Diabetic Retinopathy & Medical Retina - aioseducation

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Diabetic Retinopathy and Medical Retina Free Papers Prevalence and Risk Factors for Diabetic Retinopathy in Young Diabetic Subjects in South India Dr. R. Rajalakshmi, Dr. V. Mohan, Dr. M. Rema Diabetes has assumed epidemic proportions in developing countries of the world. India today has an estimated 50 million diabetic subjects and a significant number of these occur in early adulthood. 1 Earlier it was assumed that the majority of subjects with diabetes below 30 years of age had type 1 diabetes (T1DM), but recently there has been an increase in numbers of early onset type 2 diabetes (T2DM). 2,3 Diabetic retinopathy (DR) is a highly specific microvascular complication of diabetes. There is no data from India on the prevalence of diabetic retinopathy (DR) in early onset T2DM. In the western world, studies like the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR) have looked at the prevalence and risk factors of DR in T1DM. 4 However, there is paucity of such studies in India. The purpose of this paper is to look at and compare the prevalence of DR and risk factors for DR in T1DM versus early onset T2DM in young diabetic subjects. MATERIALS AND METHODS This is a prospective clinic based cohort study of the prevalence of DR in young diabetic subjects (with T1DM and early onset T2DM). Recruitment was done between 2005 and 2006 at Dr. Mohan’s Diabetes Specialities Centre, a large referral centre for diabetes at Chennai in South India. All subjects with T1DM or early onset T2DM diagnosed below age of 30 years and willing to undergo a clinical and biochemical assessment and digital retinal color photography were requested to participate in the study. Institutional Ethical committee approval and informed consent was also obtained from all the subjects. A questionnaire was used to obtain details including the age of the subject, the age at diagnosis of diabetes, duration of diabetes, history of hypertension and treatment details for diabetes (insulin, or oral hypoglycemic drugs or both). Baseline clinical examination included anthropometric measurements and recording the blood pressure. Anthropometric measurements like the height, the weight were taken and body mass Index (BMI) was calculated. 5 The baseline bio-chemical investigations included a fasting and post prandial plasma glucose, glycated hemoglobin (HbA1C), Serum lipid profile (Serum cholesterol, triglycerides, low density lipoprotein cholesterol and renal function test (blood 873
70th AIOC Proceedings, Cochin 2012 urea, serum creatinine, and 24 hours proteinuria/ macroalbuminuria). Serum C-peptide (fasting and stimulated) was measured. A comprehensive ophthalmic examination was done which included ocular history, assessment of the best corrected visual acuity, intra-ocular pressure (IOP), anterior segment examination, and fundus examination was done by direct and indirect ophthalmoscopy, after dilatation with tropicamide plus eye drops. Four-field digital retinal color photography was taken by a trained photographer (Carl-Zeiss Digital Fundus Camera). The 4 fields photographed were the macula, optic disc and nasal to the optic disc, superior-temporal and inferior-temporal quadrants. 6 The grading of the retinopathy was done based upon the modified Early Treatment Diabetic Retinopathy Study (ETDRS) grading system. 7 The final diagnosis for each patient was determined from the level of retinopathy of the worse eye using ETDRS final retinopathy scale for individual eyes. 6,7 Diabetic Macular Edema (DME) was defined as retinal thickening at or within one disc diameter of the centre of the macula or the presence of definite hard exudates. 8 Sight-threatening DR (STDR) was defined as proliferative retinopathy (PDR) or DME (clinically significant macular edema-CSME) in either or both eyes. Statistical Analysis All statistical analyses were performed using SAS statistical package (version 9.0; SAS Institute, Inc., Cary, NC). Regression analysis was done using diabetic retinopathy as the dependent variable and other risk variables which had p value ≤0.2 in the univariate analysis, as independent variables. For all statistical tests, p value
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