prospective cohort study of persons diagnosed with T2DM aged 30y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic dispositions. RESULTS: A total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male (P=0.031), lower income level (P=0.011), lower education background (P=0.022), longer duration of diabetes (P=0.001), younger age at diabetic onset (P=0.001), higher systolic blood pressure (P=0.007), higher glycosylated hemoglobin A1c levels (P=0.001), high albuminuria (P=0.03), and use of insulin (P<0.001). For vision-threatening DR, four factors were significant: younger age at diabetic onset (P<0.001), higher systolic blood pressure (P=0.042), high albuminuria (P<0.001), and use of insulin (P<0.001). CONCLUSION: The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.     

Visual Impairment in Diabetes

Visual acuity was measured in a population-based study of diabetic retinopathy in southern Wisconsin. Persons diagnosed prior to 30 years of age and taking insulin (younger onset, n = 996) and those diagnosed at 30 years of age or older (older onset, n = 1370) were examined. Best corrected visual acuity was determined using the Early Treatment of Diabetic Retinopathy Study protocol. In the younger onset group, 1.4% had moderate visual impairment (best corrected visual acuity in the better eye of 20/80 to 20/160) and 3.6% were legally blind (visual acuity in the better eye of 20/200 or worse). Visual impairment in this group was associated with older age at examination, longer duration of diabetes, presence of proliferative retinopathy, and presence of senile cataracts. In the older onset group, 3.0% had moderate visual impairment and 1.6% were legally blind. Visual impairment in this group was associated with older age at examination, longer duration of diabetes, presence of senile cataract, presence of macular edema, and proliferative diabetic retinopathy. When assigning causes of impaired vision, diabetic retinopathy was responsible in part for 86% of eyes with visual acuity of 20/200 or worse in younger onset persons and for 33% in older onset persons.     

Hospital based epidemiological study for diabetic retinopathy:study design and preliminary results

AIM:To describe the design and preliminary results of the hospital based epidemiological study for diabetic retinopathy(HBESDR),an ongoing epidemiological study to estimate the prevalence of diabetic retinopathy(DR) and to elucidate the clinical,anthropometric,biochemical and any other risk factors associated with diabetic retinopathy.METHODS:Totally 2000 diabetes will be recruited from the Diabetes eye clinic in the First Affiliated Hospital of China Medical University.All subjects underwent blood sugar estimation and Oral Glucose Tolerance Test to diagnose diabetes.All diabetes would undergo complete questionnaire,a comprehensive eye examination.Blood and urine would be collected for biochemical investigations.All fundus photographs for any DR will be graded.Participants who need treatment will be sent to the ophthalmic clinic and follow-up interval program for all subjects will be suggested.A computerized database is created for the records.RESULTS:To date,1174 diabetes have been recruited,there were 350(29.81%) DR in all diabetes,most of them were with mild non-proliferative diabetic retinopathy(NPDR)(139,39.71%);71(20.29%) moderate NPDR,66(18.86%) severe NPDR,74(21.14%) proliferative diabetic retinopathy(PDR).Females,longer duration of diabetes,family history of diabetes and hypertension had a statistically significant increase in risk of any DR.CONCLUSION:The study is expected to provide an estimate of the overall prevalence of DR and the prevalence with different duration of diabetes and also a better understanding of the risk factors associated with DR.     

Hospital based epidemiological study for diabetic retinopathy: study design and preliminary results

AIM: To describe the design and preliminary results of the hospital based epidemiological study for diabetic retinopathy(HBESDR), an ongoing epidemiological study to estimate the prevalence of diabetic retinopathy(DR) and to elucidate the clinical, anthropometric, biochemical and any other risk factors associated with diabetic retinopathy. METHODS: Totally 2000 diabetes will be recruited from the Diabetes eye clinic in the First Affiliated Hospital of China Medical University. All subjects underwent blood sugar estimation and Oral Glucose Tolerance Test to diagnose diabetes. All diabetes would undergo complete questionnaire, a comprehensive eye examination. Blood and urine would be collected for biochemical investigations. All fundus photographs for any DR will be graded. Participants who need treatment will be sent to the ophthalmic clinic and follow-up interval program for all subjects will be suggested. A computerized database is created for the records. RESULTS: To date, 1174 diabetes have been recruited, there were 350(29.81%) DR in all diabetes, most of them were with mild non-proliferative diabetic retinopathy (NPDR) (139, 39.71%); 71(20.29%) moderate NPDR, 66(18.86%) severe NPDR, 74(21.14%) proliferative diabetic retinopathy (PDR). Females, longer duration of diabetes, family history of diabetes and hypertension had a statistically significant increase in risk of any DR. CONCLUSION: The study is expected to provide an estimate of the overall prevalence of DR and the prevalence with different duration of diabetes and also a better understanding of the risk factors associated with DR.     

Prevalence of blindness and visual impairment among Jordanian diabetics

PURPOSE: To investigate the prevalence of blindness and visual impairment among a population of Jordanian diabetics. METHODS: A total of 986 diabetic patients were fully assessed, including complete history, examination, and laboratory tests. All patients underwent detailed eye examination, which included visual acuity, slit-lamp examination, tonometry, funduscopy, and fundus fluorescein angiography (FFA). RESULTS: Of all patients examined, 53.2% were male and 46.8% were female. The mean age and duration of diabetes were 55.3 and 11.9 years. Of all patients, 93.3% had type 2 while 6.7% had type 1 diabetes mellitus (DM). Over half (50.3%) were on oral hypoglycemic agents, 34% on insulin, and 14.5% on both types of treatment, whereas only 1.2% were on diet alone. The mean value for HbA1c was 7.7%. The prevalence of blindness among participants was found to be 7.4%, while 10.1% were visually impaired. Diabetic retinopathy (DR) was present in 64.1%, 37.8% had cataract, and 8.7% had undergone cataract surgery. Using multivariate logistic regression analysis, visual impairment was significantly associated with age, treatment of diabetes, and DR, while only age and retinopathy were significantly related to blindness. CONCLUSIONS: DM is a common disease in Jordan and DR is highly prevalent among Jordanian diabetics. National screening and educational programs are highly needed to reduce the risk of blindness and visual impairment among diabetic patients.     

【In Press】 The Beijing Desheng Diabetic Eye Study: rationale, design, methodology and baseline data

AIM: To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study (BDDES), and to determine the prevalence of diabetic retinopathy (DR) and possible risk factors in patients with type 2 diabetes mellitus (T2DM) in an urban community of Beijing, China. METHODS: A community-based prospective cohort study of persons diagnosed with T2DM aged 30y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic dispositions. RESULTS: Of a total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male (P=0.031), lower income level (P=0.011), lower education background (P=0.022), longer duration of diabetes (P=0.001), younger age at diabetic onset (P=0.001), higher systolic blood pressure (P=0.007), higher glycosylated hemoglobin A1c levels (P=0.001), high albuminuria (P=0.03), and use of insulin (P<0.001). For vision-threatening DR, four factors were significant: younger age at diabetic onset (P<0.001), higher systolic blood pressure (P=0.042), high albuminuria (P<0.001), and use of insulin (P<0.001). CONCLUSION: The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.     

THE PREVALENCE OF DIABETIC RETINOPATHY: A STUDY OF 1300 DIABETICS FROM NEWCASTLE AND THE HUNTER VALLEY

This paper examines the prevalence of retinopathy in 2 diabetic populations from the Newcastle and Hunter Valley regions. Overall, 49% of patients attending a large diabetic clinic had retinopathy. 15% had proliferative retinopathy, macular involvement or threatened macular involvement, the stages of retinopathy in which photocoagulation may be indicated to preserve vision. A comparable study of known diabetics in the town of Singleton demonstrated prevalence rates of 36% and 11% respectively. The close relationship of retinopathy prevalence to the duration and age at onset of diabetes is also presented, and simple guidelines for the planning of eye examinations for diabetics are proposed.     

北京市朝阳区南部医联体2型糖尿病患者DR患病率及相关因素分析

目的：了解北京市朝阳区南部医联体2型糖尿病患者糖尿病视网膜病变(DR)的患病情况,并分析其危险因素。

方法：于2016-11/2017-11采用分层整群随机抽样法从北京市朝阳区南部医联体社区卫生服务中心的居民健康档案中随机抽取40岁及以上的2型糖尿病患者840例作为研究对象。收集患者的临床资料、体格检查、血液检查结果,并对所有患者进行散瞳眼底检查。

结果：北京市朝阳区南部医联体40岁及以上2型糖尿病患者DR患病率为35.7%,其中轻、中、重度非增殖期和增殖期DR患病率分别为68.3%、12.3%、5.0%、14.3%。年龄、糖尿病病程、胰岛素治疗、HbA1c、合并糖尿病足是DR发生的独立危险因素。

结论：该地区DM患者DR患病率较高,社区医生在定期对糖尿病患者进行随访时,不仅应该敦促患者严格控制血糖、定期检测HbA1c,还应给予低龄、糖尿病病程长、胰岛素使用及合并糖尿病足的患者特别关注。     

Prevalence of diabetic retinopathy in patients with diabetes mellitus diagnosed after the age of 70 years

AIMS/BACKGROUND—A hospital based prevalence study was undertaken to estimate the prevalence of diabetic retinopathy (DR) in patients diagnosed as having diabetes mellitus after the age of 70 years. The prevalence of visually threatening retinopathy at the time of diagnosis of diabetes was also determined. The association between prevalence of DR and duration of diabetes mellitus, mode of treatment, HbA_1c levels, presence of hypertension, and sex of patient was examined and a comparison was drawn between this study and earlier prevalence studies of DR in older type II diabetics.
METHODS—Using data on the Irish Diabetic Retinopathy Register located in the Mater Misericordiae Hospital, Dublin, all patients who were diagnosed as having type II diabetes mellitus after the age of 70 years were invited to attend for ophthalmic review. Medical records were examined to determine the duration of diabetes mellitus, mode of treatment, recent HbA_1c levels, and the presence of systemic hypertension.
RESULTS—Of the 150 patients examined, 21 (14%) had some form of DR and 10 of these patients (6.6%) had visually threatening retinopathy or previously treated visually threatening retinopathy. Five patients (3.3%) presented with visually threatening retinopathy at the time of diagnosis of diabetes. Those patients with DR had a significantly higher median duration of diabetes (5.0 years) compared with those patients without DR (3.5 years). A significantly higher proportion of patients with DR required treatment with insulin and a correspondingly lower proportion of patients without DR were controlled on diet alone. There was no significant association between prevalence of DR and HbA_1c levels, systemic hypertension, or sex of patient. There was a lower overall prevalence of DR in comparison with earlier studies.
CONCLUSIONS—The prevalence of DR in these elderly type II diabetics is lower than that previously reported in patients with type II disease but a small percentage of patients had visually threatening retinopathy at presentation. Longer duration of diabetes and insulin use were associated with a significantly increased prevalence of DR. All elderly type II diabetic patients require thorough ophthalmic examination near to the time of first presentation and thereafter at regular intervals.