Prevalence of Diabetic Retinopathy in Diabetic Subjects Visiting Diabetic Centers of Lahore, Pakistan.

One of the chronic illnesses with the highest rate of growth in the globe and a major contributor to acquired visual loss is diabetes mellitus (DM). Globally, diabetic retinopathy (DR), a particular microvascular consequence of DM, continues to be the primary cause of acquired visual loss. Objective: To ascertain the percentage prevalence of diabetic retinopathy in diabetic subjects and the relationship between diabetic retinopathy and potential risk factors. Methods:  This study was conducted at Services Hospital, Lahore. The time duration of study was from November 2018 to June 2019. The patients were asked to fill a designed questionnaire which contained questions regarding patient’s demographic data, habits and history about the disease. Results: A total of 1000 diabetic patients were enrolled and among them 511 (51.1%) had diabetic retinopathy. Among 369 males, 173 (46.9%) males had diabetic retinopathy and among 631 females, 338 (53.6%) females had diabetic retinopathy. The mean age of studied population was 53.77±0.35 years. Logistic regression model indicated that age (years), gender, systolic blood pressure (mmHg), diastolic blood pressure (mmHg), HbA1c level (mmol/L), span of diabetes (years), family history of diabetes, sedentary lifestyle were the risk factors for incidence of diabetic retinopathy in this study. Conclusions: The occurrence of DR is high in the studied population. Age (years), span of diabetes (years), HbA1c level (mmol/L) and not doing exercise were seen to be exhibiting more important role towards the development of diabetic retinopathy.

consider the kind of lipids consumed; polyunsaturated and monounsaturated fats lower risk, while saturated and trans fats raise it [5].Consuming large amounts of white rice and other grains may also increases risk of developing diabetes.It is estimated that 7% of diabetes cases are attributed to lack of physical activity [6].Diabetes can cause major problems such as ulceration, neuropathy, retinopathy, and nephropathy as it progresses due to tissue or vascular damage.Therefore, a wide range of different disorders are included in the group of diabetes [7].The International Diabetes Federation estimates that 26.7% of Pakistani adults will have diabetes in 2022, totaling over 33,000,000 cases [8].Diabetic Retinopathy (DR) is a condition that most DM patients ultimately get.One typical effect of diabetes is diabetic retinopathy (DR), which is brought on by alterations in the retina's blood vessels.Damage to the retina's blood vessels can cause scar tissue, brittle, brush-like branches, and blood leaking.The visual images that the retina transmits to the brain may become distorted or blurry as a result.Blindness might result from it if left untreated.Blindness is typically prevented if detected early and treated appropriately [9].There are around 93 million DR patients and 17 million Poliferative Diabetic Retinopatht (PDR) patients worldwide.Twenty years after the disease's inception, almost all patients with type 1 diabetes and 58% of those with type 2 diabetes show indications of retinopathy [10].Modi able and nonmodi able risk factors can be used to categorize DR risk factors.Obesity, high blood pressure, high cholesterol, and hyperglycemia are among the modi able risk factors.On the other hand, the non-modi able risk factors for the onset and advancement of DR are pregnancy, puberty, and the length of diabetes.Tight glycemic control [HbA1c value of 7% or below] might minimize the risk of DR onset and progression in T1DM and T2DM patients, respectively, according to two seminal clinical trials: the Diabetes Control and Complications Trial (DCCT) and the UKPDS [11,12].Countless investigations have revealed that the pathophysiology of diabetic retinopathy includes longterm diabetes, persistent hyperglycemia, hyperlipidemia, and hypertension.It should come as no surprise that many routes have been implicated in the incompletely understood processes by which increased glucose triggers the vascular disruption in retinopathy [13].In order to enable prompt identi cation and subsequent therapy of the illness, diabetic individuals must undergo routine eye screenings because diabetic retinopathy is primarily asymptomatic in its early stages [14].In practice, the early clinical symptoms of this problem are visible in the fundus on ophthalmoscopic examination, even if the rst diagnosis of diabetic retinopathy may be based on functional abnormalities in electroretinography,

M E T H O D S
This cross sectional was planned to evaluate prevalence in diabetes by visiting hospital of Lahore, namely Services Hospital after receiving permission from their institutional review board (IRB/2018/483/SIMS) and consent from the patients.The study was conducted during November 2018 to June 2019.A questionnaire was designed to collect information from the diabetic patients regarding length of life (years), sex, body mass index 2 (Kg/m ), blood pressure (mmHg), Glycemic status, type of diabetes, span of diabetes, family history of diabetes, treatment (insulin, medicine or both), life style (active or sedentary), smoking, diet control and exercise.The sample size was determined by taking into account the incidence of diabetes mellitus in Pakistani society.The data collected were entered on the MS Excel sheet by using Microsoft Excel and statistically analyzed by SPSS (version 20.0).Mean values were calculated and expressed as Mean ±SEM.Independent t-tests were used to calculate the signi cance between metric variables while chi square tests were used to calculate signi cance among categorical variables.Logistic regression model was used to predict the factors affecting the development of diabetic retinopathy.Con dence level of 95% was taken into account.The p-value of ≤0.05 was taken as signi cant.

R E S U L T S
There were 1000 diabetic patients who registered in the study and among them 511 (51.1%) had diabetic retinopathy.Among 369 males, 173 (46.9%) males had diabetic retinopathy and among 631 females, 338 (53.6%) females had diabetic retinopathy.The average age of studied population was 53.77±0.353years.There were 92 (9.2%) diabetic patients that had type I diabetes mellitus while 908 (90.8%) had type II diabetes mellitus.Among 1000 diabetic patients, 166 (16.6%) had mild non-proliferative diabetic retinopathy (NPDR), 193 (19.3%) had moderate NPDR, 97 (9.7%) had severe NPDR and 55 (5.5%) patients had proliferative diabetic retinopathy (PDR) shown in table 1. retinal blood ow, and retinal blood vessel calibre [15].Based on the existence of vascular lesions and those that are closely related, as well as the presence or lack of neovascularization, diabetic retinopathy is now classi ed.A quarter of those with vision-threatening diabetic retinopathy (VTDR), which is de ned as severe nonproliferative DR, proliferative DR (PDR), and diabetic macular edema (DME), reported DR symptoms in 2010 out of an estimated 285 million persons with diabetes globally [16].Current study aimed to assess the prevalence of diabetic retinopathy in individuals with the disease as well as any possible risk factors associated with the condition.P-values for the logistic regression model together with the odds ratio and 95% con dence range.Highly signi cant factors were those with a p-value of less than 0.01 (Table 3).[1] [2] [3] [4] In this cross sectional study, the prevalence of diabetic retinopathy is (51.1%).Logistic regression model indicated that age (years), span of diabetes (years), HbA1c level (mmol/L), blood pressure and not doing exercise were exhibiting major in uence on the incidence of DR cases.To observe the importance of vision loss due to DR on health of the society, large scale population centered records are desirable in the future.

Table 2 :
Characteristics of Studied Population

Table 3 :
Utilizing a Logistic Regression Model, Assessment of Risk Factors Associated with Diabetic Retinopathy

Table 1 :
Number of Patients According to the Stage of Diabetic RetinopathyThe demographic characteristics of enrolled subjects were shown in Table2.All the risk factors for diabetic retinopathy were tested using Diabetes type, family history of Diabetes, diet control, life style, smoking and exercise.
o n , for every 1 mmHg increase in systolic and diastolic blood pressure.A signi cant risk factor for the development of diabetic retinopathy was shown to be HbA1c levels.The reason for this high value in older age could be that with advancing age glycemic control gets di cult to maintain.Hyperglycemia also distorts the maintenance of retinal perfusion, causing ampli ed exposure towards damage from systemic hypertension.Retinal hyperperfusion is a chief cause of damage in diabetic retinopathy correlated with shearing destruction of the capillaries.The present study indicated that with every 1 mmol/L rise in HbA1c level the probability of developing diabetic retinopathy increases by 1.160.Ten years following diagnosis, those without retinopathy in Europe had better glycemic control than the retinopathy population[20].https://doi.org/10.54393/pjhs.v5i02.1299Signi cant p≤ 0.05, **Highly signi cant p≤ 0.01, nsNonsigni cant p>0.05 D I S C U S S I O N DOI:*