Prevalence of diabetic retinopathy in patients with type 2 Diabetes mellitus at Moi teaching and referral hospital, Eldoret, Kenya.

Abstract

Prevalence of Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus at Moi Teaching and Referral Hospital, Eldoret, Kenya. Background: Diabetic retinopathy (DR) is the 6thleading cause of global visual impairment; accounts for 5% of the 39 million causes of blindness occurring worldwide and is estimated to contribute 3% of blindness in Kenya. The risk of DR amongst patients with diabetes mellitus is increased by dyslipidemia, high glycated hemoglobin, hypertension, obesity and long duration of 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, visual acuity testing and ophthalomoscopy examination. Grading of DR was done using international clinical diabetic retinopathy severity scale. Data were analyzed using the SPSS and presented using frequency tables, cross tabulations, means, medians and standard deviation. 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. 103(31%) had DR and 39(12%) had diabetic macula edema. Mild to moderate non proliferative diabetic retinopathy was the most prevalent grade at 79(25%). Fifty six percent (184) of participants had hypertension {133/80 (120/70-150/89)} mmHg. The median for the other assessed factors were as follows: duration of diabetes 5 (2-11) years, glycated hemoglobin 8.6 (7.2-11%), total cholesterol 4.5 (3.59-5.4) mmol/l and low density lipoprotein 2.97 (2.34-3.78) mmol/l. Duration of diabetes >10 years (OR 3.50(95% CI 1.82-6.77; p 0.0001), glycated hemoglobin > 7% (OR 5.34(95% CI 1.63- 17.48; p 0.006), systolic hypertension >160 mmHg (OR 4.94(95% CI 1.97-12.39; p 0.001) and low density lipoprotein >3.3 mmol/l (OR 2.99(95% CI 1.45-6.16; p 0.003) were associated with increased risk of diabetic retinopathy while male gender and body mass index did not. Conclusion: DR is a threat to sight in patients with type 2 diabetes in MTRH. Recommendations: Strengthen the existing eye screening program to ensure every patient is screened early enough and optimize management of the modifiable factors namely high glycated hemoglobin, systolic hypertension and high low density lipo protein.