Risk factors of diabetic retinopathy and sight-threatening diabetic retinopathy: a cross-sectional study of 13 473 patients with type 2 diabetes mellitus in mainland China

Abstract

Objective: To explore the risk factors of diabetic retinopathy (DR) and sight-threatening diabetic retinopathy (STDR) among Chinese patients with diabetes.

Design, setting and participants: A cross-sectional investigation was performed in eight screening clinics in six provinces across mainland China. Information about the risk factors was recorded in screening clinics. Some risk factors (sex, age, diagnosis age, diabetes duration, systolic blood pressure (SBP), diastolic blood pressure, fasting blood glucose (FBG) and glycosylated haemoglobin (HbA1c)) were recorded in all eight clinics, while others were collected only in a subset of the clinics. The relationships between the risk factors and DR and between the risk factors and STDR were explored for the eight factors mentioned above and for all factors studied.

Main outcomes and measures: Risk factors of DR and STDR were assessed, and a nomogram of the results was produced.

Results: Younger age, longer diabetes duration, higher SBP, higher FBG and higher HbA1c were found to be independent risk factors for both DR and STDR in the eight-factor analyses. In the all-factor analysis, younger age, longer diabetes duration, higher SBP, oral medicine use and insulin use were independent risk factors for both DR and STDR; higher postprandial blood glucose (PBG), HbA1c, triglyceride andlow-density lipoprotein were independent risk factors for DR only, and higher FBG was a risk factor for STDR only.

Conclusions: In this cross-sectional investigation, several risk factors were found for DR and STDR. Notably, FBG, PBG and HbA1c were all risk factors for DR or STDR, suggesting that stricter blood glucose control in clinical practice is required.

Keywords: BMI; WHR; diabetic retinopathy; glucose; risk factors.

Figure 1

Flow diagram of the data processing. DR, diabetic retinopathy; STDR, sight-threatening diabetic retinopathy.

Figure 2

Nomograms for DR (A) and STDR (B) risk factors. Risk factors were chosen based on results of logistic regression analysis. Each risk factor of the patient was assessed on basis of the nomogram and got a point by vertically corresponding to the first line. Aggregated points of each risk factor corresponded to a particular occurrence probability of DR or STDR in the last line. DR, diabetic retinopathy; DM, diabetes mellitus; FBG, fasting blood -glucose; HbA1c, glycosylated haemoglobin; LDL, low-density lipoprotein; PBG, postprandial blood glucose; SBP, systolic blood pressure; STDR, sight-threatening diabetic retinopathy.