Journal of ophthalmology of Eastern Central and Southern AfricaJuly 2018 Diabetic retinopathy among patients with type 2 diabetes mellitus at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Diabetic Retinopathy (DR) accounts for 5% of the 39 million causes of blindness occurring worldwide and is estimated to contribute 3% of blindness in Kenya. Dyslipidemia, poor control of sugar, hypertension and obesity increase the risk of DR in patients with diabetes. This study addresses the gap in information on the magnitude of DR and its associated factors in patients with type 2 diabetes at Moi Teaching and Referral Hospital (MTRH). Objectives: To determine the prevalence and severity of DR and its associated factors in patients with type 2 diabetes mellitus. Methods: This cross sectional study was conducted amongst patients with type 2 diabetes mellitus in MTRH. Randomly selected participants underwent anthropometric, laboratory and visual acuity testing. Direct ophthalmoscopy was used to assess DR and macula edema. Grading of DR was done using international clinical diabetic retinopathy severity scale. A univariate and multivariate logistic regression model was used to assess associations of the variables with DR. Results: Of the 329 participants enrolled, 187 (57%) were female with a mean age of 56.8 (10.99) years. One hundred and three (31%) had diabetic retinopathy and 39 (12%) had diabetic macula edema. Mild to moderate non proliferative diabetic retinopathy was the most prevalent grade at 79 (25%). One hundred and eighty four (56%) of participants had hypertension (133/80; IQR 120/70-150/89) mmHg and 158 (48%) had glycated haemoglobin between 7-10%. The median for the other assessed factors were as follows: duration of diabetes 5 (9) years, total cholesterol 4.6 (1.3) mmol/l and low density lipoprotein 3.0 (1.5) mmol/l. Increase in duration of diabetes by 5 years {OR 2.02(95% CI 1.11-3.69); p 0.02}, glycated haemoglobin > 6.5% {OR 2.13(95% CI 1.02-4.42); p 0.04}, systolic hypertension >160 mmHg {OR 1.02(95% CI 1.01-1.03); p 0.01} were associated with increased risk of diabetic retinopathy while male gender and body mass index did not. Only 15% of the participants in this study reported having had previous eye check-up. Conclusion: A third of patients with type 2 diabetes on follow up at MTRH have DR. Systolic hypertension, increased duration of diabetes and high glycated haemoglobin were positively associated with increased risk of developing DR.