2型糖尿病下肢血管病变的危险因素分析

目的:探讨2型糖尿病合并下肢血管病变的主要危险因素.方法:选择2011年2月至2012年2月我院收治的220例2型糖尿病患者为研究对象,采用彩色多普勒超声对其双下肢血管进行检查,根据检查结果将患者分为下肢血管病变组与无下肢血管病变组,对两组患者的年龄、性别、腰围、体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、餐后2h血糖(2hBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)进行测定及分析.结果:220例患者中,152例患者合并下肢血管病变,发生率69.1％.单因素分析表明年龄、SBP、2hBG、HbA1c、HOMA-IR、TC、LDL-C等因素与合并下肢血管病变有关.而多因素分析表明年龄、TC、合并神经病变是引起2型糖尿病下肢血管病变的独立危险因素.结论:2型糖尿病患者下肢血管病变的发生较高,临床应根据上述危险因素进行积极干预及预防.     

维吾尔族2 型糖尿病患者糖尿病肾病相关因素分析

目的:探讨维吾尔族2型糖尿病肾病(DN)发病的相关临来因素。方法:分析292例维吾尔族2型糖尿病患者的临床资科。结果:维吾尔族2型糖尿病患者糖尿病肾病(DN)发病率为43.49%(127/292)。DN患者的病程、SBP、TC、TG、FBG、HbAIC、LDL-C、BUN和Cr均显著高于NDN患者(P<0.05);但DBP、HDL-C、BMI之间无统计学差异(P>0.05)。Logistic归分析结果显示,DM病程、患病年龄、SBP、FBP、TC、TG、LDL-C、HbA1c、BUN、Cr是DN的危险因素(OR值>1)。结论:维吾尔族2型糖尿病患者的DM病程、患病年龄、SBP、FBP、TC、TG、LDL-C、HbA1c、BUN、Cr等参数与糖尿病肾病并发率之间有相关性。     

2型糖尿病视网膜病变患者血清Chemerin、TNF-α及Cys C水平变化及其临床意义

目的:研究2型糖尿病视网膜病变(DR)患者血清趋化素(Chemerin)、肿瘤坏死因子-α(TNF-α)及胱抑素C(Cys C)的水平变化及临床意义。方法:以114例2型糖尿病(T2DM)患者为研究对象,分为非DR(NDR)组42例、非增生型DR(NPDR)组38例和增生型DR(PDR)组34例。另外选取38例健康体检者作为正常对照(NC)组。记录并比较四组的临床检查及生化指标及血清Chemerin、TNF-α和Cys C水平,并分析患者临床检查、生化指标与Chemerin、TNF-α、Cys C的相关性以及DR的危险因素。结果:NDR组、NPDR组、PDR组的体质量指数(BMI)、收缩压(SBP)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、胰岛素抵抗指数(HONA-IR)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、Chemerin、TNF-α、Cys C水平均高于NC组,且三组SBP、HbA1c、FPG、HONA-IR、血清Chemerin、TNF-α和Cys C水平逐渐递增(P0.05)。Pearson相关性分析结果显示,血清Chemerin、TNF-α、Cys C与SBP、HbA1c、FPG、HONA-IR、TG、TC、LDL-C均呈正相关关系(P0.05),且Chemerin、Cys C、TNF-α三者亦呈正相关关系(P0.05)。多因素Logistic回归分析结果显示,HONA-IR、HbA1c、Chemerin、Cys C和TNF-α均为DR的独立危险因素。结论:高水平Chemerin、TNF-α和Cys C可能与DR的发生、发展有关,三者互相促进,均为DR发生发展的独立危险因素,可用于DR患者的早期诊断及其病情严重程度的判断。     

HbA1c和FPG水平与2型糖尿病患者视网膜病变的相关性分析

目的：探讨糖化血红蛋（HbA1c）、空腹血糖（FPG）与2型糖尿病患者视网膜病变（DR）的相关性。方法：对我院2010年1月-2012年12月住院或门诊的336例2型糖尿病（T2DM）患者进行眼底检查或眼底血管荧光素造影检测,按有无视网膜病变分为视网膜病变（DR）组和无视网膜病变（NDR）组,并对HbA1c、FBG水平进行检测。结果：DR组较NDR组HbA1c水平高,差异有统计学意义（P〈0．05）,HbA1c水平和DR分期呈正相关（I=0．526,P〈0．001）,而DR组和NDR组FPG水平差异无无统计学意义（P〉0．05）。结论：可将HbA1c作为2型糖尿病患者视网膜病变发生和发展的监测指标之一。     

2型糖尿病眼底增殖改变与冠状动脉病变关系的研究

目的:探讨2型糖尿病眼底增殖改变与冠状动脉病变的关系.方法:对330例2型糖尿病合并冠心痛患者进行眼底检测及冠状动脉造影,根据眼底是否具有增殖性改变进行对比分析,并应用多因素分析方法探讨与眼底增殖改变相关的危险因素.结果:2型糖尿病伴眼底增殖改变者,年龄较大,病程较长,尿微量白蛋白阳性检出率增加,TG、TC及HbA1c显著性升高;多支血管病变及钙化病变受累比例增高;Logistic回归分析显示,经调整糖尿病病程、HbA1c、微量白蛋白尿后,2型糖尿病眼底增殖改变仍与冠状动脉钙化相关.结论:2型糖尿病眼底增殖改变与冠状动脉钙化相关.     

2 型糖尿病合并高血压患者发生心房颤动的相关因素分析

目的:探讨2型糖尿病合并高血压住院患者发生心房颤动的相关因素。方法:选取我院收治的2型糖尿病合并高血压发生心房颤动的患者112例为研究对象(房颤组,n=112例),同期选取与房颤组年龄及性别相匹配的未发生房颤的2型糖尿病合并高血压患者150例为对照组(n=150例),比较两组患者的一般临床资料、实验室检查指标等的差异,用Logistic回归方程分析患者并发房颤的相关因素。结果:与对照组比较,房颤组患者收缩压(SBP)较高,高血压比例高、服用ACEI/ARB类药物偏低(P0.05)、左室射血分数(LVEF)偏低(P0.05)、左房内径(LAD)长(P0.05)、甘油三酯(TC)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)、血肌酐(Scr)、B型脑钠肽(BNP)、高敏C反应蛋白(hs-CRP)、尿酸均较高(P0.05);多因素Logistic回归方程分析提示:LAD、HbA1c、BNP、hs-CRP、尿酸是患者并发房颤的独立危险因素(P0.05),而服用ACEI/ARB类药物为保护性因素。结论:LAD、HbA1c、BNP、hs-CRP、尿酸均可能是2型糖尿病合并高血压患者发生心房颤动的独立危险因素。     

血清Fractalkine、Apelin水平与糖尿病视网膜病变患者血糖、血脂以及病程的关系研究

目的:研究血清Fractalkine(FKN)、爱帕琳肽(Apelin)水平与糖尿病视网膜病变(DR)患者血糖、血脂以及病程的关系。方法:选取我院于2015年1月至2016年12月收治的160例糖尿病患者为研究对象,行眼底荧光造影、裂隙灯显微镜检查,按照检查结果将其区分为非增生型DR组(稳定组,43例)、背景期DR组(背景组,62例)和增殖期DR组(增殖组,55例),另外于同期选取我院40例健康体检者为健康对照组(健康组),测量4组血清FKN、Apelin、空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)和总胆固醇(TC)水平,使用Pearson相关性分析分析血清FKN、Apelin与FPG、2hPG、HbA1c、HDL-C、LDL-C、TG、TC、糖尿病病程的相关性。结果:血清FKN、Apelin水平比较:增殖组背景组稳定组健康组,各组间比较差异具有统计学意义(P0.05);血清FPG、2hPG、HbA1c、LDL-C、TG、TC水平比较:增殖组背景组稳定组健康组,各组间比较差异具有统计学意义(P0.05);血清HDL-C水平比较:健康组稳定组背景组增殖组,各组间比较差异具有统计学意义(P0.05);采用Pearson相关性分析显示,血清FKN水平与FPG、2hPG、HbA1c、LDL-C、TG、TC、糖尿病病程呈正相关性(r=0.321、0.215、0.645、0.154、0.215、0.325、0.578,P0.05),与HDL-C呈负相关性(r=-0.547,P0.05);血清Apelin水平与FPG、2hPG、HbA1c、LDL-C、TG、TC、糖尿病病程呈正相关性(r=0.245、0.574、0.951、0.357、0.357、0.159、0.546,P0.05),与HDL-C呈负相关性(r=-0.459,P0.05);糖尿病病程、HbA1c、LDL-C、HDL-C、FKN和Apelin为DR病程的相关影响因素。结论:糖尿病伴发DR患者血清FKN、Apelin水平随着病程的加重逐渐增加,且这两种因子的水平与患者血糖、血脂代谢关系密切。     

维生素D缺乏和2型糖尿病视网膜病变风险度的相关性研究

摘要 目的：是探讨维生素D缺乏与2型糖尿病（T2DM）患者视网膜病变（DR）发生风险度的关系。方法：选取2020年12月至2022年8月在新疆医科大学第二附属医院内分泌科住院的2型糖尿病患者作为研究对象。将209名患者根据眼底检查分为DR组（n=50）和正常眼底（NDR）组（n=159）。比较各组患者一般资料、实验室检查指标;采用Spearman分析法分析病程、FBG、HbAlC、25(OH)D与DR的相关性,采用Pearson分析居住地（城镇）、与维生素D缺乏、SBP与DR的相关性,采用Logistics回归分析DR发生的影响因素,比较各组患者维生素D缺乏、病程、FBG、HbA1c及25(OH)D对DR的预测价值。结果：DR组的居住地（农村）、FBG、HbA1c、病程等均大于NDR组,25(OH)D水平低于NDR组,DR组维生素D缺乏率大于NDR组,差异有统计学意义（P＜0.05）。Pearson相关性分析结果表明DR与居住地（城镇）呈负相关（P＜0.05）,与SBP、维生素D缺乏呈正相关（P＜0.05）;Spearman相关分析表明DR与25(OH)D呈负相关（P＜0.05）,与病程、空腹血糖和糖化血红蛋白等呈正相关（P＜0.05）。Logistic回归分析结果显示,维生素D缺乏、病程、FBG、HbA1c为DR的独立危险因素（P＜0.05）,维生素D缺乏的T2DM患者DR发病风险是维生素D不缺乏者的22.019倍（OR=22.019,95%CL 2.119~228.771,P＜0.05）。受试者工作特征（ROC）曲线分析显示,病程、FBG、HbA1c、25(OH)D作为联合变量可有效预测DR,ROC曲线下面积为0.924。结论：25(OH)D与DR呈负相关,维生素D缺乏可能与T2DM患者DR的发生有关。     

2型糖尿病患者血清RANTES与下肢大血管病变的相关性

目的:探讨2型糖尿病(T2DM)患者血清RANTES与下肢大血管病变的相关性.方法:(1)T2DM 61例,根据是否合并下肢大血管病变,分为非下肢大血管病变组(30例)和下肢大血管病变组(31例),与正常对照组20例比较,采用双抗体夹心ELISA法测定血清RANTES,比较三组间血清RANTES水平的差异.(2)测定各组TG、TC、LDL、Hd1-ch、、FPG、HbA1c、FIB等水平,分析其与2型糖尿病大血管病变的相关性.结果:(1)2型糖尿病组血清RANTES水平明显高于正常对照组(P<0.05),下肢大血管病变组血清RANTES水平明显高于非下肢大血管病变组和正常对照组(P<0.05),(2)以T2DM组为整体,有无下肢大血管病变为因变量Y(有=1,无=0),以RANTES等其它危险因素为自变量,进行Logstic回归分析,SBP、病程和RANTES入回归方程.结论:RANTES可能是T2DM下肢大血管病变的一个重要的独立危险因素.     

糖尿病性视网膜病变术后CRT、SFCT、mALB、MBG、HbA1c水平的变化及相关性

本研究通过观察糖尿病性视网膜病变术后患者黄斑中心凹视网膜厚度,脉络膜厚度,尿微量白蛋白、血糖、糖化血红蛋白的水平,试图了解其差异及相关性。我们选取2016年1月至2017年12月于我院就诊的糖尿病性视网膜病变患者200例,根据其有无视网膜病变、有无肾病、术后有无黄斑水肿分为合并组和未合并组,同时选取100例正常成年人作为对照。观察糖尿病患者和对照组、未合并和合并并发症糖尿病患者的黄斑中心凹视网膜厚度(central retinal thickness, CRT),凹下脉络膜厚度(subfoveal choroidal thickness,SFCT),尿微量白蛋白(microAlbunminuria, mALB)、平均血糖(mean blood glucose, MBG)和糖化血红蛋白(glycated haemoglobin, HbA1c)水平,进一步分析了糖尿病黄斑水肿患者的尿微量白蛋白水平与黄斑中心凹视网膜厚度、脉络膜厚度、血糖、糖化血红蛋白的相关性。研究结果表明,糖尿病组患者的CRT水平较对照组低,SFCT、mALB、MBG和HbA1c水平高于对照组;合并视网膜病变、合并肾病和合并黄斑水肿组患者的CRT水平较未合并组低,SFCT、mALB、MBG和HbA1c水平均高于未合并组;黄斑水肿患者的m ALB水平与CRT水平负相关,与SFCT、MBG和HbA1c水平正相关。本研究得出结论:糖尿病性视网膜病变术后患者黄斑中心凹视网膜厚度(CRT)较薄,脉络膜厚度(SFCT)变厚,且与尿微量白蛋白密切相关。     

维吾尔族2型糖尿病患者糖尿病肾病相关因素分析

目的：探讨维吾尔族2型糖尿病肾病（DN）发病的相关临来因素。方法：分析292例维吾尔族2型糖尿病患者的临床资科。结果：维吾尔族2型糖尿病患者糖尿病肾病（DN）发病率为43,49％（127／292）。DN患者的病程、SBP、TC、TG、FBG、HbAIC、LDL—C、BUN和Cr均显著高于NDN患者（P〈0．05）;但DBP、HDL．C、BMI之间无统计学差异（P〉0．05）。Logistic归分析结果显示,DM病程、患病年龄、SBP、FBP、TC、TG、LDL—C、HbAlc、BUN、Cr是DN的危险因素（OR值〉1）。结论：维吾尔族2型糖尿病患者的Did病程、患病年龄、SBP、FBP、TC、TG、LDL—C、HbAlc、BUN、Cr等参数与糖尿病肾病并发率之间有相关性。     

2型糖尿病视网膜病变患者血清和肽素、脂质运载蛋白2水平的表达及其临床意义

摘要 目的：探讨2型糖尿病（T2DM）视网膜病变（DR）患者血清和肽素（copeptin）、脂质运载蛋白2（LCN2）的表达及其临床意义。方法：选取2021年1月~2023年1月期间江南大学附属医院接收的2型糖尿病（T2DM）患者141例，将所有患者分为不合并糖尿病视网膜病变（DR）组（NDR组，n=49）、非增生期DR组（NPDR组，n=45）和增生期DR组（PDR组，n=47），另选取同期行健康体检的志愿者50例作为对照组。比较各组临床指标、生化指标及血清copeptin、LCN2水平，采用Pearson相关性分析血清copeptin、LCN2水平与临床指标及生化指标的相关性，采用多因素Logistic回归分析DR的危险因素。结果：对照组、NDR组、NPDR组、PDR组的血清copeptin、LCN2水平呈逐渐升高趋势（P<0.05）。NDR组、NPDR组、PDR组的体重指数（BMI）、收缩压（SBP）、舒张压（DBP）、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）均高于对照组（P<0.05）；对照组、NDR组、NPDR组、PDR组的糖化血红蛋白（HbAlc）、胰岛素抵抗指数（HOMA-IR）呈逐渐升高趋势（P<0.05）；NDR组、NPDR组、PDR组糖尿病病程呈逐渐递增趋势（P<0.05）。Pearson相关性分析显示，copeptin、LCN2水平与HbAlc、HOMA-IR、糖尿病病程呈正相关（P<0.05），与血压、血脂、FPG、BMI无明显相关性（P>0.05）。多因素Logistic回归分析结果显示：糖尿病病程、HbAlc、HOMA-IR、copeptin、LCN2均为DR发生发展的独立危险因素（P<0.05）。结论：高水平copeptin、LCN2可能与DR的发生、发展有关，且与患者糖尿病病程、HbAlc、HOMA-IR关系密切，可用于DR患者的早期诊断及判断其病情的严重程度。     

Diabetic Retinopathy,Classified Using the Lesion-Aware Deep Learning System,Predicts Diabetic End-Stage Renal Disease in Chinese Patients

Objective: To characterize the relationship between diabetic retinopathy (DR) and diabetic nephropathy (DN) in Chinese patients and to determine whether the severity of DR predicts end-stage renal disease (ESRD).Methods: Bilateral fundic photographs of 91 Chinese type 2 diabetic patients with biopsy-confirmed DN, not in ESRD stage, were obtained at the time of renal biopsy in this longitudinal study. The baseline severity of DR was determined using the Lesion-aware Deep Learning System (RetinalNET) in an open framework for deep learning and was graded using the Early Treatment Diabetic Retinopathy Study severity scale. Cox proportional hazard models were used to estimate the hazard ratio (HR) for the effect of the severity of diabetic retinopathy on ESRD.Results: During a median follow-up of 15 months, 25 patients progressed to ESRD. The severity of retinopathy at the time of biopsy was a prognostic factor for progression to ESRD (HR 2.18, 95% confidence interval 1.05 to 4.53, P = .04). At baseline, more severe retinopathy was associated with poor renal function, and more severe glomerular lesions. However, 30% of patients with mild retinopathy and severe glomerular lesions had higher low-density lipo-protein-cholesterol and more severe proteinuria than those with mild glomerular lesions. Additionally, 3% of patients with severe retinopathy and mild glomerular changes were more likely to have had diabetes a long time than those with severe glomerular lesions.Conclusion: Although the severity of DR predicted diabetic ESRD in patients with type 2 diabetes mellitus and DN, the severities of DR and DN were not always consistent, especially in patients with mild retinopathy or microalbuminuria.Abbreviations: CI = confidence interval; DM = diabetic mellitus; DN = diabetic nephropathy; DR = diabetic retinopathy; eGFR = estimated glomerular filtration rate; ESRD = end-stage renal disease; HbA1c = hemoglobin A1c; HR = hazard ratio; NPDR = nonproliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; SBP = systolic blood pressure; T2DM = type 2 diabetes mellitus; VEGF = vascular endothelial growth factor     

Berberine improves insulin-induced diabetic retinopathy through exclusively suppressing Akt/mTOR-mediated HIF-1α/VEGF activation in retina endothelial cells

Background: Insulin therapy is the major treatment of glycaemic control in type I diabetes mellitus (DM) and advanced type II DM patients who fail to respond to oral hypoglycemic agents. Nonetheless, insulin therapy is deemed unsuccessful in controlling the incidence of diabetic retinopathy (DR) and is likely a risk factor. Berberine, an isoquinoline alkaloid, has caught great attention towards its anti-diabetic mechanisms. This study aims to investigate the effect of berberine in decelerating DR progression in insulin-treated DM.Methods: To better understand the therapeutic potential of berberine in the presence of insulin, we elaborated the action of mechanism whether berberine inhibited retinal expression of HIF-1α and VEGF through regulating AKT/mTOR pathway. Suppression of insulin-induced neovasculature of retina endothelial cells by berberine was also studied. Lastly, the in vivo efficacy and safety of berberine as adjuvant therapy for the treatment of DR were systemically investigated in experimental type I and type II DM mice with insulin treatment.Results: Among various types of retinal cells, the activity of HIF-1α and VEGF in retinal endothelial cells could be particularly and exclusively stimulated by insulin intervention, which could be inhibited by berberine treatment in a dose- and time-dependent manner. Berberine suppressed Akt/mTOR activity in these cells, and restoration of Akt/mTOR signalling attenuated berberine''s inhibition on HIF-1α and VEGF expression. Berberine suppressed the progression of DR in experimental type I and type II diabetic mice receiving insulin therapy.Conclusion: Berberine improves insulin-induced diabetic retinopathy in type I and II diabetes through inhibiting insulin-induced activation of retinal endotheliocytes via Akt/mTOR/ HIF-1α/VEGF pathway.     

上海市杨浦区社区2型糖尿病患者周围神经病变患病率调查及其影响因素分析

摘要 目的：调查上海市杨浦区社区2型糖尿病（T2DM）患者周围神经病变（DPN）患病率,并分析其影响因素。方法：于2019年3月~2020年3月在上海市杨浦区所辖社区中随机选取5个社区,采用分层随机抽样法从每个社区选取100例T2DM患者进行调查,统计T2DM患者DPN患病率,采用多因素Logistic回归分析DPN发生的影响因素。结果：本次研究共发放500份调查问卷,回收498份,回收率为99.60%（498/500）,其中DPN患者222例,DPN发生率为44.58%（222/498）,纳为DPN组,276例未发生DPN纳为非DPN组。单因素分析结果显示：DPN组与非DPN组在腰围、合并糖尿病视网膜病变（DR）、合并下肢血管病变（PVD）、吸烟史、高血压、脑梗死病史、文化程度、婚姻状况、收缩压（SBP）、空腹血糖（FPG）、葡萄糖达标时间百分比（TIR）、载脂蛋白B、尿酸方面比较有差异（P<0.05）。进一步多因素Logistic回归分析结果显示：合并DR、合并PVD、有吸烟史、有脑梗死病史、婚姻状况为未婚/离异/丧偶、FPG水平较高是T2DM患者发生DPN的危险因素（P<0.05）。结论：T2DM患者中DPN的患病率较高,合并DR、PVD、吸烟史、脑梗死病史以及婚姻状况是DPN发生的影响因素,应重视DPN筛查并进行干预,针对上述影响因素对T2DM患者开展健康宣教,减少DPN的发生。     

Chronic Kidney Disease and Diabetic Retinopathy in Patients with Type 2 Diabetes

Purpose

To explore the relationship between chronic kidney disease (CKD) and diabetic retinopathy (DR) in a representative population of type 2 diabetes mellitus (DM2) patients in Catalonia (Spain).

Methods

This was a population-based, cross-sectional study. A total of 28,344 patients diagnosed with DM2 who had recorded ophthalmologic and renal functional examinations were evaluated. Data were obtained from a primary healthcare electronic database of medical records. CKD was defined as an estimated glomerular filtration ratio (eGFR) of <60 ml/min/1.73m² and/or urine albumin to creatinine ratio (UACR) ≥30 mg/g. DR was categorized as non-vision threatening diabetic retinopathy and vision threatening diabetic retinopathy.

Results

CKD was associated with a higher rate of DR [OR], 95% confidence interval [CI], 1.5 (1.4–1.7). When we analyzed the association between different levels of UACR and DR prevalence observed that DR prevalence rose with the increase of UACR levels, and this association was significant from UACR values ≥10 mg/g, and increased considerably with UACR values ≥300mg/g (Odds ratio [OR], 95% confidence interval [CI], 2.0 (1.6–2.5). This association was lower in patients with eGFR levels 44 to 30 mL/min/1.73m² [OR], 95% confidence interval [CI], 1.3 (1.1–1.6).

Conclusions

These results show that CKD, high UACR and/or low eGFR, appear to be associated with DR in this DM2 population.     

Haptoglobin phenotypes in diabetes mellitus and diabetic retinopathy.

An analysis of haptoglobin (HP) phenotypes in 81 cases of diabetes mellitus (DM) without retinopathy and 122 cases with diabetic retinopathy (DR) were studied in relation to 180 normal and healthy controls matched for age and sex. A significant decrease in HP 2-1 frequency was found, suggesting protection for heterozygotes in both DM and DR (with a relative risk of about 0.31). As an acute-phase reactant HP may be functionally involved in the etiology of DM and DR, which are associated with immunologic and inflammatory processes, respectively. No significant differences were found with respect to sex, age at onset, duration of DR, types of DM and DR, and family history.     

Diabetic retinopathy in the Eastern Morocco: Different stage frequencies and associated risk factors

Diabetes is a major cause of morbidity and mortality worldwide. It can affect many organs and, over time, leads to serious complications. Diabetic retinopathy (DR), a specific ocular complication of diabetes, remains the leading cause of vision loss and vision impairment in adults. This work is the first in Eastern Morocco aimed at identifying the different stages of DR and to determine their frequencies and associated risk factors. It is a case-control study conducted from December 2018 to July 2019 at the ophthalmology department of Al-Irfane Clinic (Oujda). Data were obtained from a specific questionnaire involving 244 diabetic patients (122 cases with retinopathy vs 122 controls without retinopathy). All results were analyzed by the EPI-Info software. This study shows a predominance of proliferative diabetic retinopathy (PDR) with 57.4% of cases (uncomplicated proliferative diabetic retinopathy (UPDR): 23.8%; complicated proliferative diabetic retinopathy (CPDR): 33.6%). The non-proliferative diabetic retinopathy (NPDR) represents 42.6% (minimal NPDR: 8.2%; moderate NPDR: 26.2%; severe NPDR: 8.2%). The determinants of DR were insulin therapy, high blood pressure, poor glycemic control and duration of diabetes. Regarding the chronological evolution, retinopathy precedes nephropathy. Diabetic nephropathy (DN) was present in 10.6% of cases especially in patients with PDR. In summary, the frequency of PDR was higher than that of NPDR. DR appears before DN with a high frequency of DN in patients with PDR. Good glycemic control and blood pressure control, as well as early diagnosis are the major preventive measures against DR.