Diabetic Retinopathy and Diabetic Macular Edema in a population of Antioquia. Cross-sectional study
DOI:
https://doi.org/10.17533/udea.iatreia.125Keywords:
diabetes mellitus, diabetic retinopathy, macular edema, prevalence, tomography, optical coherenceAbstract
Introduction: Diabetes Mellitus (DM) is a worldwide epidemic disease, with significant microvascular compromise. Proliferative diabetic retinopathy (PDR) as well as diabetic macular edema (DME) are currently two of the leading causes of visual impairment and blindness in adults of productive age. Approximately one in three people with DM have diabetic retinopathy (DR), and 1 in 10 have PDR or DME. This study emphasizes in the last one, being the first one with these characteristics in Colombia.
Methods: This descriptive cross-sectional study includes 1203 patients diagnosed with DM evaluated in the No more blindness due to diabetes” diabetic retinopathyscreening program of the San Vicente Foundation Hospital in Medellín between 2017 and 2018. The presence of DR and clinical macular edema with the epidemiologic variables were evaluated in a bivariate analysis.
Results: From the total number of patients with DM screened (1203), 5,4% (65) had DME, 7,7% had DM type 1 and 89,2% had DM type 2, 10,8% had PDR and 73.8% had nonproliferative diabetic retinopathy NPDR. Most of the patients (93,8%) were diagnosed de novo with DR. The median illness time was 14 years with interquartile range (IQR) between 7 and 19,5. The median glycosylated hemoglobin (HbA1C) was 8.3% (IQR:7,1-11). Optical coherence tomography (OCT) study was done in 28 out of 65 patients with DME (56 out of 130 eyes with DME), in which 85.7% of patients were confirmed to have DME and the mean central macular thickness was 249 microns (IQR:231-341) (n=48 eyes).
Conclusion: DM complications were more frequent in patients suffering from DR. The median onset time of DME symptoms was found to be similar to the time of microvascular complications appear; however, it should be considered along with the patient’s metabolic control.
Downloads
References
(1) Simó-Servat O, Hernández C, Simó R. Diabetic Retinopathy in the Context of Patients with Diabetes. Ophthalmic Res. 2019;62(4):211-7. DOI 10.1159/000499541.
(2) Ting DSW, Cheung GCM, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol. 2016;44(4):260-77. DOI 10.1111/ceo.12696.
(3) Yau JWY, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-64. DOI 10.2337/dc11-1909.
(4) He F, Xia X, Wu XF, Yu XQ, Huang FX. Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis. Diabetologia. 2013;56(3):457-66. DOI 10.1007/s00125-012-2796-6.
(5) Lightman S, Towler HM. Diabetic retinopathy. Clin Cornerstone. 2003;5(2):12-21. DOI 10.1016/S1098-3597(03)90015-9.
(6) Kim EJ, Lin WV, Rodriguez SM, Chen A, Loya A, Weng CY. Treatment of Diabetic Macular Edema. Curr Diab Rep. 2019;19(9):68. DOI 10.1007/s11892-019-1188-4.
(7) Mesa EV, Alvira FJR. Epidemiología de la retinopatía diabética y su relación con la diabetes. Revista Colombiana de Endocrinología, Diabetes & Metabolismo. 2017;3(1):12-5.
(8) Bourne RRA, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, et al. Causes of vision loss worldwide, 1990-2010: a systematic analysis. Lancet Glob Health. 2013;1(6):e339-349. DOI 10.1016/S2214-109X(13)70113-X.
(9) Sánchez Thorin JC, Chica LG, González AL, Bohórquez MC, Lizcano F, Ocampo HH, et al. Panel de expertos sobre la atención inicial de la retinopatía diabética. ALAD. 2018;8(4):175-83. DOI 10.24875/ALAD.18000235.
(10) Gómez FR, Guerrero CED, Bernal GB, Gaviria Uribe A. Programa nacional de atención integral en salud visual 2016-2022 [Internet]. Colombia: Ministerio de Salud y Potección Social; 2015 [citado 2020 Nov 23]. Disponible en: https://cutt.ly/Pb4AmxR
(11) Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology. 2020 Jan;127(1):P66-P145. DOI 10.1016/j.ophtha.2019.09.025.
(12) Jampol LM, Glassman AR, Sun J. Evaluation and Care of Patients with Diabetic Retinopathy. N Engl J Med. 2020;382(17):1629-37. DOI 10.1056/NEJMra1909637.
(13) Wong TY, Sun J, Kawasaki R, Ruamviboonsuk P, Gupta N, Lansingh VC, et al. Guidelines on Diabetic Eye Care: The International Council of Ophthalmology Recommendations for Screening, Follow-up, Referral, and Treatment Based on Resource Settings. Ophthalmology. 2018;125(10):1608-22. DOI 10.1016/j.ophtha.2018.04.007.
(14) Martinez J, Hernandez-Bogantes E, Wu L. Diabetic retinopathy screening using single-field digital fundus photography at a district level in Costa Rica: a pilot study. Int Ophthalmol. 2011 Apr;31(2):83-8. DOI 10.1007/s10792-010-9413-9.
(15) Amador-Rosa ME. Prevalencia de Retinopatía Diabética en el Instituto Nacional del Diabético de Honduras, en el periodo Febrero-Julio 2016. Arch Med. 2016;12(4):7.
(16) Ortiz-Lerma R, González-Cervantes CP, Hernández-Núñez F, Ancona-Durán I, Betesh-Rodríguez I, Méndez N, et al. Recomendaciones para el uso de ranibizumab en edema macular diabético en el IMSS. Rev Med Inst Mex Seguro Soc. 2018;55(6):758-67.
(17) Abuauad S, Guzmán P, Urzúa C. Prevalencia de retinopatía diabética y edema macular en población diabética del CESFAM Cordillera Andina de Los Andes. Rev. chil. salud pública. 2014;18(1):81-6.
(18) Stewart MW. The clinical utility of aflibercept for diabetic macular edema. Diabetes Metab Syndr Obes. 2015;8:473-82.
(19) Williams R, Airey M, Baxter H, Forrester J, Kennedy-Martin T, Girach A. Epidemiology of diabetic retinopathy and macular oedema: a systematic review. Eye (Lond). 2004;18(10):963-83. DOI 10.1038/sj.eye.6701476.
(20) Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics. ETDRS report number 7. Ophthalmology. 1991;98(5 Suppl):741-56. DOI 10.1016/S0161-6420(13)38009-9.
(21) Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. The Lancet. 2010;376(9735):124-36. DOI 10.1016/S0140-6736(09)62124-3.
(22) Retina AM de, Oftalmología SM de, Oftalmología AP de. Resultados del Día Panamericano de detección de retinopatía diabética (3 de julio de 1999, día “D”). Rev Mex Oftalmol. 2005;79(2):88-92.
(23) Alayón AN, Altamar-López D, Banquez-Buelvas C, Barrios- López K. Complicaciones crónicas, hipertensión y obesidad en pacientes diabéticos en Cartagena, Colombia. Revista de Salud Pública. 2009;11(6):857-64. DOI 10.1590/S0124-00642009000600002.
(24) Villegas Perrasse A, Abad SB, Faciolince S, Hernández N, Maya C, Parra L, et al. El control de la diabetes mellitus y sus complicaciones en Medellín, Colombia, 2001-2003. Rev Panam Salud Publica. 2006;20:393-402. DOI 10.1590/S1020-49892006001100005.
(25) Carmona-Moxica LR, Hernández-Núñez F. Revisión bibliográfica: edema macular diabético, repercusiones y tratamiento. Rev Med Inst Mex Seguro Soc. 2015;53(5):600-7.
(26) Graue-Hernandez EO, Rivera-De-La-Parra D, Hernandez-Jimenez S, Aguilar-Salinas CA, Kershenobich-Stalnikowitz D, Jimenez-Corona A. Prevalence and associated risk factors of diabetic retinopathy and macular oedema in patients recently diagnosed with type 2 diabetes. BMJ Open Ophthalmol. 2020 Mar 10;5(1):e000304. DOI 10.1136/bmjophth-2019-000304.
(27) Kramer CK, Rodrigues TC, Canani LH, Gross JL, Azevedo MJ. Diabetic Retinopathy Predicts All-Cause Mortality and Cardiovascular Events in Both Type 1 and 2 Diabetes: Meta-analysis of observational studies. Diabetes Care. 2011;34(5):1238-44. DOI 10.2337/dc11-0079.
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Universidad de Antioquia
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Papers published in the journal are available for use under the Creative Commons license, specifically Attribution-NonCommercial-ShareAlike 4.0 International.
The papers must be unpublished and sent exclusively to the Journal Iatreia; the author uploading the contribution is required to submit two fully completed formats: article submission and authorship responsibility.
